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Kungwengwe G, Gowthorpe C, Ali SR, Warren H, Drury DJ, Ang KL, Gibson JAG, Dobbs TD, Whitaker IS. Prevalence and odds of anxiety and depression in cutaneous malignant melanoma: a proportional meta-analysis and regression. Br J Dermatol 2024; 191:24-35. [PMID: 38197404 DOI: 10.1093/bjd/ljae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND The psychological burden of cutaneous malignant melanoma (CM) is all-encompassing, affecting treatment adherence, recurrence and mortality. However, the prevalence and risk factors of anxiety and depression in CM remain unclear. OBJECTIVES To establish a benchmark pooled prevalence of anxiety and depression in CM, to provide magnitudes of association for clinical, therapeutic and demographic correlates, and to elucidate temporal trends in anxiety and depression from the time of diagnosis. METHODS This review followed the MOOSE guidelines. MEDLINE, Embase, PsychINFO, Web of Science and the Cochrane Library were queried from database inception to 24 August 2023. Study selection, data extraction and quality assessment were performed by two independent authors, utilizing both the Joanna Briggs Institute (JBI) and National Institutes of Health risk-of-bias tools for the latter. The GRADE approach was used to rate the certainty of evidence. Prevalence rates, 95% confidence intervals (CIs) and prediction intervals (PIs) were derived using a random-effects model and estimating between- and within-study variance. RESULTS Nine longitudinal and 29 cross-sectional studies were included (7995 patients). Based on the JBI and NIH tools, respectively, quality assessment found 20 and 17 to be at low risk of bias, 12 and 15 to be at moderate risk and 6 and 5 to be at high risk of bias. The prevalence of anxiety [30.6% (95% CI 24.6-37.0; PI 18-47%)] and depression [18.4% (95% CI 13.4-23.9; PI 10-33%)] peaked during treatment, declining to pretreatment levels after 1 year [anxiety: 48% vs. 20% (P = 0.005); depression: 28% vs. 13% (P = 0.03)]. Female sex [odds ratio (OR) 1.8, 95% CI 1.4-2.3; P < 0.001], age < 60 years (OR 1.5, 95% CI 1.2-2.0; P = 0.002) and low educational level (OR 1.5, 95% CI 1.2-2.0; P < 0.001) were likely to result in a large increase in the odds of anxiety. Depression was 12.3% higher in those with stage IV vs. those with stage I CM (P = 0.05). Relative to immune checkpoint inhibition, the rates of depression were 22% (P = 0.002) and 34% (P < 0.001) higher among patients with advanced-stage CM receiving interferon-α and chemotherapy, respectively. A significant reduction in self-reported depression scores was demonstrated over time (P = 0.003). CONCLUSIONS Notably, anxiety and depression in CM affect women, those younger than 60 years of age and the less educated, with up to 80% higher odds of anxiety in these groups. Anxiety and depression surge during chemotherapy and interferon treatment, especially in advanced CM. Our findings facilitate risk stratification and underscore the need for multidisciplinary vigilance.
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Affiliation(s)
- Garikai Kungwengwe
- Chelsea and Westminster Hospital, Imperial College Healthcare Trust, London, UK
| | | | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Damien J Drury
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - John A G Gibson
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Group, Swansea University, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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Martinez-Calderon J, García-Muñoz C, Heredia-Rizo AM, Cano-García FJ. The prevalence of anxiety and depression in cancer around the world: An overview of systematic reviews evaluating 128 meta-analyses. J Affect Disord 2024; 351:701-719. [PMID: 38311072 DOI: 10.1016/j.jad.2024.01.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND This overview of systematic reviews with meta-analysis summarized the prevalence of anxiety and depression in different types of tumors around the world. METHODS The quality of reviews was assessed. The degree of overlap between reviews was calculated. The regional prevalence of anxiety and depression was shown in the main text based on the World Health Organization regions. RESULTS Twenty-five reviews including 128 meta-analyses of interest were selected. The pooled prevalence of anxiety in breast tumors was in Africa (19 %), the Americas (38 %), Eastern Mediterranean (56 %), Europe (38 %), South-East Asia (42 %), and Western Pacific (26 %). The pooled prevalence of depression in breast tumors was in Africa (40 %), the Americas (23-25 %), Eastern Mediterranean (49-51 %), Europe (27-29 %), South-East Asia (23-33 %), Western Pacific (29 %). The pooled prevalence of depression in digestive tumors was in the Americas (4-44 %), Eastern Mediterranean (42 %), Europe (20-27 %), South-East Asia (66 %), and Western Pacific (24-40 %). The pooled national prevalence of anxiety and depression was mainly evaluated in China and Iran. LIMITATIONS Important methodological issues were identified. For example, no reviews judged the certainty of evidence. CONCLUSIONS The Eastern Mediterranean region showed the highest prevalence of anxiety and depression for breast tumors. The South-East Asian region showed the highest prevalence of depression for digestive tumors. In these regions, many countries are considered low-income and middle-income countries. Further research funding would help increase the investigation on this topic, which may allow the development of preventive strategies that reduce the prevalence of anxiety and depression.
