==== Front Cancer Med Cancer Med 10.1002/(ISSN)2045-7634 CAM4 Cancer Medicine 2045-7634 John Wiley and Sons Inc. Hoboken 37119042 10.1002/cam4.6012 CAM46012 CAM4-2023-02-0643.R1 Research Article RESEARCH ARTICLES Cancer Prevention A systematic review with evidence mapping of supportive care interventions for melanoma patients and caregivers Thompson et al. Thompson Jake R. https://orcid.org/0000-0002-0823-3218 1 2 jake.thompson@sydney.edu.au Salam Rehana A. https://orcid.org/0000-0001-5423-7343 2 Hanna Sarah https://orcid.org/0000-0001-5270-0517 3 Dieng Mbathio https://orcid.org/0000-0001-6714-9633 4 Saw Robyn P. M. https://orcid.org/0000-0002-3354-806X 2 5 6 Bartula Iris https://orcid.org/0000-0002-4084-4115 1 2 1 Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia 2 Melanoma Institute Australia The University of Sydney Sydney New South Wales Australia 3 Department of Dermatology Royal Prince Alfred Hospital Camperdown New South Wales Australia 4 National Health and Medical Research Council (NHMRC) Clinical Trials Centre The University of Sydney Sydney New South Wales Australia 5 Department of Melanoma and Surgical Oncology Royal Prince Alfred Hospital Camperdown New South Wales Australia 6 Sydney Medical School The University of Sydney Sydney New South Wales Australia * Correspondence Jake R. Thompson, Melanoma Institute Australia, The University of Sydney, 40 Rocklands Road, Wollstonecraft, Sydney, NSW 2065, Australia. Email: jake.thompson@sydney.edu.au 29 4 2023 6 2023 12 12 10.1002/cam4.v12.12 1375813773 18 4 2023 09 2 2023 20 4 2023 © 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Abstract Aim We conducted a systematic review and evidence gap mapping to explore the existing supportive care interventions and their impact on well‐being outcomes for melanoma patients and caregivers. Methods We searched MEDLINE, Embase, Web of Science Index Medicus, CINAHL, Lilacs, CENTRAL (Cochrane Library) and PsycINFO in December 2022, including interventional studies assessing the effectiveness of any supportive care intervention among melanoma patients and/or their caregivers. Findings Twenty studies were included in this review. These studies consisted of randomised controlled trials (n = 11, 55%), pre‐post studies (n = 7, 35%) and quasi‐experimental trials (n = 2, 10%). All studies originated from high‐income countries and focused primarily on melanoma patients, with no studies identified that focused solely on caregivers. Educational interventions were the most common (n = 7, 35%), followed by psychoeducational interventions (n = 6, 30%) and psychotherapeutic interventions (n = 4, 20%). Nearly all included studies (n = 18, 90%) reported a positive effect of the intervention on the primary outcome of interest; however, most studies (n = 17, 85%) were judged to be at moderate or high risk of bias. Due to heterogeneity of study designs, intervention characteristics and outcome measures, meta‐analysis was not conducted. Implications Supportive care interventions have positive impacts on melanoma patient well‐being outcomes, while being acceptable and feasible to conduct. More research is needed regarding supportive care interventions for melanoma caregivers. Future research should focus on eliminating sources of bias through rigorous methodology, with the development of standardised outcome measures for psychosocial outcomes to facilitate future meta‐analyses. With increasing global incidence and survival rates, the number of people living with a previous diagnosis of melanoma is expected to grow in coming years. People diagnosed with melanoma, as well as their caregivers, often report decreased quality of life and daily functioning as a result of diagnosis and the adverse effects of treatment. We performed a systematic review with evidence gap mapping to synthesize the available evidence regarding the effectiveness of supportive care interventions for melanoma patients and their caregivers. Caregivers Evidence Gap Map Melanoma Supportive Care Systematic Review Bill and Patricia Ritchie FoundationN/A Melanoma Institute Australia 10.13039/501100015626 source-schema-version-number2.0 cover-dateJune 2023 details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.3.0 mode:remove_FC converted:03.07.2023 Thompson JR , Salam RA , Hanna S , Dieng M , Saw RPM , Bartula I . A systematic review with evidence mapping of supportive care interventions for melanoma patients and caregivers. Cancer Med. 2023;12 :13758‐13773. doi:10.1002/cam4.6012 Jake R. Thompson and Rehana A. Salam are co‐first authors. ==== Body pmc1 INTRODUCTION Melanoma, the deadliest form of skin cancer, represents 90% of skin cancer mortality and was responsible for an estimated 57,000 deaths globally in 2020. 1 , 2 The global incidence of melanoma has steadily increased, 1 and is predicted to increase a further 18% in the 2020–2025 period. 3 However, despite the increasing global incidence of melanoma, the global mortality rate has seen progressive improvements throughout the last decade owing to advancements in targeted and immune therapies. 2 , 4 In 2017, the overall 5‐year survival rate for people diagnosed with melanoma was 93%. 5 As a result, there is a growing emphasis on the well‐being of melanoma patients during diagnosis, treatment and into survivorship, as many of the therapies leading to long‐term survival are associated with persistent, and often severe, adverse effects that can impact daily functioning and health‐related quality of life (HRQOL). 6 Furthermore, several patient‐reported outcomes that are common among melanoma patients (≥25%) have been associated with poorer patient well‐being, such as fear of melanoma recurrence/progression, anxiety, depression and sleeping difficulties. 7 Poor patient well‐being is also exacerbated by approximately half of melanoma patients (between 45% and 56%) reporting decreased HRQOL as a result of having at‐least one moderate or high severity unmet supportive care need. 8 Of these unmet needs, psychological needs (76%), informational needs (64%) and physical needs (59%), were the most commonly reported, all of which are associated with decreased HRQOL. 8 This highlights the supportive care needs of melanoma patients, not only in the domain of treatment‐related toxicities, but also in regard to their well‐being. These needs are also influenced by the stage of the patients' melanoma; American Joint Committee on Cancer Stage 0 being melanoma in situ, ranging to Stage IV being wide spread metastatic melanoma. 9 Historically, supportive care interventions for melanoma patients typically involved the management of treatment‐related side effects 10 ; however, this field has recently evolved to more broadly improve patient well‐being by addressing unmet needs and improving the different aspects of HRQOL. 11 There are several pillars of an effective supportive care intervention, including: patient‐centred care; the inclusion of caregivers; temporality of support; multidimensional and holistic care; multidisciplinary and coordinated care; evidence‐based interventions; and adaptability. 