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Psychosocial Predictors of Survival in Metastatic Melanoma

From the Medical Psychology Unit and Department of Cancer Medicine, University of Sydney, Sydney, and Sydney Melanoma Unit, Royal Prince Alfred Hospital, Camperdown, Australia.

Address reprint requests to Phyllis Butow, PhD, Medical Psychology Unit, Royal Prince Alfred Hospital, Camperdown NSW 2050, Australia; email medpsych{at}mail.usyd.edu.au

PURPOSE: Research interest in psychosocial predictors of the onset and course of cancer has been active since the 1950s. However, results have been contradictory and the literature is noted for methodologic weaknesses. In this prospective study, we aimed to systematically obtain data on psychosocial factors associated with human response to illness.

PATIENTS AND METHODS: One hundred twenty-five patients with metastatic melanoma completed questionnaires measuring cognitive appraisal of threat, coping, psychologic adjustment, perceived aim of treatment, social support, and quality of life (QOL). Questionnaires were completed, where possible, every 3 months for 2 years after diagnosis. Survival was measured from date of study entry to date of death or was censored at the date of last follow-up for surviving patients.

RESULTS: In a multivariate Cox regression analysis of baseline data, which controlled for demographic and disease predictors, the psychologic variables of perceived aim of treatment (P < .001), minimization (P < .05), and anger (P < .05) were independently predictive of survival. Patients who were married (P < .01) and who reported a better QOL (P < .05) also survived longer.

CONCLUSION: The prognostic significance of psychologic and QOL scores remained after allowance for conventional prognostic factors. If these associations reflect an early perception by the patient or doctor of disease progression, then measures are at least valuable early indicators of such progression. If psychologic processes have a more direct influence on the course of the underlying illness, then it may be possible to manipulate them for therapeutic effect. We are now conducting a randomized controlled trial of a psychologic intervention to further elucidate these issues.

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