Health-related quality of life in older survivors of melanoma: a SEER-MHOS study

Melanoma, which accounts for only 1% of skin cancers, causes the majority of skin cancer-related deaths and morbidity. Health-related quality of life (HRQOL) outcomes in melanoma survivors have not been well-described. Given increasing melanoma survivorship in recent years, there is a need to describe and quantify HRQOL outcomes in a U.S. population-based sample of melanoma cancer survivors. This study aims to characterize HRQOL in melanoma survivors based on stage of diagnosis, demographic factors, and clinical characteristics.

This cross-sectional cohort study used data from the Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (SEER-MHOS) to identify 2955 Medicare beneficiaries diagnosed with melanoma between 1998 and 2019. HRQOL was assessed using physical (PCS) and mental (MCS) component summary scores from the Veterans Rand (VR-12), along with CDC Healthy Days. We created matched non-cancer comparison groups using 1:1 propensity score matching based on covariates including sex, age, race, education, marital status, BMI, region, and medical comorbidities.

Less than 10% of the study population had advanced melanoma (N = 253). Advanced melanoma survivors were more likely to be non-White (5.9 vs. 3.4%; p < 0.04) and to lack a high school diploma (11.7 vs. 7.7%; p < 0.05) compared to those with localized melanoma. They also reported lower mean PCS (38.3 vs. 41.6; p < 0.05) and MCS (51.9 vs. 54.0; p < 0.05) scores compared to localized melanoma survivors, and lower mean PCS scores compared to the matched non-cancer group (38.3 vs. 42.0; p < 0.05). Furthermore, advanced melanoma survivors reported more physically unhealthy (8.3 vs. 4.8; p < 0.05) and activity limitation days (12.5 vs. 8.4; p < 0.05) compared to the matched non-cancer group.

Individuals with advanced melanoma experience poorer physical and mental health than those with localized melanoma. The difference in physical health remains significant and is clinically meaningful when comparing advanced melanoma survivors to matched non-cancer individuals. These findings underscore the value of early melanoma detection and targeted psychosocial interventions for cancer survivors.