Anxiety, depression, fear of cancer recurrence (FCR) and health-related quality of life (HRQL) in people with melanoma receiving adjuvant therapies.

Abstract

9566 Background: One year ofadjuvant anti-programmed cell death protein-1 (anti-PD1) or dabrafenib-trametinib are standards of care for patients (pts) with resected stage III-IV melanoma. Emotional distress has been linked to inferior disease outcomes following neoadjuvant immunotherapy for stage III melanoma. We aimed to assess the anxiety, depression, FCR and HRQL in a real-world population up to 2 years post initiation of adjuvant therapy. Methods: A prospective, longitudinal study of pts with resected stage IIB-IV melanoma receiving adjuvant anti-PD1 or dabrafenib-trametinib at an Australian comprehensive cancer center. The Patient-Reported Outcomes Measurement Information System (PROMIS) Network Emotional Distress-Anxiety 7a and Depression 8b, Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF), and Functional Assessment of Cancer Therapy-General (FACT-G) were collected pre-treatment, and at 1, 3, 6, 12, and 24 months post treatment initiation. PROMIS t-scores were categorized as mild (55-59), moderate (60-69) and severe (≥70). Clinically significant FCR was categorized as a FCRI-SF score ≥22. Results: From September 2021-December 2024 , 70 pts were eligible and 52 (74%) consented: 17 (33%) female, median age 64 years (IQR 60-71), 46 (89%) resected stage III, 32 (62%) on adjuvant anti-PD1. 41 pts had completed treatment and 11 were still receiving treatment at data cut off (17 December 2024). 51 pts completed at least 1 set of surveys. The prevalence of mild, moderate or severe anxiety, depression and clinically significant FCR up to 2 years post initiation of adjuvant therapy is shown in the table. People experiencing anxiety or depression at 24 months reported worse HRQL compared to those without (mean FACT-G score- anxiety: 67.8 vs 82.8; depression: 69.7 vs 84.2). Of the 18 pts with data at both 12 and 24 months, all those with clinically significant FCR at 12 months continued to report FCR at 24 months. All those with clinically significant FCR at 24 months reported worse HRQL compared to those without clinically significant FCR at 24 months (mean FACT-G score: 67.7 vs 80.5). Conclusions: A significant number of pts report anxiety, depression, and clinically significant FCR up to 2 years post initiation of adjuvant therapy, which is associated with worse HRQL. Screening for psychological issues can identify those who may benefit from psychological and/or pharmacological intervention to improve disease outcomes. Pre-treatment(n= 51) 1 month(n= 46) 3 months(n=44) 6 months(n= 38) 12 months (n=31) 24 months (n=18) Anxiety (n, %) 20 (40%) 19 (41%) 16 (36%) 15 (39%) 13 (42%) 7 (39%) Depression (n, %) 16 (31%) 17 (37%) 13 (30%) 17 (45%) 14 (45%) 9 (50%) Clinically significant FCR (n, %) 10 (20%) 12 (26%) 9 (20%) 10 (26%) 6 (19%) 5 (28%)