11 Supportive care interventions need to offer high adaptability to address patient needs, often utilising interventions focusing on psychological support, education, exercise, nutrition and/or behavioural change. Thus, although inherently complex and multifaceted, supportive care interventions may improve aspects of HRQOL of patients throughout their melanoma journey, with evidence demonstrating this effectiveness in other cancer settings. 12 , 13 , 14 , 15 As the supportive care and well‐being of melanoma patients and their caregivers is becoming an increasingly vital part of clinical practice, it is crucial that the available evidence regarding the effectiveness of these interventions is synthesised. This systematic review and evidence gap map (EGM) aim to synthesise the existing supportive care interventions aiming to improve well‐being that are available for melanoma patients and their caregivers, while highlighting gaps in the available evidence for future research. 2 METHODS The protocol for this systematic review was registered with the International Prospective Register of Systematic Reviews (registration ID: CRD42022296812). The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines 16 were used to guide the reporting of this systematic review (PRISMA 2020 Checklist provided in Supplementary Material 1). Furthermore, standard EGM methodology was used to synthesise evidence from existing studies assessing the effectiveness of supportive care interventions for melanoma patients and caregivers. 17 , 18 2.1 Criteria for considering studies for this systematic review 2.1.1 Types of studies Interventional studies assessing the effectiveness of supportive care interventions in melanoma patients and their caregivers were included. Eligible study designs included individually and cluster‐randomised controlled trials (RCTs), quasi‐experimental trials, controlled pre‐post studies, uncontrolled pre‐post studies and intermittent time series. Observational studies, cross sectional surveys, case reports, case studies, opinions, editorials, commentaries, letters, conference abstracts, books, grey literature and narrative or systematic reviews were excluded. Qualitative studies were also excluded. 2.1.2 Types of participants Studies conducted among melanoma patients and/or their caregivers of any age or sex were included. Studies that included patients diagnosed with other cancers as well as melanoma were only included if melanoma‐specific outcomes were reported. 2.1.3 Types of interventions Supportive care interventions included (but were not restricted to) educational (i.e. focusing primarily on the provision of information regarding melanoma diagnosis, treatment and prevention), psychoeducational (i.e. providing information, skills and techniques to facilitate better coping), psychotherapeutic (i.e. providing therapeutic intervention to facilitate better coping), exercise, nutritional and behavioural interventions, or any combination of these. Pharmacological interventions were excluded. 2.1.4 Types of outcome measures Primary outcomes of interest included psychological distress (including but not restricted to stress, anxiety and depression), fatigue, fear of new or recurrent melanoma and HRQOL. Secondary outcomes of interest included acceptability, feasibility, coping strategies, melanoma‐related knowledge, melanoma‐related health behaviours (including but not restricted to sun exposure, sun protection and skin self‐examination), satisfaction with care or information and unmet supportive care needs. No studies were excluded based on reported outcomes. 2.2 Search methods for the identification of studies Searches were conducted in November–December 2022 in the following databases: MEDLINE, Embase, Web of Science Index Medicus, CINAHL, Lilacs, CENTRAL (Cochrane Library) and PsycINFO (search strategy provided in Supplementary Material 2). The reference list of all included studies and relevant systematic reviews were also reviewed to identify studies missed during the electronic search. In the case of missing/unpublished studies or data, corresponding authors were contacted. No language or date restriction for publication was employed. 2.3 Data collection and analysis 2.3.1 Selection of studies Search results were exported into Covidence 19 before duplicates were removed for screening. Within Covidence, three investigators (RAS, SH, JRT) independently screened titles, abstracts and full texts for potential inclusion. Any discrepancies were resolved by consensus or contacting a fourth investigator (IB). Attempts were made to contact authors of included studies to obtain clarifications or additional data if required. 2.3.2 Data extraction Data were extracted for key study characteristics and outcomes in a standardised data collection form. Two investigators (RAS, JRT) independently extracted data and any discrepancies were resolved through discussion until consensus was reached or by consulting a third investigator (IB). Data were extracted on the following categories: Study characteristics: Journal, publication year, study design, total duration of the study, study location, sampling procedure and study setting. Study participants: Type of participants (including stage of disease), sample size, mean age, age range, sex, inclusion and exclusion criteria. Study interventions: Type of intervention, intervention description, therapeutic modality of the intervention, duration of intervention and comparison group description. Study outcomes: Primary and secondary outcomes specified and collected, time points reported and outcome measures used. Additional information: Funding sources, study limitations and notable conflicts of interest. 2.3.3 Data synthesis Included studies were categorised based on the aforementioned variables and risk of bias assessments. Furthermore, a clinical psychologist (IB) reviewed each included study to categorise the type of intervention, as well as its therapeutic modality. All included studies were then entered into EPPI‐Reviewer 20 and its accompanying program to visually synthesise the evidence. Using these programs, an EGM matrix was generated to illustrate the overlap between intervention category and primary outcome, while illustrating study design and whether the intervention had a positive or non‐positive impact on the primary study outcome. Where data was available from two or more studies utilising the same category of intervention on the same primary outcome where pooling was considered meaningful (i.e. if the underlying clinical questions were sufficiently similar), a meta‐analysis was planned. However, due to heterogeneity of study designs, intervention characteristics and outcome measures, meta‐analysis could not be performed. 2.3.4 Quality assessment The Cochrane risk of bias tool version 2 (RoB 2) 21 was used to assess the risk of bias in the included RCTs, while the risk of bias in non‐randomised studies of intervention (ROBINS‐I) 22 was used to assess risk of bias in non‐randomised studies. Two investigators (RAS, JRT) assessed risk of bias with disagreements resolved by consensus or through consulting a third investigator (IB). 