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Affiliation(s)
- Javier Martinez-Calderon
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain; CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
| | - Cristina García-Muñoz
- CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain; Departamento Ciencias de la Salud y Biomédicas, Universidad Loyola de Andalucía, Sevilla, Spain.
| | - Alberto Marcos Heredia-Rizo
- Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain; CTS 1110: Understanding Movement and Self in health from Science (UMSS) Research Group, Andalusia, Spain
| | - Francisco Javier Cano-García
- Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, 41018 Sevilla, Spain
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Avino A, Ion DE, Gheoca-Mutu DE, Abu-Baker A, Țigăran AE, Peligrad T, Hariga CS, Balcangiu-Stroescu AE, Jecan CR, Tudor A, Răducu L. Diagnostic and Therapeutic Particularities of Symptomatic Melanoma Brain Metastases from Case Report to Literature Review. Diagnostics (Basel) 2024; 14:688. [PMID: 38611601 PMCID: PMC11011469 DOI: 10.3390/diagnostics14070688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, prevent recurrence and restore patients' biological and psychological resources for fighting malignancy. This paper aims to provide the latest scientific evidence about the rationale and timing of treatment, emphasizing the complementary roles of surgery, radiotherapy, and systemic therapy in eradicating brain metastases, with a special focus on the distinct response of intracranial and extracranial disease, which are regarded as separate molecular entities. To illustrate the complexity of designing individualized therapeutic schemes, we report a case of delayed BRAF-mutant diagnosis, an aggressive forearm melanoma, in a presumed psychiatric patient whose symptoms were caused by cerebral melanoma metastases. The decision to administer molecularly targeted therapy was dictated by the urgency of diminishing the tumor burden for symptom control, due to potentially life-threatening complications caused by the flourishing of extracranial disease in locations rarely reported in living patients, further proving the necessity of multidisciplinary management.
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Affiliation(s)
- Adelaida Avino
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Ion
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Daniela-Elena Gheoca-Mutu
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
- Discipline of Anatomy, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Abdalah Abu-Baker
- Doctoral School, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Andrada-Elena Țigăran
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Teodora Peligrad
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Cristian-Sorin Hariga
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Andra-Elena Balcangiu-Stroescu
- Discipline of Physiology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cristian-Radu Jecan
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
| | - Adrian Tudor
- Discipline of Anatomy and Embriology, University of Medicine, Sciences and Technology “George Emil Palade”, 540139 Targu Mures, Romania;
- Department of General Surgery I, Targu Mures Emergency Clinical Hospital, 540136 Targu Mures, Romania
| | - Laura Răducu
- Discipline of Plastic Surgery, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.A.); (C.-R.J.); (L.R.)
- Department of Plastic and Reconstructive Surgery, ‘Prof. Dr. Agrippa Ionescu’ Clinical Emergency Hospital, 011356 Bucharest, Romania; (D.-E.G.-M.); (A.-E.Ț.); (T.P.)
