About 30 percent of patients with melanoma report clinically significant psychological distress symptoms, including anxiety and depression.(1) Symptoms of distress can extend into the survivorship period as well.(2), (3)
At Memorial Sloan Kettering, full recovery from melanoma does not end with medical care. Fortunately, our melanoma treatment includes psychological care tailored specifically to the needs and challenges faced by our melanoma patients as well as their families. Defined as the emotional, cognitive, behavioral, and physiological reactions when a person confronts a challenging situation,(4) psychological stress can often be mobilized in positive directions to motivate compliance with treatment as well as prevention strategies such as sun protection.
However, persistent high levels of stress can lead to psychological distress, which in the melanoma patient can manifest as a range of debilitating symptoms such as excessive worry and rumination, difficulty concentrating, insomnia, increased use of alcohol and other drugs, social withdrawal, and somatic complaints.(5) We offer short- and long-term psychological treatment to melanoma patients and survivors to address these very common reactions to melanoma diagnosis and treatment.
In this team approach, we work closely with our melanoma dermatologists, oncologists, and surgeons to treat the whole patient, finding ways for them to resume normal functioning at home and at work.
Stages of Psychological Distress
Psychological distress is often most severe during the initial diagnosis phase. At this stage, patients often experience high levels of distress about death and dying and concerns about how their treatment may affect their family and professional responsibilities.(6) Psychological interventions can help to address these reactions, and also facilitate improved communication with doctors to clarify preferences and desires concerning treatment.
During treatment, patients sometimes seek help with anxiety associated with scans and tests; we have multiple methods of addressing this discomfort directly to reduce or eliminate it, so that nervousness associated with testing is much less disruptive to psychological well-being.
Treatment for melanoma – whether it includes surgical management, standard therapeutic agents, or joining a clinical trial – can involve physical side effects. With psychological support, quality of life can be improved by identifying active ways to manage these side effects, as well as by helping patients find new ways to enjoy life and maintain quality of life despite these side effects.(7)
Many patients also have initial or continuing concerns about the cosmetic results of their surgery, which are often a focus for psychological intervention.(8)
Common Behavioral Changes
Health behavior change is another vitally important area of concern for many people who have undergone treatment for melanoma,(9)often leading them to think more carefully about their sun protection strategies. The motivation to protect oneself from the sun can increase substantially.
Certainly exercise and enjoyment of life often takes us outdoors, and it makes sense for melanoma patients and survivors to continue to enjoy life in the ways they have always done. We use specific motivational counseling techniques to help patients identify their own personal difficulties in adopting sun protection,(10) and strategies to confront these difficulties, while not avoiding exercise or other outdoor recreation.
Many of our patients are also concerned about the sun protection choices of their children and grandchildren. Again, these are common topics of discussion in psychotherapy, and we can often strategize to find the best ways for patients to discuss personal risk and the relevance of having a family history of melanoma.(11)
Melanoma is a relatively common disease in younger adults. Accordingly, psychotherapy can focus around many of the common issues affecting, but not limited to, younger patients – including dating, family planning, and return to work.(12), (13)
Dating, marriage, and deciding on the right time to start a family are certainly very personal decisions for anyone. The added complexity of melanoma can be challenging, and some of these complexities can be addressed head-on in the psychotherapy context.
When do I tell someone that I am dating seriously that I am being treated for melanoma? What do I expect from a new spouse regarding support for treatment for my advanced disease? When will I be ready to be a parent? These common concerns (14) often are made easier to identify and address through psychotherapy. The therapeutic process can help not only in clarifying personal values but in finding ways to to communicate needs clearly and calmly, and get social support for these challenging situations.
Another common issue of concern to our melanoma patients and survivors is returning to work. In this situation, good communication with colleagues and supervisors becomes vitally important. In counseling, we often focus on coming up with a personalized plan for a comfortable, feasible return to work – whether part-time or full-time – as well as a list of topics to discuss with workplace personnel.
Privacy about personal medical information remains important, so each plan must prioritize respect for privacy as well. Often, a personal decision about the best balance between maintaining privacy but communicating enough information to get needs met. can be developed. This can be done through frank discussions in psychotherapy to clarify personal preferences given specific work situations and contexts.
In summary, the challenges that patient with melanoma face are diverse. Distress reactions are common after a diagnosis, and psychological treatment geared to these patients is readily available at Memorial Sloan Kettering. There is strong evidence that psychological intervention can improve psychological outcomes for patients with melanoma. (15), (16), (17), (18), (19), (20), (21)
While healing the body, we are focused just as strongly on helping patients regain their peace of mind.We welcome family members to make use of our services as well, as they also face challenges in adjusting to the diagnosis, taking on the role of caregiver, and facilitating their loved one’s trajectory toward survivorship.