Cognitive‐behavioral intervention for distress in patients with melanoma

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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