Psychological distress and unmet supportive care needs in melanoma survivors and patients at high risk of developing melanoma: a Swiss cross-sectional study

Abstract

Background: Many patients with melanoma experience worry, anxiety and distress. Screening for psychological distress can facilitate early identification and management. However, little is known about such distress in melanoma survivors and patients at high risk of developing melanoma.

Objectives: The primary outcome was to assess the melanoma-related worry in melanoma survivors and patients at high risk of melanoma. Additionally, a secondary outcome was to determine the optimal Distress Thermometer (DT) cutoff for identifying those needing psycho-oncological support.

Methods: We prospectively collected the distress-related patient-reported outcomes at the Department of Dermatology of the University Hospital in Basel, Switzerland between January 2021 and January 2024. Validated questionnaires including the DT, Melanoma Worry Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder were used to assess the primary outcome. For the secondary outcome, receiver operating characteristic (ROC) analysis was used to estimate the optimal DT cutoff.

Results: The study population comprised 430 individuals, including 175 (41%) melanoma survivors and 255 (59%) patients at high risk for melanoma. Worry about getting a primary or subsequent melanoma was more prominent in melanoma survivors (26%) compared with patients at high risk for melanoma (16%). Patients at high risk for melanoma had less melanoma worry compared with melanoma survivors, with an odds ratio (OR) of 0.56 [95% confidence interval (CI) 0.34-0.93]. Melanoma worry predictors included being divorced (OR 3.08, 95% CI 1.28-7.38) and younger age (OR 0.97, 95% CI 0.95-0.99). Patients at high risk of melanoma showed significant higher distress [median DT 4, interquartile range (IQR) 2-6] compared with melanoma survivors (DT 2, IQR 1-5) (P < 0.001). ROC analysis estimated a DT score of 3 as the optimal cutoff for melanoma survivors, whereas a DT score of 6 was optimal in patients at high risk of melanoma.

Conclusions: This study found that melanoma survivors exhibit greater disease-specific worry, whereas patients at high risk for melanoma show increased general distress, underscoring their distinct psycho-oncological needs. Adopting tailored DT cutoffs (≥ 3 for melanoma survivors, ≥ 6 for patients at high risk for melanoma) may improve the detection of clinically relevant distress. Importantly, interest in psychological support was observed across all DT scores, indicating the need for flexible, patient-centred approaches. These findings highlight the unmet need for psychosocial care in both melanoma survivors and patients at high risk of melanoma, and could aid dermatologists in screening patients for psychological distress.