Elsevier

Surgical Clinics of North America

Volume 76, Issue 6, 1 December 1996, Pages 1413-1421
Surgical Clinics of North America

THE PSYCHOLOGICAL CHALLENGES FACING MELANOMA PATIENTS

https://doi.org/10.1016/S0039-6109(05)70523-5Get rights and content

There are better and worse ways of coping with a melanoma diagnosis or with any life-threatening illness—“better” or “worse” in the sense that some ways of coping have been found to promote the process of psychological adjustment and to foster emotional well-being over time, whereas other ways of coping are less successful along these lines.13 The difference in outcome is one of degree: The better ways are not perfect, and worse ways are not totally useless. All ways of coping have an adaptive intent, for that is explicit in the concept of coping16; but some ways lead to more adaptive outcomes.

As a construct, “coping” includes emotions, attitudes, and behaviors. These are interrelated: How a person feels implies certain attitudes and beliefs, and these in turn result in certain behaviors. The better ways of coping with a serious illness, as several studies have shown, include certain key characteristics:

  • For the patient to face the reality of his or her illness and to seek to learn about the disease, the relevant treatment modalities or options, and factors relating to prognosis.10, 19

  • For the patient to experience an emotional response that is proportional to this reality (I will return later to what this actually means) and to express these emotions.21

  • For the patient to adopt an active, participatory stance that involves the feeling of self-efficacy (that the person is an active agent who can influence psychosocial and/or medical outcomes) and behaviors that stem from this feeling.5, 20

  • For the patient to have a perspective on illness as part of the human condition (as opposed to feeling singled out for adversity or deserving of it).7

  • For the patient to reach out for interpersonal support and help and to include loved ones in his or her illness experience (as opposed to stoically “going it alone” or protecting others from one's experience).11, 22

Many factors determine the degree to which a patient achieves these coping characteristics. One's personality, past coping style, and current psychosocial situation are all important.12 Certain social expectations or norms about positive coping behavior also influence the person, often in nonconstructive ways.17 Illness often takes on certain meanings in the context of one's personal life history (e.g., as a kind of “crowning blow” in light of other traumas in the person's life), and these also influence the patient's emotional and coping reactions.7 The attitudes and expectations of the patient's physicians also affect how the person copes. If we had enough information about all these factors for any given patient, we would be able to predict a kind of coping profile that the patient is likely to display.

This article focuses on the challenges and dilemmas facing melanoma patients with regard to their emotional reactions to their diagnosis and the prognosis associated with it. How patients feel, of course, is not the only aspect of their coping response. But it is a central component of their lived experience with the threat posed by the disease. Moreover, how patients feel usually implies a great deal about their psychological make-up and cognitive appraisals about their illness and also leads to certain behavioral coping responses.16 As the following discussion shows, many conflicts and dilemmas complicate how patients feel and their striving to feel how they “should” (i.e., to adopt emotional responses that are optimally adaptive and right for them).

Section snippets

THE NEED FOR PROPORTION AND BALANCE

As mentioned above, the most adaptive emotional responses are proportional to the reality of one's illness. In principle, this means that a patient is not overly worried, upset, and preoccupied and also not overly cheerful or complacent. For purposes of discussion, which I will follow throughout this article, let us consider a patient with an average-risk melanoma (the average 5-year mortality threat posed by a primary, cutaneous melanoma is 17%; of course, many lesions are lower risk than

OBSTACLES TO PROPORTION AND BALANCE

It is a common experience for patients to be overly worried or upset, to deny or avoid legitimate negative emotions, or to vacillate between negative and positive emotions, often feeling in an overall quandary as to how they “should” feel. The right proportion and balance are often difficult to define or achieve for several reasons:

HOW PHYSICIANS CAN HELP

The most important rule of thumb is this: Physicians should adopt the same attitude about their patient's melanoma that would be optimally adaptive for the patient to adopt. This means that physicians should convey—in their attitude, demeanor, and the information they provide— both sides of the patient's medical situation: that the diagnosis poses a serious threat that must be taken seriously and the patient would understandably feel worried and upset; but also that chances of a full recovery

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  • Cited by (10)

    • Delayed treatment and continued growth of nonmelanoma skin cancer

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      Citation Excerpt :

      Early diagnosis and treatment will usually result in cure and in markedly reduced functional loss and disfigurement. Further research is likely to improve understanding of delayed presentation for NMSC26-28 and melanoma skin cancer.29-37 Delayed treatment of NMSC may result in tumor enlargement, functional loss, and the need for larger excisions that may impact cosmetic and motor function.

    • Psychological adjustment to the melanoma experience

      2003, Seminars in Oncology Nursing
    • Distress and coping strategies among patients with skin cancer

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    Address reprint requests to Andrew W. Kneier, PhD, UCSF/Mount Zion Cancer Center, 2356 Sutter Street, San Francisco, CA 94115

    *

    From the Department of Psychosocial Oncology, the University of California, San Francisco, Mount Zion Cancer Center, San Francisco, California

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