title: Prevalence and correlates of unmet supportive care needs in patients with resected invasive cutaneous melanoma.
abstract: BACKGROUND
  Knowledge about supportive care needs in patients with cutaneous invasive melanoma is scarce. We examined the unmet needs of melanoma patients treated with surgery and factors associated with these needs to assist health professionals identify areas needing clinical attention.
  
  
  METHODS
  Cross-sectional multisite survey of UK patients ascertained 3 months to 5 years after complete resection of stage I-III cutaneous melanoma. Participants completed the following validated questionnaires: Supportive Care Needs Survey (SCNS-SF34 with melanoma module), Hospital Anxiety and Depression Scale and 51-item Functional Assessment of Cancer Therapy-Melanoma quality-of-life scale.
  
  
  RESULTS
  A total of 472 participants were recruited [319 (67%) clinical stage I-II). Mean age was 60 years (standard deviation = 14) and 255 (54%) were female. One hundred and twenty-three (27%) participants reported at least one unmet need (mostly 'low' level). The most frequently reported unmet needs were fears of cancer returning (n = 138, 29%), uncertainty about the future (n = 119, 25%), lack of information about risk of recurrence (n = 112, 24%) and about possible outcomes if melanoma were to spread (n = 91, 20%). One hundred and thirty-eight (29%) participants reported anxiety and 51 (11%) depression at clinical or subclinical levels. Patients with nodal disease had a significantly higher level of unmet supportive care needs (P < 0.001) as did patients with anxiety or depression (P < 0.001). Key correlates of the total SCNS-SF34 score for unmet supportive care needs were younger age (odds ratio, OR = 2.23, P < 0.001) and leaving school early (OR = 4.85, P < 0.001), while better emotional (OR = 0.89, P < 0.001) and social well-being (OR = 0.91, P < 0.001) were linked with fewer unmet needs. Neither patients' sex nor tumour thickness was associated with unmet needs.
  
  
  CONCLUSIONS
  Around a quarter of melanoma patients may have unmet support needs in the mid to long term after primary treatment. In particular, patients who are younger, less educated, distressed or socially isolated could benefit from more support.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong; School of Nursing, Midwifery and Social Work, University of Manchester, Manchester. Electronic address: alex.molasiotis@polyu.edu.hk.
authors.forename: A
authors.initials: A
authors.lastname: Molassiotis
authors.affiliation: School of Nursing, Midwifery and Social Work, University of Manchester, Manchester.
authors.forename: L
authors.initials: L
authors.lastname: Brunton
authors.affiliation: Christie NHS Foundation Trust, Manchester.
authors.forename: J
authors.initials: J
authors.lastname: Hodgetts
authors.affiliation: Institute of Inflammation and Repair, University of Manchester, Manchester, UK; Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Brisbane.
authors.forename: A C
authors.initials: AC
authors.lastname: Green
authors.affiliation: Gynaecological Cancers Group, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
authors.forename: V L
authors.initials: VL
authors.lastname: Beesley
authors.affiliation: St James's Institute of Oncology, Leeds.
authors.forename: C
authors.initials: C
authors.lastname: Mulatero
authors.affiliation: Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Newton-Bishop
authors.affiliation: Christie NHS Foundation Trust, Manchester.
authors.forename: P
authors.initials: P
authors.lastname: Lorigan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000150:complications / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D008875:Middle Aged; D020380:Needs Assessment; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D009367:Neoplasm Staging; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012878:Skin Neoplasms; D012944:Social Support; D011795:Surveys and Questionnaires; D000096142:Cutaneous Malignant Melanoma
keywords: anxiety; depression; melanoma; quality of life; supportive care needs