Comparison of patient-reported need of psycho-oncologic support and the doctor's perspective: how do they relate to disease severity in melanoma patients?

Objective: Psycho-neuro-immune research suggests an association between cancer outcomes and psychosocial
distress. Objective criteria to determine patients’ levels of distress are important to establish
potential links to disease outcomes.
Methods: We compared three patient-reported with one doctor-reported measures of psychooncologic
distress frequently used in routine cancer care and investigated associations with standard
disease severity parameters in melanoma patients. We enrolled n = 361 patients, successively seen at
two outpatient university clinics in Germany. In the naturalistic study, n = 222 patients had been diagnosed
<180 days and were seen for the first time (Group I); n = 139 had been diagnosed >180 days
and were in after-care (Group II).
Results: Across groups, only moderate associations were seen between patient- reported and doctorreported
measures. Regarding clinical variables, disease severity and perceived need of psychooncologic
support reported by patients or doctors showed hardly any association. After subgroup
stratification, in patients of Group II, patient-reported and doctor-reported instruments showed some
small associations with disease parameters commonly linked to more rapid cancer progression in
patients who are in cancer after-care.
Conclusions: Overall, the few and low associations suggest that need of psycho-oncologic support
and clinical variables were largely independent of each other and doctors’ perception may not reflect
the patient’s view. Therefore, the assessment of the patient perspective is indispensable to ensure that
melanoma patients receive appropriate support, as such need cannot be derived from other disease
parameters or proxy report. More research is needed applying psychometrically robust instruments
that are ideally combined with sensitive biomarkers to disentangle psycho-neuro-immune implications
in melanoma patients.