Mood state and melanoma outcome in the Multicenter Selective Lymphadenectomy Trial

Abstract

9603 Background: Emotional state has been linked to cancer survival, but its influence on the outcome of early melanoma is unclear. The Multicenter Selective Lymphadenectomy Trial (MSLT-I) randomized patients with clinically localized cutaneous melanoma to wide local excision (WEX) plus observation or to WEX plus sentinel lymph node biopsy (SNB). Clinical endpoints included disease-specific and disease-free survival. A substudy of this phase III trial evaluated the impact of mood state on survival, and the impact of recurrence on mood state. Methods: Patients were asked to complete a 65-question form within 6 months of enrollment (baseline) and every 12 months thereafter. This questionnaire measured 6 identifiable mood states (vigor-activity, tension-anxiety, depression, anger-hostility, fatigue-inertia, confusion-bewilderment) of the Profile of Mood States (POMS), a validated mood scale for assessing responses to therapy. Self-reported data from the questionnaires were linked to demographic and clinical variables. Results: Of 2,001 patients accrued to MSLT-I, 1,620 completed the questionnaire at baseline. The baseline distribution of POMS variables was similar in the two treatment arms (data not shown). Patients with more vigor at baseline had a significantly longer disease-free and overall survival ( Table ), even after adjusting for age, tumor thickness, site, and ulceration status (p <0.001). Among 136 patients who completed a questionnaire within 6 months after recurrence, comparison of baseline and post-recurrence responses revealed significant changes in mood state: tension, fatigue and confusion increased, whereas vigor decreased (p = 0.0004, 0.0171, 0.0089, and 0.0028, respectively). Conclusions: Vigor, a measure of energy and optimism, is directly correlated with disease-free and overall survival in early melanoma. The negative impact of recurrence on mood state suggests that SNB as a tool for preventing recurrence might also improve mood state and psychological well-being. Supported by NIH CA29605. [Table: see text] No significant financial relationships to disclose.