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Kudsi MA, Kudsi MS, Ghazy A, Alyousfi R, Khouja MN, Etr A. Unusual location of subungual melanoma surgically managed successfully: A rare case report from Syria. Int J Surg Case Rep 2023; 113:109062. [PMID: 37980775 PMCID: PMC10694301 DOI: 10.1016/j.ijscr.2023.109062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 11/11/2023] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Acral lentiginous melanoma (ALM), the least common subtype of cutaneous melanoma, poses challenges in early detection, resulting in low survival rates. Subungual melanoma (SUM), a rare form of ALM originating from the nail matrix, is less common on the hands than on the feet, accounting in the hands for only 0.3 % of all cutaneous melanomas. This makes the case of hand subungual melanoma that we are presenting very rare and significant. CASE PRESENTATION A 64-year-old woman presented with an asymptomatic subungual lesion on her left fifth finger. The lesion, ranging in color from brown to black, did not cause bleeding and exhibited a clear nail plate rupture. An incisional biopsy confirmed the diagnosis of subungual melanoma. The patient underwent a proximal interphalangeal (PIP) joint amputation and remains in good health. Regular CT scans and clinical examination have shown no recurrence. CLINICAL DISCUSSION Subungual melanoma, a rare subtype of acral lentiginous melanoma, comprises less than 1 % of all melanomas. While the Hallux and thumb are commonly affected, our case involved the little finger which is the rarest site of hand subungual melanoma. Occurrence ages are between 50 and 70. The Hutchinson sign, nail fold pigmentation, indicates poor prognosis in advanced stages, which was positive in our case. Recommended management is amputation at the level of the most distal unaffected joint. CONCLUSION Our aim is to raise healthcare professionals' awareness of early recognition and management of subungual melanoma. Early detection and treatment reduce metastasis risk and improve survival rates.
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Affiliation(s)
| | - Mohammed Sami Kudsi
- Department of General Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Ayesha Ghazy
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Rama Alyousfi
- Department of Pathology, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - M Noor Khouja
- Department of Plastic Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Aleppo University Hospital, Aleppo University, Aleppo, Syria
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Fraterman I, Reijers ILM, Dimitriadis P, Broeks A, Gonzalez M, Menzies AMM, Lopez-Yurda M, Kapiteijn E, van der Veldt AAM, Suijkerbuijk KPM, Hospers GAP, Long GV, Blank CU, van de Poll-Franse LV. Association between pretreatment emotional distress and neoadjuvant immune checkpoint blockade response in melanoma. Nat Med 2023; 29:3090-3099. [PMID: 37957378 DOI: 10.1038/s41591-023-02631-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023]
Abstract
Neoadjuvant immune checkpoint blockade (ICB) outperforms adjuvant ICB for treatment of stage IIIB-D melanoma, but potential biomarkers of response, such as interferon-gamma (IFNγ) signature and tumor mutational burden (TMB), are insufficient. Preclinical studies suggest that emotional distress (ED) can negatively affect antitumor immune responses via β-adrenergic or glucocorticoid signaling. We performed a post hoc analysis evaluating the association between pretreatment ED and clinical responses after neoadjuvant ICB treatment in patients with stage IIIB-D melanoma in the phase 2 PRADO trial ( NCT02977052 ). The European Organisation for Research and Treatment of Cancer scale for emotional functioning was used to identify patients with ED (n = 28) versus those without (n = 60). Pretreatment ED was significantly associated with reduced major pathologic responses (46% versus 65%, adjusted odds ratio 0.20, P = 0.038) after adjusting for IFNγ signature and TMB, reduced 2-year relapse-free survival (74% versus 91%, adjusted hazard ratio 3.81, P = 0.034) and reduced 2-year distant metastasis-free survival (78% versus 95%, adjusted hazard ratio 4.33, P = 0.040) after adjusting for IFNγ signature. RNA sequencing analyses of baseline patient samples could not identify clear β-adrenergic- or glucocorticoid-driven mechanisms associated with these reduced outcomes. Pretreatment ED may be a marker associated with clinical responses after neoadjuvant ICB in melanoma and warrants further investigation. ClinicalTrials.gov registration: NCT02977052 .
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Affiliation(s)
- Itske Fraterman
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Irene L M Reijers
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Petros Dimitriadis
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Annegien Broeks
- Core Facility and Molecular Pathology & Biobanking Department, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - M Gonzalez
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - A M M Menzies
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Marta Lopez-Yurda
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Astrid A M van der Veldt
- Departments of Medical Oncology and Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Geke A P Hospers
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Georgina V Long
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Christian U Blank
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Molecular Oncology and Immunology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands.
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, the Netherlands.
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