Exploring the Long-Term Psychosocial Impacts of Stage IV Melanoma in Survivors

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A recent trial has evaluated persistent psychosocial effects and long-term toxicity in stage IV melanoma survivors.¹ This study is the first of its kind to evaluate the long-term psychological impacts of late-stage melanoma.

Stage IV melanoma survival rates have increased from 5% to 30% in the last 15 years. Patients who received immune checkpoint inhibition and targeted therapy have an even higher survival rate of 50%.²

“While overall survival remains the primary benchmark in cancer treatment, psychosocial aspects and coping mechanisms gain increasing importance as survival extends,” the authors wrote. “The important question is, what price the long-term survivors pay in terms of toxicity and psychosocial burden.”

A cross-sectional, paper-based questionnaire of 93 participants, who were identified through the Central Malignant Melanoma Registry (CMMR), was administered in November 2023. About 60% were male, with a median age of 63 years. Patients were first diagnosed with stage IV melanoma ≥5 years prior between January 2014 and December 2017. They were treated at the University Hospital Tuebingen with a variety of methods including surgery, radiotherapy, and systemic therapy.

Screening tools included the Hornheide Screening Instrument (HSI), the Distress Thermometer (DT), and the National Comprehensive Cancer Network (NCCN) problem list. DT scores ranged from 0 to 10 and anything ≥ 5 was above the threshold. The HIS measured 7 areas, with a score of ≥ 4 indicating a need for psychosocial help. Melanoma-specific questions were also given, focusing on social impairments, work life, leisure activities, emotional needs, financial concerns, and adverse events. A self-assessment section also measured whether participants perceived their own need for psycho-oncological support.

One-third of DT and HIS values exceeded the threshold, emphasizing the need for psychological support. There was a strong correlation between the 2 measurement tools, as identified via a two-tailed Spearman correlation analysis (ρ = 0.674). Interestingly, only 12% of patients expressed that they needed psycho-oncological support. But one-fifth of all patients were in contact with a psycho-oncological or social service. Additionally, about 80% are regularly screened for other cancers such as breast, colorectal, and prostate.

Over 40% of respondents had treatment-related complaints, especially physical concerns. Nearly half of participants reported between 4 to 10 problems. Five patients had more than 20 reported problems. Fatigue was the most common issue, identified in 43.3% of patients. Others included dry and itchy skin, sleep issues, anxiety and nervousness, and paresthesia.

Skin issues, dry mouth, and joint discomfort were the most frequently mentioned complaints in patients who had received at least 1 systemic therapy. For those who underwent radiation therapy, edema, swelling, and skin numbness were the most common adverse events. Memory and concentration problems were frequently noted in patients who received cerebral radiotherapy.

Moreover, less than 10% of patients were severely affected in their work life and financial stability, based on their disease. The survey did not ask whether patients stopped working due to their diagnosis. One-third felt limited in their leisure time, especially because of their limited physical mobility. Nearly 50% of long-term survivors still experience physical discomfort from their past surgeries and procedures.

Overall, the data suggests that stage IV melanoma survivors should be considered differently from other long-term survivors of varying types of cancer. Although these results are significant, larger multicenter trials across the globe can confirm these conclusions and better understand this vulnerable patient group.

“Long-term cancer survivors are often considered cured; however, it remains uncertain whether they can truly be regarded as healthy and fully resilient compared to the general population,” the authors concluded.

References

1. Reitmajer M, Schäffeler N, Bach A, et al. Psychosocial distress and persistent adverse events in long-term survivors of stage IV melanoma - a cross-sectional questionnaire study. J Dtsch Dermatol Ges. Published online April 25, 2025. doi:10.1111/ddg.15712

2. Long GV, Carlino MS, McNeil C, et al. Pembrolizumab versus ipilimumab for advanced melanoma: 10-year follow-up of the phase III KEYNOTE-006 study. Ann Oncol. 2024;35(12):1191-1199. doi:10.1016/j.annonc.2024.08.2330