Psychological responses and coping strategies among patients with malignant melanoma: A systematic review of the literature

Objective: To conduct a systematic review of the literature to identify the prevalence of, and demonstrated risk factors for, psychological distress among individu-als affected by, or at high risk of developing, melanoma. For a substantial subset of patients, the diagnosis and/or treatment of cutaneous malignant melanoma may cause significant psychological distress. Data Sources: Using the MEDLINE, PsycINFO, and CINAHLdatabases, published studies (1988 to March 2008) of individuals affected by melanoma were included if they examined the demographic, clinical, psychological, and/or social correlates of emotional distress. Study Selection: Searches were restricted to publica-tions in English and were supplemented by citation lists in retrieved articles and contact with researchers. Data Extraction: A total of 356 articles were critically appraised by 2 reviewers to assess eligibility and clinical evidence level. A total of 44 studies met the inclusion criteria. Data Synthesis: Approximately 30% of patients with melanoma reported clinically relevant levels of psycho-logical distress, as measured by a range of validated scales, with symptoms of anxiety more prevalent than depres-sion. A number of empirically demonstrated risk factors for distress were identified, including female sex, younger age, lower education, visibility of affected body site, lack of social support, and negative appraisal of melanoma. Conclusions: Routine psychological screening of pa-tients with melanoma is widely recommended as stan-dard practice; however, standard screening measures may have limited sensitivity and specificity as demonstrated by the wide range of results reported in this review. De-velopment of a brief screening tool that incorporates empirically supported risk factors is recommended to improve the timely identification and support of those patients most susceptible to adverse psychological outcomes.