3 RESULTS Our search identified 13,062 records for screening. After removing duplicates and screening for eligibility, a total of 147 full texts were identified for consideration. A total of 20 individual studies 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 (with intervention details and results published across a total of 35 papers 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ) were included in our review (Figure 1). A further three studies 58 , 59 , 60 were identified but inaccessible for screening with corresponding authors contacted; however, no response was received. Details of the study design of the included studies are outlined in Table 1, whereas details of the supportive care intervention of the included studies are outlined in Table 2. FIGURE 1 Flow chart of search strategy results. TABLE 1 Methodological design of included studies. Primary publication Relevant ancillary publications Study design Melanoma stage Specificity b Number of participants Average age (% Female) Primary intervention category Control group Primary outcome(s) Boesen et al. 23 Boesen et al. 43 Boesen et al. 44 Randomised controlled trial (RCT) I–III Broad 262 40–49 years a (64%) Psychoeducational Standard care Distress and coping Bowen et al. 24 Bowen et al. 45 Bowen et al. 46 RCT 0–IV+FDRs General 311 56 ± 12 years (56%) Educational Standard care Preventative behaviours Brandberg et al. 25 Brandberg et al. 47 RCT I Specific 149 NR Educational Standard care Satisfaction with melanoma‐related information Cole et al. 26 N/A RCT IV Specific 83 54 ± 12 years (45%) Psychotherapeutical Standard care Adjustment to melanoma diagnosis Dieng et al. 27 Dieng et al. 48 Dieng et al. 49 Dieng et al. 50 Kan et al. 51 Thompson et al. 52 RCT 0–II Broad 164 59 ± 12 years (45%) Psychoeducational Standard care Severity of fear of cancer recurrence Fawzy et al. 28 Fawzy et al. 53 Fawzy et al. 54 RCT I–II Specific 66 42 years (53%) Psychoeducational Standard care Distress and coping Fawzy 29 N/A RCT I–II Specific 62 44 ± 12 years (45%) Psychoeducational Standard care Distress and coping Fox et al. 30 N/A Pre‐post study III–IV Specific 15 50–64 years a (47%) Psychosocial N/A Acceptability and feasibility Garrett et al. 31 N/A Pre‐post study I–III Broad 66 60 years (52%) Psychotherapeutical N/A Acceptability and feasibility Gordon et al. 42 N/A Quasi‐experimental 0–II Broad 127 48 ± 14 years (58%) Psychoeducational Standard care Distress and coping Kotronoulas et al. 32 N/A Pre‐post study I–II Specific 10 52 ± 14 years (80%) Educational N/A Acceptability and feasibility Lacey et al. 33 N/A Pre‐post study IV Specific 28 66 years a (43%) Educational N/A Acceptability and feasibility Lai‐Kwon et al. 34 N/A Pre‐post study III–IV Specific 31 67 years (32%) Educational N/A Acceptability and feasibility Lynch et al. 35 N/A Pre‐post study IV Specific 61 61 ± 12 years (33%) Psychotherapeutical N/A Acceptability and feasibility Orringer et al. 36 N/A RCT I–III Broad 217 NR Educational Standard care Melanoma‐related knowledge Robinson et al. 37 Turrisi et al. 55 Hultgen et al. 56 Robinson et al. 57 RCT 0–II+Caregivers Broad 500 55 years (51%) Educational Standard care Preventative behaviours Russell et al. 38 N/A RCT II–III Specific 69 53 ± 14 years (54%) Psychoeducational Standard care Acceptability and feasibility Skovlund et al. 39 N/A Quasi‐experimental IV Specific 279 64 years a (45%) Discussion of PRO results Standard care Patient self‐management Trask et al. 40 N/A RCT 0–III General 48 54 years (71%) Psychotherapeutical Standard care Distress and coping Virago 41 N/A Pre‐post study 0–III General 11 57 years (20%) Art therapy N/A Distress and coping Abbreviations: FDR, first‐degree relative; NR, not reported; PRO, patient‐reported outcomes. a Median age. b Specific, 1–2 stages; Broad, 3 stages; General, 4–5 stages. TABLE 2 Intervention details of included studies. Primary publication Individual / group Mode of delivery Frequency Duration Facilitators Primary intervention category Therapeutic modality Primary outcome result Conclusions Boesen et al. 23 Group Face‐to‐face Weekly 6 weeks Clinician, nurse, psychologist Psychoeducational Behaviour therapy Intervention group reported significantly larger decrease in total mood disturbance (p = 0.04) and significantly more behavioural (p < 0.01) and cognitive (p < 0.01) coping skills at 6‐month than control group. These effects were no longer present at 12‐month Decreased psychological distress and enhanced coping Bowen et al 24 Individual Online N/A a 12 months Self‐managed Educational ‐ At 1‐year follow‐up both patients and FDRs in the intervention group reported significant improvements in thorough full‐body skin self‐examinations, seeking shade and avoiding the outdoors in strong sunlight (p < 0.01) Improved skin self‐examination and sun protection Brandberg et al. 25 Group Face‐to‐face Single session ‐ Nurse Educational ‐ The intervention group had a significant improvement in melanoma‐related knowledge (p < 0.01), with a majority (89%) of participants reporting a positive attitude towards the intervention at 6‐month Increased satisfaction and knowledge Cole et al. 26 Individual Face‐to‐face Monthly 4 months Psychologist Psychotherapeutical Behaviour therapy Participants who received spiritually focused meditation reported significantly lower levels of depression (p = 0.02) and a more positive affective state (p = 0.045) than the control group post‐intervention Reduced depression and increase positive affective state Dieng et al. 27 Individual Telephone Fortnightly 5 weeks Psychologist Psychoeducational Brief psychodynamic psychotherapy The intervention group reported a significantly lower fear of cancer recurrence severity at 6‐ (p < 0.01; Cohen d = 0.03) and 12‐month (p = 0.02; Cohen d NR) follow‐up compared to control group Decreased fear of cancer recurrence severity Fawzy et al. 28 Group Face‐to‐face Weekly 6 weeks Clinician, nurse Psychoeducational Behaviour therapy The intervention group reported significantly more behavioural and cognitive coping skills post‐intervention (p < 0.01, p = 0.04) and at 6‐month (p < 0.01, p = 0.3). This group also reported significantly less total mood disturbance at 6‐month (p < 0.01) Decreased distress and enhanced coping Fawzy et al. 29 Individual Face‐to‐face Varied Varied Nurse Psychoeducational Behaviour therapy Participants who received therapy reported significantly lower total mood disturbance at 3‐month compared to baseline (p < 0.01), and when compared to the control group (p < 0.05). The intervention group also reported significant decreases in the general severity index (p = 0.02), positive symptom distress index (p = 0.03) and total score (p = 0.02) of the Brief Symptom Inventory at 3‐month compared to baseline Decreased distress and enhanced coping Fox et al. 30 Individual Telephone Single session ‐ Counsellor, social worker Psychosocial Supportive counselling The mean satisfaction score of participants was 4.35/5 (SD: 0.62). The average total duration of time for each participant was 117 min (SD: 35.92) The intervention was acceptable and feasible Garrett et al. 31 Individual Telephone Fortnightly 3 months Psychologist Psychotherapeutical Motivational interviewing The mean satisfaction score of participants was 9/10. Of the 66 participants enrolled, 46 (70%) completed the intervention. In participants who chose one module, 78% completed all three sessions. In participants who chose both modules, 66% completed all three sessions. Sessions lasted 45 min on average The intervention was acceptable and feasible Gordon