Social support decreases depressogenic effect of low-dose interferon alpha treatment in melanoma patients

Exploring the Psychological Experiences of Patients With Melanoma: A Narrative Review

The increased prevalence of psychological stressors in individuals diagnosed with melanoma, compared to the general population, is well-documented. Understanding the psychological experiences of patients with advanced unresectable stage 3 or 4 melanoma is essential for providing holistic treatment and supporting the unique physical, emotional, and mental health needs of this population. Literature searches were conducted in MEDLINE, PubMed, and Google Scholar to identify studies that focused on the psychological experiences of patients with unresectable stage 3 or 4 melanoma, resulting in a narrative review. Records (n=482) were screened to include peer-reviewed studies published in the last 25 years, primary research involving melanoma patients, or systematic reviews and meta-analyses involving melanoma and mental health. The studies reviewed (n=13) consistently observed psychological changes in melanoma patients, with many reporting higher rates of anxiety and depression compared to the general population. Despite these findings, research on advanced melanoma and its psychological impact remains diverse but lacks specificity regarding the experiences of patients with unresectable stage 3 or 4 melanoma. While valuable insights have been gained into the assessment tools, prevalence, and potential treatments for psychological stressors, no study has explored these psychological experiences in-depth from the patient's perspective. Further investigation into the psychological experiences of this patient group is critical to improving psychological support and fostering more comprehensive care for oncology patients.

For the Long Haul: Management of Long-Term Survivors after Melanoma Systemic Therapy

PURPOSE OF REVIEW

This review summarizes the latest advancements in survivorship care for patients with advanced melanoma who received systemic therapy and emphasizes the areas where more research is needed.

RECENT FINDINGS

Over the last decade there have been remarkable advances in the treatment of advanced and metastatic melanoma. Due to these novel treatments, including several immune checkpoint inhibitors and tyrosine kinase inhibitors, there are and will continue to be increasing numbers of long-term melanoma survivors who have been treated with systemic therapy. These patients will navigate new challenges are they are essentially among the first long term survivors after these novel therapies. Survivorship care focuses on improving the health-related quality of life of patients including the physical, emotional, social and functional effects of cancer that begin at diagnosis and continue through the end of life. Survivorship also includes screening for cancer recurrence and second cancers. As the number of melanoma survivors who received systemic therapy continues to grow, the survivorship care plan will become increasingly important for optimal care of patients even after their cancer treatments. Understanding the many domains of survivorship care for this group of patients is imperative for their care now and to identify unmet needs for future research.

Patient empowerment among adults with arthritis: the case for emotional support

Objective

This study aimed to identify differences in patient empowerment based on biopsychosocial patient-reported measures, the magnitude of those differences, and which best explain differences in patient empowerment.

Methods

This was a cross-sectional observational study of 6,918 adults with arthritis in the United States. Data were collected from March 2019 to March 2020 through the Arthritis Foundation's Live Yes! INSIGHTS program. Patient empowerment, measured by the Health Care Empowerment Questionnaire, included two scales: Patient Information-Seeking and Healthcare Interaction

Results

Patient-reported outcomes were measured using the PROMIS- 29® and PROMIS® Emotional Support scale. Analysis of variance assessed differences between groups; Spearman's Rank Correlation assessed correlations between variables. Hierarchical regression analysis determined the contributions of sociodemographic characteristics, arthritis type, and patent-reported health measures in explaining patient empowerment (α=0.05).

Results

Empowerment was lower among those who were male, older, less educated, or who had lower income, osteoarthritis, less emotional support, or better physical function, although the effect was small to negligible for most of these variables in the final regression models. Empowerment did not differ by race/ethnicity in unadjusted or adjusted analysis. In final regression models, Emotional Support contributed the most to explaining patient empowerment.

Conclusion

Emotional support is important for patient empowerment. This suggests that programs that seek to improve patient empowerment should target and measure impacts on emotional support.

Regional variability of melanoma incidence and prevalence in Hungary. Epidemiological impact of ambient UV radiation and socioeconomic factors

BACKGROUND

The incidence of cutaneous melanoma has risen faster than almost any other type of cancer in the last 50 years. Ultraviolet (UV) radiation and genetic susceptibility are the most important risk factors.

OBJECTIVE

We aimed to determine the epidemiologic indicators of melanoma in Hungary, a country with an estimated population of 9.8 million and an area of 93 030 km2.

METHODS

Anonymized patient records from the National Health Insurance Fund Management covering the entire population were used to determine the incidence and prevalence of melanoma in the counties of Hungary from 2013 to 2017. Altogether 20 030 melanoma cases were identified for inclusion in this study.

