Baseline psychosocial predictors of survival in localized melanoma.
OBJECTIVE
There is no certainty about the contributing factors or the psychological processes involved in cancer progression. Many studies have suffered from poor theoretical basis, methodological flaws, and only one or few psychosocial factors investigated at a time. We examined the simultaneous contribution of several theory-based psychosocial elements to survival time in melanoma.


METHODS
A consecutive sample of patients with localized (Clarke II-IV) melanoma (N=59) were evaluated with validated questionnaires on coping with cancer, anger expression, perceived social support, noncancer life stresses, and domains of quality of life (QOL) 3-4 months after diagnosis. Cox regression analyses were used to determine the predictors of survival time from the date of diagnosis to the date of death or the last follow-up.


RESULTS
After controlling for age, gender, and Breslow depth for the tumor, the baseline psychological variables related to the cancer-prone Type C response pattern, namely, anger nonexpression (repression), hopelessness, and better single-item self-reported QOL predicted shorter survival. Before hopelessness was added to the model, the amount of depressive symptoms and heavy perceived impact of diagnosis were also predictive. In addition, longer survival was strongly predicted by Cognitive Escape-Avoidance coping, which included items close to the concept of denial/minimizing.


CONCLUSIONS
Anger nonexpression, hopelessness, and overpositive reporting of QOL--all proposed to include in the Type C response style or reflect emotional nonexpression--seem to comprise a set of factors that reduce survival, whereas denial/minimizing response to the diagnosis as such predicts longer survival.
Lehto
Ulla-Sisko
US
University of Tampere, Medical School, and Department of Oncology, Tampere University Hospital, Finland. ulla-sisko.lehto@ktl.fi
Ojanen
Markku
M
Dyba
Tadeusz
T
Aromaa
Arpo
A
Kellokumpu-Lehtinen
Pirkko
P
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000786:Anger; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000473:pathology / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D009367:Neoplasm Staging; D011788:Quality of Life / Q000523:psychology; D012803:Sick Role; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D016019:Survival Analysis