et al. 42 Individual Face‐to‐face Varied 6 months Psychiatric nurse, psychologist, social worker Psychoeducational Psychodynamic psychotherapy Melanoma patients in both the intervention and control groups reported a lower number of psychosocial problems at 3‐month post‐baseline. No between group differences were reported The intervention did not have a significant impact Kotronoulas et al. 32 Individual Face‐to‐face Bi‐monthly 3 months Nurse Educational ‐ The intervention reported a 55% recruitment rate and 90% retention rate. Qualitative feedback from participants indicated the intervention PROMs were easy to complete, and consultations with a nurse specialist were timed appropriately and useful The intervention was acceptable and feasible Lacey et al. 33 Individual Face‐to‐face Varied 9 weeks Clinician, dietician, exercise physiologist Educational ‐ Adherence to the intervention exceeded 75%, with 93% of participants completing follow‐up with supportive care physician, exercise physiologist, and dietician. Exercise adherence was 85%, and 85% of participants also accessed integrative therapies The intervention was acceptable and feasible Lai‐Kwon et al. 34 Individual Telephone Tri‐monthly 3 months Nurse Educational ‐ Ninety‐seven percent of participants completed both consultations, with the mean total nursing time to prepare and deliver the intervention being 19 min (SD: 5) and 96 min (SD: 15), respectively. Eighty‐six percent of participants stated the intervention met their approval and 83% stated they liked the program The intervention was acceptable and feasible Lynch et al. 35 Individual Face‐to‐face Fortnightly 10 weeks Psychologist Psychotherapeutical Metacognitive therapy / acceptance and commitment therapy Ninety‐eight percent of participants agreed the screening questionnaires were easy to complete and understand. The mean time to complete the questionnaire was 3.25 min (SD: 2.30). Participants reported that the intervention was very important and acceptable The intervention was acceptable and feasible Orringer et al. 36 Individual Videotape N/A b 11 min Clinician, nurse, psychiatrist, psychologist, social worker Educational ‐ The intervention group reported a significant (p < 0.01) increase in melanoma knowledge than the clinical visit control group post‐intervention. However, the control group reported a significant decrease in participant anxiety (p < 0.01) and distress (p < 0.01) compared to the intervention group The videotape effectively improved knowledge, but standard care better addressed anxiety/distress Robinson et al. 37 Dyad Face‐to‐face and online Varied Varied Trained facilitator Educational ‐ Participants who received the in‐person, workbook, or electronic intervention reported significantly more skin self‐examinations at 4‐, 12‐, and 24‐month post‐intervention than the control group (p < 0.01). Participants who received an intervention also identified more recurrent melanomas than the control group (p < 0.05) Electronic interactive interventions can effectively deliver preventative education Russell et al. 38 Individual Online N/A a 6 weeks Self‐managed Psychoeducational Mindfulness‐based meditation The intervention was found helpful by 72% of participants, with at least 61% of participants utilising meditation each week of follow‐up. Participants also reported numerous benefits, challenges, and feedback for the intervention The intervention was acceptable and feasible Skovlund et al. 39 Individual Face‐to‐face Tri‐monthly 12 months Clinician Discussion of PRO results ‐ The intervention did not significantly improve knowledge, skills, or confidence in participant self‐management (p = 0.37), coping self‐efficacy (p = 0.31), and patient‐perceived patient‐physician interaction efficacy (p = 0.42) at 12‐month post‐intervention The intervention did not improve knowledge, skills, or confidence in self‐management Trask et al. 40 Individual Face‐to‐face Weekly 4 weeks Psychologist Psychotherapeutical Cognitive‐behavioural therapy Both ITT and EOI analysis showed the intervention significantly (p < 0.05) reduced participant anxiety at 2‐ and 6‐month follow‐up and increased vitality and general health at 2‐month follow‐up. EOI analysis demonstrated the intervention significantly reduced distress at 2‐month follow‐up (p = 0.01) Reduced distress and improved HRQOL Virago 41 Group Face‐to‐face Weekly 6 months Trained facilitator Art therapy Phenomenological / psychodynamic art therapy The intervention significantly (p = 0.02) increased participant levels of secretory immunoglobulin A over a 6‐month period. The intervention also significantly reduced total mean avoidance at 6‐month (p = 0.05) and mental disengagement at 6‐ (p = 0.02) and 12‐month (p = 0.05) Enhanced immunological function, coping skills, and interpersonal relations Abbreviations: EOI, effect of intervention; FDR, first‐degree relative; HRQOL, health‐related quality of life; ITT, intention‐to‐treat; NR, not reported; SD, standard deviation. a Participants were provided access to an educational website. b Participants were provided an educational videotape. 3.1 Study designs Of the 20 included studies, 11 were RCTs, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 36 , 37 , 38 , 40 seven were pre‐post studies 30 , 31 , 32 , 33 , 34 , 35 , 41 and two were quasi‐experimental trials. 39 , 42 Furthermore, seven of the included studies were acceptability and feasibility trials. 30 , 31 , 32 , 33 , 34 , 35 , 38 All studies were conducted in high‐income countries, including the United States of America (n = 9), 24 , 26 , 28 , 29 , 31 , 36 , 37 , 40 , 42 Australia (n = 7), 27 , 30 , 33 , 34 , 35 , 38 , 41 Denmark (n = 2), 23 , 39 Scotland (n = 1) 32 and Sweden (n = 1). 25 Date of publications ranged from 1980 to 2022 with the highest number of publications occurring in the 2012–2022 period (n = 13). 3.2 Study participants Combined, these studies included a total of 2558 melanoma patients. Each study included participants that were on average 40 years of age or older, with majority of studies reporting a relatively equal (40%–60%) representation of males and females. 24 , 26 , 27 , 28 , 29 , 30 , 31 , 33 , 37 , 38 , 39 , 42 Majority of studies included patients diagnosed with Stage I (n = 13, 65%) and Stage II (n = 13, 65%) melanoma. Less than half of the studies included patients diagnosed with Stage III (n = 9, 45%) or Stage IV (n = 7, 35%), with the least studied patients diagnosed with melanoma in situ (Stage 0; n = 5, 25%). When the stage of included melanoma patients was categorised (i.e. the specificity of each intervention), a total of 11 (55%) studies 25 , 26 , 28 , 29 , 30 , 32 , 33 , 34 , 35 , 38 , 39 were classified as specific (including patients across 1–2 stages of the disease), six (30%) studies 23 , 27 , 31 , 36 , 37 , 42 were broad (3 stages), and three (15%) studies 24 , 40 , 41 were general (4–5 stages). No included studies focused primarily on melanoma caregivers. Only two studies included both patient and non‐patient participants: Bowen et al. 24 included first‐degree relatives of melanoma patients as‐well‐as the patients themselves to evaluate the impact of melanoma education on preventative behaviours, while Robinson et al. 37 included early‐stage patients and their caregivers to investigate the impact of melanoma education on skin self‐examination. 