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Cognitive-behavioral intervention for distress in patients with melanoma

Comparison with standard medical care and impact on quality of life

  1. Peter C. Trask Ph.D.1,†,*,
  2. Amber G. Paterson Ph.D.2,
  3. Kent A. Griffith M.S., M.P.H.3,
  4. Michelle B. Riba M.D.4,
  5. Jennifer L. Schwartz M.D.5

Article first published online: 27 JUN 2003

DOI: 10.1002/cncr.11579

Issue

Cancer

Cancer

Volume 98, Issue 4, pages 854–864, 15 August 2003

Additional Information

How to Cite

Trask, P. C., Paterson, A. G., Griffith, K. A., Riba, M. B. and Schwartz, J. L. (2003), Cognitive-behavioral intervention for distress in patients with melanoma. Cancer, 98: 854–864. doi: 10.1002/cncr.11579

Author Information

  1. 1

    Behavioral Medicine Program, University of Michigan, Ann Arbor, Michigan

  2. 2

    Kaplan and Kaplan Psychologists, Ontario, Canada

  3. 3

    Biostatistics Unit, University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan

  4. 4

    Department of Psychiatry, University of Michigan, Ann Arbor Michigan

  5. 5

    Department of Dermatology, University of Michigan, Ann Arbor, Michigan

  1. †

    Fax: (734) 998-6423

*Behavioral Medicine Program, University of Michigan, 475 Market Place, Suite L, Box 7, Ann Arbor, MI 48108-0757

Publication History

  1. Issue published online: 1 AUG 2003
  2. Article first published online: 27 JUN 2003
  3. Manuscript Accepted: 12 MAY 2003
  4. Manuscript Revised: 23 APR 2003
  5. Manuscript Received: 31 DEC 2002

Funded by

  • University of Michigan Faculty Group Practice. Grant Number: VIF Number 99-101
  • National Institutes of Health. Grant Number: P30 CA46592

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Keywords:

  • intent-to-treat analysis;
  • melanoma;
  • distress;
  • cognitive-behavioral interventions

Abstract

BACKGROUND

Melanoma accounts for > 79% of skin cancer-related deaths, although it accounts for only 4% of skin cancer incidence. Given the potential for lethality, it is likely that patients with melanoma may experience significant emotional distress. The current study was designed to determine the effect of a cognitive-behavioral intervention on distress and health-related quality of life (HRQOL) in patients with melanoma who had medium-to-high distress.

METHODS

Forty-eight patients who had Global Severity Index scores ≥ 60 2 months after their initial visit to the multidisciplinary melanoma clinic were randomized to receive either standard care or 4 sessions of a cognitive-behavioral intervention (CBI). Repeated assessments using the Brief Symptom Inventory, the Medical Outcomes Survey Short Form-36, and the State-Trait Anxiety Inventory occurred at baseline, at 2 months, and at 6 months after intervention for both groups.

RESULTS

An intent-to-treat analysis did not reveal significantly lower distress in the CBI group at 2 months or 6 months of follow-up, although differences were noted in anxiety and HRQOL. An effect-of-intervention analysis did reveal lower levels of distress in the CBI group at 2 months, with differences approaching significance at 6 months.

CONCLUSIONS

The four-session CBI significantly reduced distress and improved HRQOL for a period of 2 months in patients with melanoma who had medium-to-high distress, with improved general health evident 6 months after the intervention. Some variation in results was revealed in an intent-to-treat analysis. The initial evidence from the current study showed that a brief intervention may be effective for creating change in individuals with cancer who have increased distress, although further research is needed to identify the most optimal approach for delivering the intervention. Cancer 2003;98:854–64. © 2003 American Cancer Society.

DOI 10.1002/cncr.11579

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