Table 3.

Summary of eligible and reviewed studies on melanoma and HRQOL impairment

Country, year [Ref.]	Research type	Study population	No. patients	HRQOL instrument	Conclusions	Quality score (range 0–14)
USA, 2008 [8]	Cohort prospective 12 months	MD Anderson Cancer Center: patients recruited with new melanoma or within the first 3 years of follow-up.	225	FACT, EORTC QLQ, POMS, MCSDS	Reliable QOL questionnaire for patients with melanoma in clinical trials.	9
aEurope, 2004 [9]	Randomised prospective 2 months	Centres throughout Europe: patients with non-ocular melanoma, with or without brain metastases; phase III study comparing fotemustine (F) and dacarbazine (D) (one in each of the patient arms); metastasised disease.	229 (112F, 117D)	EORTC QLQ-C30	‘No significant difference in QOL between two groups. The general tendency in the selected QOL dimensions was degradation over time in both arms.’	10
Finland, 2007 [10]	Cohort prospective 3–4 months after diagnosis	Oncology Clinic of Tampere University Hospital, Finland: patients with cutaneous melanoma with localised disease. Included patients with Clarke II, II or IV. Breslow 0.20–7.00 mm. Excluded patients with in situ melanoma, Clark V and orbital melanoma.	59	WOC, SSF, AX, LES, CSS, RSCL, DEPS	‘Women tend to have slightly more psychological symptoms (P = 0.085). Patients reported self-perceived QOL as quite good to good.’	8
UK, 2006 [11]	Randomised prospective 60 months	Weston Park Teaching Hospital, Sheffield: melanoma patients, all stages.	674	EORTC QLQ-C30, EQ5D	‘Patients in observational group had significantly higher mean QOL than interferon patients.’	8
Poland, 2005 [12]	Controlled trial, prospective minimum of 56 days after surgery	Department of Soft Tissue and Bone Cancer, Institute of Oncology, Warsaw: two equal groups of 110 patients after radical surgery for melanoma. One group received supplementary IFN-α2b therapy. Stage unclearly mentioned.	220	EORTC QLQ-C30	‘The IFN-α2b significantly affected the emotional, social and physical health of the patients. In spite of adverse effects of treatment, patients scored their QOL as good.’	10
Finland, 2005 [13]	Cohort prospective 3 months after diagnosis	Oncology Clinic of Tampere University Hospital: patients with melanoma and breast cancer patients. Localised disease, newly diagnosed.	175 (melanoma 72)	WOC, SFSS, AX, LES, RSCL, DEPS, EORTC-QLQ (breast cancer module)	‘QOL of newly diagnosed cancer patients is highly associated with psychosocial factors. Non-cancer life stresses seem to be very important in the QOL in newly diagnosed cancer patients. Adjuvant treatment may compromise supportive psychosocial factors that enhance QOL in cancer.’	9
UK, 2006 [14]	Cohort prospective 6 months	Pigmented Lesion Clinic: malignant and non-malignant skin lesions, all stages.	195 (melanoma 10)	EORTC QLQ-C30, HAD, STAI-SSF	‘QOL pre-diagnosis was excellent. Emotional functioning, insomnia and global health status deteriorated throughout diagnostic process for patients with malignant melanoma.’	12
USA 2004 [15]	Cohort prospective 9 months	Multidisciplinary Melanoma Clinic: melanoma patients with stages I–III.	351	MOC, BSI, SF-36, WOC, STAI	The healthy cluster reported a significantly higher HRQOL than the unhealthy clusters when confronted with melanoma.	11
USA 2003 [16]	Cohort prospective 3 months	Anderson Cancer Centre, Houston: population with metastatic renal cell carcinoma or metastatic melanoma. Phase I/b trial for trial vaccination.	53 (melanoma 24)	ISEL, IES, BSI, SF 36	‘The results suggest that social support buffers the negative association between intrusive thoughts/avoidance and psychological adjustment. Overall the results are consistent with a social-cognitive processing model of post-trauma reactions among cancer patients.’	10
USA, 2003 [17]	Randomised prospective 6 months	Melanoma Clinic: melanoma patients with stages I–III	48	BSI SF-36 STAI	‘Distress significantly reduced after 4 CBI sessions, with an increase in HRQOL in patients with medium-high distress.’	10
USA, 2003 [18]	Cross-sectional retrospective	Population-based study; patients with melanoma, breast, colon or lung cancer <1 year, 1–5 years and >5 years, stage unknown.	692 (melanoma  = 92)	HALex	‘Health utility score lowest directly after treatment and improve over time. Long term (>5 years) survivors have the highest score.’	9
USA, 2001 [19]	Cohort	Multidisciplinary Melanoma Clinic: melanoma patients with stages I–III.	287	BSI, SF-36, WOC, STAI	‘A significant minority of patients are distressed and rely heavily on non-beneficial coping strategies.’	10

^aFrance, Germany, Norway, Hungary, Spain, Slovakia, Austria.

Abbreviations: AX, Anger Expression Scale; BSI, Brief Symptom Inventory; CSS, Chronic Strains Survey; DEPS, Depression Anxiety Scale; EQ-5D, EuroQol group; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer; FACT-M, Functional Assessment of Cancer Therapy—Melanoma; HAD, Hospital Anxiety and Depression; HALex, Health and Activities Limitation Index; IES, Impact of Event Scale; ISEL, Interpersonal Support Evaluation List; LES, Life Experience Survey; MCSDS, Marlowe–Crowne Social Desirability Scale, POMS, Profile of Mood States; PAIS-SR, Psychosocial Adjustment of Illness Scale—Self Report; RSCL, Rotterdam Symptom Checklist; SF-36, Short Form-36; SFSS, Structural–Functional Social Support Scale; SSF, Social Support Survey; STAI, State Trait Anxiety Inventory; WOC, Ways of Coping.