3.3 Intervention characteristics A total of seven (35%) studies 24 , 25 , 32 , 33 , 34 , 36 , 37 were educational in nature, whereas six (30%) studies 23 , 27 , 28 , 29 , 38 , 42 were psychoeducational, and four (20%) studies 26 , 31 , 35 , 40 were psychotherapeutic. The final three studies were classified as psychosocial, 30 a discussion of patient reported outcomes 39 and art therapy. 41 The most common therapeutic modality for these interventions was behaviour therapy (n = 4, 20%). 23 , 26 , 28 , 29 Individual patient interventions 24 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 42 were the most common (n = 15, 75%), followed by patient group interventions 23 , 25 , 28 , 41 (n = 4, 20%) and one (5%) intervention 37 was conducted in patient‐caregiver dyads. The majority of interventions were conducted face‐to‐face with participants 23 , 25 , 26 , 28 , 29 , 32 , 33 , 35 , 39 , 40 , 41 , 42 (n = 12, 60%), followed by telephone 27 , 30 , 31 , 34 (n = 4, 20%), online 24 , 38 (n = 2, 10%) and via videotape 36 (n = 1, 5%). One (5%) study was conducted with both a face‐to‐face and online group. 37 Majority of interventions (n = 12, 60%) were provided by a single facilitator, with psychologists being the most common (n = 5, 25%), 26 , 27 , 31 , 35 , 40 followed by nurses (n = 4, 20%), 25 , 29 , 32 , 34 trained facilitators (n = 2, 10%) 37 , 41 and clinicians (n = 1, 5%). 39 In six (30%) studies interventions were provided by a multi‐disciplinary team, 23 , 28 , 30 , 33 , 36 , 42 while the remaining two (10%) were patient self‐managed. 24 , 38 Interventions were largely conducted at‐least once a month (n = 10, 50%), 23 , 25 , 26 , 27 , 28 , 30 , 31 , 35 , 40 , 41 lasting for up‐to 3 months (n = 13, 65%). 23 , 25 , 27 , 28 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 38 , 40 Finally, the most common primary outcome of the included studies were acceptability and feasibility (n = 7, 35%), 30 , 31 , 32 , 33 , 34 , 35 , 38 followed by distress and coping (n = 6, 30%) 23 , 28 , 29 , 40 , 41 , 42 and preventative behaviours (n = 2, 10%), 24 , 37 with the remaining studies reporting unique primary outcomes. 3.4 Intervention effectiveness The majority of included studies reported a positive impact of their respective interventions on the primary outcome of interest. Interventions that were educational in nature were found to improve the efficacy of both patient and caregiver/relative skin self‐examinations and sun protection behaviours, 24 , 37 increased melanoma‐related knowledge, 36 and participant satisfaction with melanoma knowledge at diagnosis and throughout treatment, 25 while being acceptable and feasible to conduct. 32 , 33 , 34 The included studies also suggest that psychoeducational interventions reduce distress and improve participant coping, 23 , 28 , 29 reduce severity of fear of cancer recurrence, 27 and are acceptable and feasible to conduct. 38 , 48 Furthermore, psychotherapeutic interventions have also demonstrated efficacy in improving participant positive affective states, coping and adjustment following diagnosis of melanoma, 26 decrease distress, 26 , 40 improve HRQOL, 40 and are acceptable and feasible to conduct. 31 , 35 Art therapy was found to enhance patient coping and interpersonal relations when conducted in groups, 41 while supportive counselling was acceptable and feasible. 30 Only two studies reported a non‐positive interventional effect. Skovlund et al. 39 reported that the use of patient‐reported outcomes to facilitate clinician‐led discussions with patients during a clinical appointment did not improve patient confidence in self‐management, which may have been due to baseline ceiling effects. Gordon et al. 42 further reported that psychodynamic psychotherapy did not significantly reduce anxiety and depression in melanoma patients, likely due to the poor prognosis of these patients at time of publication. 3.5 Risk of bias The assessment of bias in the included studies are provided in Table 3A for RCTs and Table 3B for non‐randomised designs. TABLE 3 Risk of bias within included studies. (A) Cochrane risk of bias tool (RoB 2) results for randomised controlled trials. (B) Risk of bias in non‐randomised studies of intervention (ROBINS‐I) results. A Author/Citation D1 D2 D3 D4 D5 Overall Boesen et al. 23 + + + + ! ! + Low risk Bowen et al. 24 + + + + ! ! ! Some concerns Brandberg et al. 25 ! + + + ! ! − High risk Cole et al. 26 + + − + ! − Dieng et al. 27 + + + + + + D1 Randomisation process Fawzy et al. 28 − + + + ! − D2 Deviations from the intended intervention Fawzy 29 − + + + ! − D3 Missing outcome data Orringer et al. 36 ! + + + ! ! D4 Measurement of the outcome Robinson et al. 37 + + + + + + D5 Selection of reported results Russell et al. 38 + + + + + + Trask et al. 40 + + ! + ! ! B Author/Citation D1 D2 D3 D4 D5 D6 D7 Overall Fox et al. 30 − + + + ! ! ! − + Low risk Garrett K, 2013 31 − + + + ! ! + − ! Moderate risk Gordon et al. 42 ! + + ! ! ! + ! − Serious risk Kotronoulas et al. 32 − + + + + ! + − * Critical risk Lacey et al. 33 − + + + − ! + − Lai‐Kwon et al. 34 − + + + + ! + − Lynch et al. 35 − + ! + − ! + − D1 Confounding Skovlund et al. 39 + + + + ! + + ! D2 Selection of participants Virago 41 − − + − − ! − − D3 Classification of interventions D4 Deviations from intended intervention D5 Missing outcome data D6 Measurement of the outcome D7 Selection of reported results Of the 11 included RCTs, three were determined to be at low risk of bias, 27 , 37 , 38 while some concerns were raised regarding five 23 , 24 , 25 , 36 , 40 and the remaining three were classified as high risk. 26 , 28 , 29 The most common domain where concerns were raised was the selection of reported results domain (n = 8, 73%), 23 , 24 , 25 , 26 , 28 , 29 , 36 , 40 as most RCTs did not have a pre‐specified analysis plan available prior to the publishing of results. This was only classified as ‘some concerns’ and not ‘high risk’ for the effected studies, as it was assumed the included studies had pre‐specified analysis plans in place, they were simply not publicly available (i.e. in a published study protocol). Four RCTs raised ‘some concerns’ or a ‘high risk’ of bias regarding the Randomisation Process domain, 25 , 28 , 29 , 36 as detailed information on the randomisation process used was not available. Finally, two RCTs were classified as ‘some concerns’ and ‘high risk’ due to high loss‐to‐follow‐up rates. 26 , 40 Of the nine non‐randomised studies, two were classified as having a ‘moderate risk’ of bias, 39 , 42 while seven were classified as having a ‘serious risk’. 30 , 31 , 32 , 33 , 34 , 35 , 41 The majority of ‘serious risk’ is evident in the Confounding domain (n = 7, 78%), 30 , 31 , 32 , 33 , 34 , 35 , 41 , 42 as few studies utilised statistical analysis techniques that account for confounding variables. It should be noted, however, that many of the included non‐randomised studies were acceptability and feasibility trials, and thus, are more susceptible to inherent biases due to their study design. 