RESULTS

The prevalence of melanoma increased over the investigated period and was significantly higher among women than men. The incidence of melanoma stagnated during this period and the incidence rate was the highest among the elderly. Interestingly, the incidence was higher in males in the elderly population, while the incidence was higher in females in the younger (<60 years) population. Geographical variations in ambient UV radiation did not show statistically significant correlation with the regional variability of epidemiologic indicators, probably due to small differences in the number of bright sunshine hours per year between regions. Although Hungary is a relatively small country, we observed regional heterogeneity in socioeconomic factors. Notably, a significant and strong negative correlation was found between single-person household rates and melanoma prevalence.

CONCLUSION

In addition to ambient UV radiation, melanoma incidence and prevalence appear to be related to age, gender and socioeconomic factors.

Social and emotional support as a protective factor against current depression among individuals with adverse childhood experiences

Depression is one of the most prevalent mental health disorders among adults with adverse childhood experiences (ACE). Several studies have well documented the protective role of social support against depression in other populations. However, the impact of perceived social and emotional support (PSES) on current depression in a large community sample of adults with ACE has not been studied yet. This study tests the hypothesis that PSES is a protective factor against current depression among adults with ACE.

Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) involving adults with at least one ACE were used for the purpose of this study (n = 12.487). PSES had three categories: Always, Usually/Sometimes, and Rarely/Never. Current depression, defined based on the responses to the eight-item Patient Health Questionnaire (PHQ-8) depression scale, was treated as a binary outcome of interest: Present or absent. Logistic regression models were used for the analysis adjusting for all potential confounders.

When compared to individuals who reported that they rarely/never received social and emotional support, individuals who reported that they always received were 87% less likely to report current depression (AOR: 0.13 [95% CI: 0.08–0.21]); and those who reported that they usually/sometimes received social and emotional support were 69% less likely to report current depression (AOR: 0.31 [95% CI: 0.20–0.46]).

The results of this study highlight the importance of social and emotional support as a protective factor against depression in individuals with ACE. Health care providers should routinely screen for ACE to be able to facilitate the necessary social and emotional support.

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This study is the first to show PSES protects against depression among adults with ACE.

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Those who ‘always’ received support were 87% less likely to report depression.

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Those who ‘usually/sometimes’ received support were 69% less likely to report depression.

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Implications of study include emphasis on screening and supportive interventions.

Psychological side effects of immune therapies: symptoms and pathomechanism

Immunotherapies revolutionised the treatment of several disorders but show specific side-effect profiles which frequently involve psychological symptoms. Long term interferon-alpha (IFN-alpha) therapy can cause wide-ranging psychiatric side-effects from fatigue, insomnia, anxiety to full-blown depression. This treatment-emergent depression shares several symptoms with major depressive disorder (MDD) with a predominance of somatic/neurovegetative symptoms, and can be treated with antidepressants. However, this experience directed research to inflammatory mechanisms in MDD. MDD has been confirmed as a heterogeneous disorder with a subgroup of patients suffering from low-grade chronic inflammation and frequently resistant to traditional antidepressant treatment. Thus future research should develop strategies to identify those MDD patients who could benefit from drugs acting through inflammatory pathways.

Interleukin-6 promoter polymorphism interacts with pain and life stress influencing depression phenotypes

Interleukin-6 (IL-6) has emerged as a potent biomarker for depression as its elevated plasma levels in patients with clinical depression have been confirmed by meta-analyses. Increased plasma IL-6 concentration was associated with various psychological stress factors and physical disorders accompanied by pain. Another modulator of the IL-6 level is rs1800795, a promoter polymorphism in the IL-6 gene which is able to influence its expression rate. Therefore, we examined in a Hungarian population sample of 1053 volunteers with European origins if rs1800795 polymorphism can affect depression symptoms measured by Zung Self-rating Depression Scale (ZSDS), and Brief Symptom Inventory (BSI). We also investigated the interactions of the polymorphism with reported painful physical conditions and Recent Negative Life Events (RLE) measured by the List of Life Threatening Experiences. Rs1800795 significantly interacted with both RLE and painful condition on depressive symptoms measured by ZSDS and BSI using different heritability models, while no main effects of the polymorphism were identified. After correction for multiple testing only the rs1800795 × RLE interaction effect (recessive model) remained significant on the BSI score, while both RLE and painful conditions significantly interacted on the ZSDS. In conclusion, the functional IL-6 rs1800795 polymorphism in interaction with various stress factors increases the risk of depression and has a greater impact on symptoms measured by the ZSDS. Thus, IL-6 and other cytokines may be more relevant in the development of somatic symptoms compared to affective signs of depression, delineating a specific genotype–phenotype relationship in this heterogeneous disorder.