By Jennifer L. Hay, PhD
In the past several years, the survivorship experiences for patients diagnosed with melanoma have improved dramatically.
Starting with the approval of ipilimumab (Yervoy™) in 2011 for the treatment of advanced melanoma, the FDA has approved more than 25 new immunotherapies and targeted drugs. As a result of these new options, patient experience, quality of life, and the challenges facing survivors have changed significantly.
Psychological counseling has always been an important part of the integrated services provided by our Melanoma Disease Management Team at Memorial Sloan Kettering. It is essential that, in this new age of immunotherapy, we help patients with melanoma maximize the opportunities and overcome the challenges that arise in the lives of survivors.
The opportunities available to survivors today are unprecedented. Many more patients have the chance to return to their normal, busy lives filled with myriad professional, volunteer, and family responsibilities as well as personally meaningful activities including travel, sports, and hobbies. Having much longer intervals between appointments is a great relief for those who have spent significant chunks of time traveling to appointments and receiving treatments.
It is hard to describe fully the gratitude and renewed energy for life these patients experience after they have faced difficult, advanced diagnoses and uncertain disease courses. Some patients take the opportunity to take their lives in new directions during or after treatment. Major life changes such as new jobs, the resumption of dating, and new parenthood are all quite common once health and energy return. Our counseling service helps patients enhance this adjustment and make the most of their new and ongoing life challenges.
The landscape of melanoma survivorship includes psychological challenges. Frequent imaging highlights the uncertainty of progress. For many, scans are conducted every three months, and the anticipation can provoke anxiety. (1) This worry can make it difficult for patients to concentrate at work and may also cause insomnia, appetite changes, and social withdrawal, among other disruptive symptoms.
In the clinic, we use evidenced-based cognitive strategies (2) to help patients manage acute anxiety as they prepare for scans and chronic anxiety that persists between appointments. Immunotherapy treatment raises particular psychosocial challenges, given that medicines such as ipilimumab can lead to delayed treatment responses. (3), (4) By providing excellent education and counseling to patients before treatment commences, we ensure that patients are fully aware of the potential for a delayed treatment effect, help them prepare for possible side effects from medications, and address their concerns about disease progression. (5)
Shifting Gears with Improved Outcomes
Many patients need help redirecting their formidable energy from fighting the disease to more common challenges when they are off treatment. During treatment, patients’ energies — as well as the energies of their families — are generally all focused toward the same goal. It can be quite disorienting when their disease is stable, when they are feeling well, or when there is no evidence of disease. In particular, family members can be disappointed that patients are not adapting quickly to take advantage of their good health.
In counseling, we focus on pinpointing this disorientation, helping patients to free up energy that can remain too fully bound in the fight against the disease. We help survivors integrate important goals back into their lives and engage family and friends to help with that reorientation.