3.6 Evidence gap map The EGM of included study designs, primary intervention categories and primary study outcomes is provided in Figure 2. As evident in the EGM, substantial gaps in the evidence still exist regarding the supportive care interventions in the melanoma space. Educational, psychoeducational and psychotherapeutic interventions have the most evidence for affecting supportive care outcomes, but other types of intervention such as exercise, music and nutrition‐based interventions are under‐represented. While evidence‐based interventions are emerging for addressing distress, improving coping and encouraging melanoma‐related preventative behaviours, more research is needed to explore ways to increase melanoma‐related knowledge, satisfaction with the provision of this information, adjustment to melanoma diagnosis, patient self‐management and decrease fear of cancer recurrence. FIGURE 2 Evidence gap map of included study designs, intervention categories and outcomes. 4 DISCUSSION To the best of our knowledge, this is the first systematic review to explore the scale and depth of the current, available evidence on supportive care interventions for individuals diagnosed with melanoma and their caregivers, while identifying gaps to guide future research. Findings from this systematic review suggest a positive impact of educational, psychoeducational and psychotherapeutic supportive care interventions on patient distress and coping, melanoma‐related knowledge, adjustment to melanoma diagnosis and fear of cancer recurrence, while being acceptable and feasible, in participants aged over 40 years on average and regardless of gender. However, the existence of bias was considerable in both randomised and non‐randomised studies. Furthermore, there is a clear scarcity of evidence regarding supportive care interventions aimed at supporting caregivers. Thus, the findings of this systematic review and EGM have several implications. First, a substantial proportion of included studies were acceptability and feasibility pilot studies, 30 , 31 , 32 , 33 , 34 , 35 , 38 which did not seem to progress past the pilot stage. This may be because six of the seven pilot studies were published in the 3 years (2019–2022) prior to the search conducted for this systematic review. 30 , 32 , 33 , 34 , 35 , 38 As the introduction of immune and targeted therapies have resulted in melanoma patients living longer than ever before, 2 , 4 a recent shift of focus has occurred regarding the emerging field of supportive care. This may explain why the majority of pilot studies have been conducted in the previous 3 years, with associated RCTs possibly planned or underway in 2023 and beyond. Therefore, if not already planned or underway, these interventions should be further explored in rigorously designed RCTs to investigate their impact on well‐being outcomes, with reasons for the failed progression past the pilot study phase investigated if relevant. Second, the identified supportive care interventions were primarily educational, psychoeducational or psychotherapeutic in nature, and concerned with the informational and psychological needs of participants. As supportive care remains an emerging field, there are several therapeutic approaches that have shown promise in other oncological populations that remain unexplored in the melanoma space. These other approaches include exercise, dance, music, massage and nutrition‐based interventions in individual and group formats, 61 , 62 which have shown promise in reducing fatigue, nausea and improving diet in general cancer populations. Thus, interventions based on these approaches may represent viable methods to address prevalent the unmet social and physical needs of people diagnosed with melanoma, 8 and should be investigated. Third, the majority of psychoeducational and psychotherapeutic interventions utilised behaviour therapy. Two recent systematic reviews have highlighted that third wave cognitive‐behavioural therapies, in particular acceptance and commitment therapy (ACT), are effective in treating anxiety, depression, distress, poor quality of life and fear of cancer recurrence. 63 , 64 Although melanoma patients are reporting similar concerns, 65 , 66 these interventions are yet to be implemented in this context. To date, ACT has been implemented mostly with women diagnosed with breast cancer, and to a lesser extent in ovarian, colorectal, brain and testicular cancers. 63 , 64 Melanoma diagnosis and treatment often result in adverse effects, which can affect the ability to participate in meaningful activities. 66 ACT aims to educate and encourage flexible thinking, in order to accept the experiences associated with painful life events, and engage meaningfully and fully with activities in life, 67 , 68 which appears to be a viable yet unexplored method to address the challenges faced by melanoma patients. Fourth, the majority of interventions were conducted individually and face‐to‐face, with few studies exploring the utility of digital technology to deliver individual or group interventions. As a result of the COVID‐19 pandemic, telehealth and digital technologies have become increasingly implemented in routine medical care, 69 and represent an opportunity to overcome barriers to accessing supportive care interventions, especially in rural/remote areas where melanoma is more prevalent. 70 , 71 Thus, melanoma‐specific supportive care interventions delivered through digital technology should be further explored in future research. Fifth, the majority of interventions were conducted by one facilitator, 24 , 25 , 26 , 27 , 29 , 31 , 32 , 34 , 35 , 37 , 38 , 39 , 40 , 41 with few interventions employing multidisciplinary teams. 23 , 28 , 30 , 33 , 36 , 42 Evidence from interventions conducted in head and neck cancer patients have demonstrated that the implementation of multidisciplinary teams increases adherence to guidelines and protocols, is cost‐effective, reduced time to treatment and further support and increased patient and clinical satisfaction. 72 In future studies, multidisciplinary teams should be employed to implement supportive care interventions within the melanoma space due to these positive outcomes through the co‐ordination of support services and increased ability to holistically address unmet needs. Sixth, most studies had at least a moderate risk of bias. To address the domains where bias was most prevalent, future RCTs should endeavour to provide sufficient detail regarding the randomisation process and ensure pre‐specified analysis plans are publicly available. Non‐randomised studies should prioritise the use of analysis methods that account for possible confounding and effect modification, while employing robust follow‐up routines to prevent participant loss‐to‐follow‐up. However, removing risk of bias regarding measurement of the outcome in both randomised and non‐randomised studies will be difficult, given the widespread adoption of self‐reported outcome measures ensuring outcome assessors (i.e. the participants) will be aware of whether they received the intervention or not. Penultimately, studies were too heterogeneous to conduct meta‐analysis. Many interventions did not report a standardised frequency or duration of intervention, with results being unclear regarding what the appropriate frequency or duration of intervention is. Furthermore, each intervention focused on unique ranges of melanoma patients (Stages 0–IV), with