title: Psychosocial aspects of post-treatment follow-up for stage I/II melanoma: a systematic review of the literature.
abstract: BACKGROUND
  Patients treated for melanoma are advised to have lifelong full body skin examinations. Extended intervals between examinations have been proposed, but although this may be clinically effective, psychosocial aspects of follow-up are not well understood. This systematic review summarised patient and clinician preferences, experiences and adherence with recommended follow-up of stage I/II melanoma.
  
  
  METHODS
  Medline, PsycINFO, CINAHL, Embase, Cochrane Library, ACP Journal Club and NHS Economic Evaluation Database were searched from database inception to week 3 April 2010, to identify original studies of psychosocial outcomes of follow-up after treatment of stage I/II primary cutaneous melanoma, as reported by patients or clinicians. The results were synthesised, and characteristics likely to maximise patients' well-being and adherence to follow-up schedules were proposed.
  
  
  RESULTS
  We found 15 studies that met the inclusion criteria. Anxiety with melanoma follow-up was common; patients valued reassurance, information and psychosocial support, but long-term adherence to schedules was variable. Some wanted more emotional support from their clinician than was provided. Clinicians sometimes ordered additional blood and imaging tests to reassure patients. GPs were hesitant to conduct melanoma follow-up, but a trial providing technical training and protocols reported positive outcomes. Both patients and GPs wanted prompt access to melanoma specialists when suspicious lesions were found.
  
  
  CONCLUSIONS
  Psychosocial aspects of follow-up impact on patient well-being and potential adherence to schedules, and may influence clinician practice. If follow-up schedules or personnel are to be revised, psychosocial impacts on patients must be explicitly addressed, as well as guidance and specialist support for clinicians.
authors.affiliation: Screening and Test Evaluation Program, School of Public Health, The University of Sydney, Camperdown, Australia. rychetnik@sydney.edu.au
authors.forename: Lucie
authors.initials: L
authors.lastname: Rychetnik
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
authors.forename: Rachael
authors.initials: R
authors.lastname: Morton
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
mesh_terms: D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D003266:Continuity of Patient Care; D006801:Humans; D008545:Melanoma / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D009367:Neoplasm Staging; D010349:Patient Compliance; D057240:Patient Preference; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D012878:Skin Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D012944:Social Support