title: Systematic review of psychosocial outcomes for patients with advanced melanoma.
abstract: BACKGROUND
  New advanced melanoma therapies are associated with improved survival; however, quality of survivorship, particularly psychosocial outcomes, for patients overall and those treated with newer therapies is unclear.
  
  
  OBJECTIVE
  Synthesize qualitative and quantitative evidence about psychosocial outcomes for advanced (stage III/IV) melanoma patients.
  
  
  METHODS
  Five databases were searched (01/01/1980 to 31/01/2016). Inclusion criteria were as follows: advanced melanoma patients or sub-group analysis; assessed psychosocial outcomes; and English language.
  
  
  RESULTS
  Fifty-two studies met review criteria (4 qualitative, 48 quantitative). Trials comprise mostly medical not psychosocial interventions, with psychosocial outcomes assessed within broader quality of life measures. Patients receiving chemotherapy or IFN-alpha showed decreased emotional and social function and increased distress. Five trials of newer therapies appeared to show improvements in emotional and social function. Descriptive studies suggest that patients with advanced, versus localized disease, had decreased emotional and social function and increased distress. Contributors to distress were largely unexplored, and no clear framework described coping/adjustment trajectories. Patients with advanced versus localized disease had more supportive care needs, particularly amount, quality, and timing of melanoma-related information, communication with and emotional support from clinicians. Limitations included: lack of theoretical underpinnings guiding study design; inconsistent measurement approaches; small sample sizes; non-representative sampling; and cross-sectional design.
  
  
  CONCLUSIONS
  Quality trial evidence is needed to clarify the impact of treatment innovations for advanced melanoma on patients' psychosocial well-being. Survivorship research and subsequent translation of that knowledge into programs and services currently lags behind gains in the medical treatment of advanced melanoma, a troubling circumstance that requires immediate and focused attention.
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.|School of Social Science, The University of Queensland, St Lucia, Queensland, Australia.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia.
authors.forename: Jeff
authors.initials: J
authors.lastname: Dunn
authors.affiliation: Pastoral and Psychological Care, Royal Marsden Hospital, Sutton, Surrey, UK.
authors.forename: Maggie
authors.initials: M
authors.lastname: Watson
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.|Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Australia.|School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Joanne F
authors.initials: JF
authors.lastname: Aitken
authors.affiliation: Cancer Council Queensland, Brisbane, Queensland, Australia.|Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
authors.forename: Melissa K
authors.initials: MK
authors.lastname: Hyde
mesh_terms: D000223:Adaptation, Psychological; D003142:Communication; D003376:Counseling; D003430:Cross-Sectional Studies; D004644:Emotions; D006801:Humans; D008297:Male; D008545:Melanoma / Q000523:psychology* / Q000628:therapy; D010361:Patients / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D012878:Skin Neoplasms / Q000523:psychology* / Q000628:therapy
keywords: advanced melanoma; cancer; distress; metastatic melanoma; oncology; psychosocial; supportive care; survivorship