early‐stage melanoma being the most researched group, with interventions in advanced melanoma patients less prevalent. Each included study also differed not only in outcomes of interest, but in the tools used to measure these outcomes. Future research can mitigate these points of heterogeneity by developing and utilising melanoma‐specific standardised outcome measures. Furthermore, future research should investigate whether interventions should be tailored to specific stages of the disease or adapted across different stages. This future research should consider the changing context of melanoma patients due to improvements in available treatments, such as the introduction of immune checkpoint inhibitors and targeted therapy improving long‐term survival of Stage IV patients, 73 and the introduction of adjuvant therapy for patients diagnosed with Stages II and III. 74 Through addressing these points of heterogeneity, effective comparison of intervention effectiveness can be conducted through the successful pooling of data for meta‐analyses, informing guideline development. Finally, more research is needed regarding the effectiveness of supportive care interventions for caregivers of melanoma patients, as evidence from other oncological populations has demonstrated the significant burden and supportive care needs of caregivers, 75 with some interventions beginning to emerge. 76 , 77 Further research is also needed regarding the effectiveness of supportive care interventions for younger melanoma patients, as melanoma is one of the most common cancers among individuals aged 20–39 years in the United States, 78 and the most common cancer among individuals aged 15–24 years in Australia. 79 Therefore, future research should aim to investigate the effectiveness of supportive care interventions in younger melanoma populations. This literature review and EGM synthesises the effectiveness of supportive care interventions in melanoma patients and caregivers globally, allowing for a comprehensive snapshot of the existing evidence within this field. However, we acknowledge the possibility of bias being introduced at every stage of our review process. To address this, a comprehensive search strategy was utilised with a list of pre‐determined electronic databases to capture eligible studies. Furthermore, a minimum of two investigators assessed eligibility of identified studies, extracted data and evaluated the risks of bias. While we attempted to be as inclusive as possible in our search strategy, all identified studies were published in English and originated from high‐income countries. Furthermore, although we attempted to assess reporting bias, this assessment largely relies on information available in published articles and supplementary material, and thus, may be underrepresented. While supportive care interventions in the melanoma context are an emerging field of research, this systematic review and EGM has demonstrated that they are effective in improving patient well‐being, and acceptable and feasible. Our confidence in these interventions will increase with higher quality, rigorous research conducted using standardised outcome measures while assessing a broader range of interventions and delivery methods, which may increase choice and accessibility to the appropriate supportive care intervention for both melanoma patients and caregivers. AUTHOR CONTRIBUTIONS Jake Robert Thompson: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (equal); project administration (equal); writing – original draft (equal); writing – review and editing (equal). Rehana A Salam: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (equal); project administration (equal); writing – original draft (equal); writing – review and editing (equal). Sarah Hanna: Data curation (equal); methodology (equal); writing – review and editing (equal). Mbathio Dieng: Data curation (equal); writing – review and editing (equal). R. Saw: Conceptualization (equal); writing – review and editing (equal). Iris Bartula: Conceptualization (equal); project administration (equal); supervision (lead); writing – review and editing (equal). FUNDING INFORMATION This work and the researchers time was supported by Melanoma Institute Australia and the Bill and Patricia Ritchie Foundation. CONFLICT OF INTEREST STATEMENT Jake R. Thompson, Rehana A. Salam, Mbathio Dieng and Iris Bartula report no competing interests. Robyn P.M. Saw has received honoraria from advisory board participation from MSD, Novartic, and QBiotics, and speaking honoraria from BMS. Supporting information Supplementary Material 1 Click here for additional data file. Supplementary Material 2 Click here for additional data file. ACKNOWLEDGEMENT Open access publishing facilitated by The University of Sydney, as part of the Wiley ‐ The University of Sydney agreement via the Council of Australian University Librarians. DATA AVAILABILITY STATEMENT Data sharing is not applicable to this study as no new data were created or analysed in this study. ==== Refs REFERENCES 1 Ferlay J , Ervik M , Lam F , et al. Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer; 2022. Accessed December 12, 2022. https://gco.iarc.fr/today 2 Garbe C , Amaral T , Peris K , et al. European consensus‐based interdisciplinary guideline for melanoma. Part 2: treatment‐update 2022. Eur J Cancer. 2022;170 :256‐284. doi:10.1016/j.ejca.2022.04.018 35623961 3 Global Coalition for Melanoma Patient Advocacy, EuroMelanoma . Melanoma Skin Cancer Report: Stemming the Global Epidemic . 2020 Accessed January 2, 2023. https://melanomapatients.org.au 4 Ervik M , Lam F , Laversanne M , Ferlay J , Bray F . Global Cancer Observatory: Cancer over Time. International Agency for Research on Cancer; 2021. Accessed December 12, 2022. https://gco.iarc.fr/overtime 5 American Cancer Society . Survival Rates for Melanoma Skin Cancer . Accessed December 12, 2022. https://cancer.org/cancer/melanoma‐skin‐cancer 6 Franken MG , Leeneman B , Gheorghe M , Uyl‐de Groot CA , Haanen JBAG , van Baal PHM . A systematic literature review and network meta‐analysis of effectiveness and safety outcomes in advanced melanoma. Eur J Cancer. 2019;123 :58‐71. doi:10.1016/j.ejca.2019.08.032 31670077 7 Lisy K , Lai‐Kwon J , Ward A , et al. Patient‐reported outcomes in melanoma survivors at 1, 3 and 5 years post‐diagnosis: a population‐based cross‐sectional study. Qual Life Res. 2020;29 (8 ):2021‐2027. doi:10.1007/s11136-020-02464-y 32140919 8 Fu H , Teleni L , Crichton M , Chan RJ . Supportive care and unmet needs in patients with melanoma: a mixed‐methods systematic review. Support Care Cancer. 2020;28 (8 ):3489‐3501. doi:10.1007/s00520-020-05464-3 32342223 9 Gershenwald JE , Scolyer RA , Hess KR , et al. Melanoma staging: evidence‐based changes in the American joint committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67 (6 ):472‐492. doi:10.3322/caac.21409 29028110 10 Hui D , De La Cruz M , Mori M , et al. Concepts and definitions for “supportive care,” “best supportive care,” “palliative care,” and “hospice care” in the published literature, dictionaries, and textbooks. Support Care Cancer. 2013;21 (3 ):659‐685. doi:10.1007/s00520-012-1564-y 22936493 11 Olver I , Keefe D , Herrstedt J , Warr D , Roila F , Ripamonti CI . Supportive care in cancer—a MASCC perspective. Support Care Cancer. 