title: Psychosocial predictors of outcome: time to relapse and survival in patients with early stage melanoma.
abstract: This study explored psychosocial predictors of relapse and survival in early stage melanoma patients. Patients with locoregional melanoma whose tumour thickness exceeded 0.69 mm, seen at the Sydney Melanoma Unit between 1991 and 1996 participated in the study. Questionnaires were sent to participating patients every 3 months for 2 years. Domains measured included cognitive appraisal of threat, coping, psychological adjustment, quality of life and perceived aim of treatment. Disease and demographic data were obtained from medical records. Multivariate analyses from baseline data used the Cox proportional hazards model. Of the 682 patients invited to participate 426 (62%) agreed. 91 (21%) relapsed and 60 (14%) died within the follow-up period, that ended in October 1997. After controlling for known prognostic indicators, several psychosocial variables predicted time to relapse and/or survival duration. Patients who perceived their aim of treatment to be cured, who did not use avoidance as a coping strategy or who were concerned about their disease experienced longer periods without relapse. Shorter survival duration was associated with a positive mood, the use of avoidance as a coping strategy, not being concerned with their disease and concern about the impact of the disease on family. There is still much to learn about the potential relationships between psychological well being, human behaviours and cancer outcome. Research in this area needs to clarify the psychological processes, as well as understand the biological and/or behavioural mechanisms that may link them to outcome.
authors.affiliation: Medical Psychology Unit, University of Sydney, NSW, 2006.
authors.forename: J E
authors.initials: JE
authors.lastname: Brown
authors.forename: P N
authors.initials: PN
authors.lastname: Butow
authors.forename: G
authors.initials: G
authors.lastname: Culjak
authors.forename: A S
authors.initials: AS
authors.lastname: Coates
authors.forename: S M
authors.initials: SM
authors.lastname: Dunn
mesh_terms: D000223:Adaptation, Psychological; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000401:mortality* / Q000523:psychology*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011788:Quality of Life; D011795:Surveys and Questionnaires; D015996:Survival Rate