Is Distress Accurately Assessed among Melanoma Survivors?

The distress thermometer (DT) and the problem list (PL) are tools used to assess stress and issues experienced by cancer patients and survivors. Because these tools are easy to administer and take little time to complete, they can be highly effective, feasible, and valuable modes of measuring stress in ambulatory settings and primary care environments.

However, there is a lack of research supporting the use of DT and PL for melanoma survivors. Melanoma is unique to other cancers for a variety of reasons. First, clients are usually diagnosed at a young age when they may be preoccupied with raising children, work, and financial obligations. Second, the survival rate for melanoma is high if caught early, but the chance of recurrence presents an ongoing threat. Third, the visibility of melanoma on exposed skin can lead to body image concerns not common with other forms of cancer.

Because of these characteristics, Carmen Loquai of the Department of Dermatology at the University of Mainz in Germany wanted to see how well the DT and PL captured psychological distress among melanoma cancer survivors that were and were not currently receiving treatment. A total of 734 participants were enrolled, yet only 520 completed both screening tools.

Of the 520, nearly half met the criteria for psychological distress. When Loquai looked at specific characteristics, the evidence showed that the youngest participants were more likely to be distressed than older participants. Individuals who were still working also had higher levels of distress than retired individuals. Specific problems relating to the cancer such as pain, mobility, physical scarring, and nausea were also related to distress. Other factors that increased distress in this sample included family problems and work challenges.

Loquai believes that even though survival rates are high for melanoma patients, the chance of recurrence and its effect on mental health should not be overlooked. “This underlying fear could explain the distress of our patients regardless of disease stage, suggesting that the possibility of disease recurrence/metastasis is the major stress factor.” This, coupled with the physical and practical problems that increased stress in the participants provides support for the use of the DT and PL, especially in routine clinical settings where primary care doctors may be the first to identify and recommend treatment for potential distress resulting from melanoma diagnosis and treatment.

Loquai, C., Scheurich, V., Syring, N., Schmidtmann, I., Rietz, S., et al. (2013). Screening for distress in routine oncological care—A survey in 520 melanoma patients. PLoS ONE 8(7): e66800. doi:10.1371/journal.pone.0066800

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  • Leslie


    July 23rd, 2013 at 4:24 AM

    Even though my own experience with melanoma has ended well, there is still that fear that it could show back up at anytime and it might be too far gone before it is caught again. Maybe it is like this with all cancer survivors? But for me it is this little nagging that I can’t ever seem to shake.

  • MOrgAN


    July 23rd, 2013 at 10:51 AM

    My mom is such a hero to me, surviving this and never letting it get her down when there are so many reasons why it could.
    I just applaud her for not letting it control her life and she lives in spite of her cancer and not as a slave to it.

  • val


    July 24th, 2013 at 12:11 AM

    any form of serious health problem can be stressful and mentally is necessary to check for stress and tension in affected individuals.this should be a compulsory thing if I have my way.

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