Survival after a psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study.
OBJECTIVE
The results of a randomized, intervention study done in 1993 of psychoeducation for patients with early-stage malignant melanoma showed a beneficial effect on recurrence and survival 6 years after the intervention. In the present study, we replicated the study with 258 Danish patients with malignant melanoma. We also compared recurrence and survival among the participants in the randomized study with 137 patients who refused to participate.


METHODS
We randomly assigned 262 patients with primary malignant melanoma to a control or an intervention group. Patients in the intervention group were offered six weekly 2-hour sessions of psychoeducation. Participants and nonparticipants were followed up for vital status and recurrence 4 to 6 years after surgical treatment. Prognostic factors (thickness of the tumor and lymph node status), sex, and age were adjusted for in a Cox regression model (proportional hazards regression) to derive an adjusted survival rate ratio and an adjusted relapse-free survival rate ratio, with 95% CIs.


RESULTS
The hazard ratio was 1.30 (95% CI, 0.5 to 3.5) for survival and 0.73 (95% CI, 0.3 to 1.9) for recurrence. Being a nonparticipant increased the risk for death by more than two-fold (hazard ratio, 2.26; 95% CI, 1.0 to 5.2) over that of participants.


CONCLUSIONS
Psychoeducation did not increase survival or the recurrence-free interval among patients with malignant melanoma; however, nonparticipants had a statistically significantly greater risk for death than participants.
Boesen
Ellen H
EH
Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. ellen@cancer.dk
Boesen
Sidsel H
SH
Frederiksen
Kirsten
K
Ross
Lone
L
Dahlstrøm
Karin
K
Schmidt
Grethe
G
Naested
Jesper
J
Krag
Christen
C
Johansen
Christoffer
C
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010353:Patient Education as Topic; D011613:Psychotherapy; D012878:Skin Neoplasms / Q000523:psychology / Q000628:therapy*; D016019:Survival Analysis