2020;28 (8 ):3467‐3475. doi:10.1007/s00520-020-05447-4 32342221 12 Xunlin N , Lau Y , Klainin‐Yobas P . The effectiveness of mindfulness‐based interventions among cancer patients and survivors: a systematic review and meta‐analysis. Support Care Cancer. 2020;28 (4 ):1563‐1578. doi:10.1007/s00520-019-05219-9 31834518 13 Badger TA , Segrin C , Sikorskii A , et al. Randomized controlled trial of supportive care interventions to manage psychological distress and symptoms in Latinas with breast cancer and their informal caregivers. Psychol Health. 2020;35 (1 ):87‐106. doi:10.1080/08870446.2019.1626395 31189338 14 Gabriel I , Creedy D , Coyne E . A systematic review of psychosocial interventions to improve quality of life of people with cancer and their family caregivers. Nurs Open. 2020;7 (5 ):1299‐1312. doi:10.1002/nop2.543 32802350 15 Myrhaug HT , Mbalilaki JA , Lie N‐EK , Hansen T , Nordvik JE . The effects of multidisciplinary psychosocial interventions on adult cancer patients: a systematic review and meta‐analysis. Disabil Rehabil. 2020;42 (8 ):1062‐1070. doi:10.1080/09638288.2018.1515265 30497305 16 Moher D , Shamseer L , Clarke M , et al. Preferred reporting items for systematic review and meta‐analysis protocols (PRISMA‐P) 2015 statement. Syst Rev. 2015;4 (1 ):1‐9. doi:10.1186/2046-4053-4-1 25554246 17 Snilstveit B , Vojtkova M , Bhavsar A , Stevenson J , Gaarder M . Evidence & gap maps: a tool for promoting evidence informed policy and strategic research agendas. J Clin Epidemiol. 2016;79 :120‐129. doi:10.1016/j.jclinepi.2016.05.015 27387966 18 White H , Albers B , Gaarder M , et al. Guidance for producing a Campbell evidence and gap map. Campbell Syst Rev. 2020;16 (4 ):e1125. doi:10.1002/cl2.1125 37016607 19 Covidence Systematic Review Software . Veritas Health Innovation; Melbourne, Australia . Accessed December 15, 2022. https://covidence.org 20 Thomas J , Brunton J , Graziosi S . EPPI‐reviewer 4.0: software for research synthesis. EPPI‐Centre Software Accessed December 15, 2022. https://eppi.ioe.ac.uk 21 Sterne JAC , Savović J , Page MJ , et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366 :l4898. doi:10.1136/bmj.l4898 31462531 22 Sterne JAC , Hernán MA , Reeves BC , et al. ROBINS‐I: a tool for assessing risk of bias in non‐randomised studies of interventions. BMJ. 2016;355 :i4919. doi:10.1136/bmj.i4919 27733354 23 Boesen EH , Ross L , Frederiksen K , et al. Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol. 2005;23 (6 ):1270‐1277. doi:10.1200/JCO.2005.05.193 15718325 24 Bowen DJ , Burke W , Hay JL , Meischke H , Harris JN . Effects of web‐based intervention on risk reduction behaviors in melanoma survivors. J Cancer Surviv. 2015;9 (2 ):279‐286. doi:10.1007/s11764-014-0412-0 25425205 25 Brandberg Y , Bergenmar M , Bolund C , et al. Information to patients with malignant melanoma: a randomized group study. Patient Educ Couns. 1994;23 (2 ):97‐105. doi:10.1016/0738-3991(94)90047-7 21207908 26 Cole BS , Hopkins CM , Spiegel J , Tisak J , Agarwala S , Kirkwood JM . A randomised clinical trial of the effects of spiritually focused meditation for people with metastatic melanoma. Ment Health, Relig Cult. 2012;15 (2 ):161‐174. doi:10.1080/13674676.2011.562492 27 Dieng M , Butow PN , Costa D , et al. Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol. 2016;34 (36 ):4405‐4414. doi:10.1200/JCO.2016.68.2278 27998215 28 Fawzy FI , Cousins N , Fawzy NW , Kemeny ME , Elashoff R , Morton D . A structured psychiatric intervention for cancer patients: I. changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry. 1990;47 (8 ):720‐725. doi:10.1001/archpsyc.1990.01810200028004 2378543 29 Fawzy NW . A psychoeducational nursing intervention to enhance coping and affective state in newly diagnosed malignant melanoma patients. Cancer Nurs. 1995;18 (6 ):427‐438.8564938 30 Fox J , Janda M , Bennett F , Langbecker D . An outreach telephone program for advanced melanoma supportive care: acceptability and feasibility. Eur J Oncol Nurs. 2019;42 :110‐115. doi:10.1016/j.ejon.2019.08.010 31493669 31 Garrett K , Okuyama S , Jones W , et al. Bridging the transition from cancer patient to survivor: pilot study results of the cancer survivor telephone education and personal support (C‐STEPS) program. Patient Educ Couns. 2013;92 (2 ):266‐272. doi:10.1016/j.pec.2013.04.002 23647980 32 Kotronoulas G , Connaghan J , Grenfell J , et al. Employing patient‐reported outcome (PRO) measures to support newly diagnosed patients with melanoma: feasibility and acceptability of a holistic needs assessment intervention. Eur J Oncol Nurs. 2017;31 :59‐68. doi:10.1016/j.ejon.2017.10.002 29173828 33 Lacey J , Lomax AJ , McNeil C , et al. A supportive care intervention for people with metastatic melanoma being treated with immunotherapy: a pilot study assessing feasibility, perceived benefit, and acceptability. Support Care Cancer. 2019;27 (4 ):1497‐1507. doi:10.1007/s00520-018-4524-3 30392112 34 Lai‐Kwon J , Kelly B , Lane S , et al. Feasibility, acceptability, and utility of a nurse‐led survivorship program for people with metastatic melanoma (MELCARE). Support Care Cancer. 2022;30 (11 ):9587‐9596. doi:10.1007/s00520-022-07360-4 36136246 35 Lynch FA , Katona L , Jefford M , et al. Feasibility and acceptability of fear‐less: a stepped‐care program to manage fear of cancer recurrence in people with metastatic melanoma. J Clin Med. 2020;9 (9 ):e2969. doi:10.3390/jcm9092969 36 Orringer JS , Fendrick AM , Trask PC , et al. The effects of a professionally produced videotape on education and anxiety/distress levels for patients with newly diagnosed melanoma: a randomized, prospective clinical trial. J Am Acad Dermatol. 2005;53 (2 ):224‐229. doi:10.1016/j.jaad.2005.03.061 16021114 37 Robinson JK , Gaber R , Hultgren B , et al. Skin self‐examination education for early detection of melanoma: a randomized controlled trial of internet, workbook, and in‐person interventions. J Med Internet Res. 2014;16 (1 ):e2883. doi:10.2196/jmir.2883 38 Russell L , Ugalde A , Orellana L , et al. A pilot randomised controlled trial of an online mindfulness‐based program for people diagnosed with melanoma. Support Care Cancer. 2019;27 (7 ):2735‐2746. doi:10.1007/s00520-018-4574-6 30506103 39 Skovlund PC , Vind Thaysen H , Schmidt H , et al. Effect of patient‐reported outcomes as a dialogue‐based tool in cancer consultations on patient self‐management and health‐related quality of life: a clinical, controlled trial. Acta Oncol. 2021;60 (12 ):1668‐1677. doi:10.1080/0284186X.2021.1962972 34403293 40 Trask PC , Paterson AG , Griffith KA , Riba MB , Schwartz JL . Cognitive‐behavioral intervention for distress in patients with melanoma: comparison with standard medical care and impact on quality of life. Cancer. 2003;98 (4 ):854‐864. doi:10.1002/cncr.11579 12910531 41 Virago MC . Art psychotherapy and public health. Public Health. 2021;196 :150‐157. doi:10.1016/j.puhe.2021.05.020 34218075 42 Gordon WA , Freidenbergs I , Diller L , et al. Efficacy of psychosocial intervention with cancer patients. J Consult Clin Psychol. 1980;48 (6 ):743‐759. doi:10.1037/0022-006X.48.6.743 7440831 43 Boesen EH , Boesen SH , Frederiksen K , et al. Survival after a psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. J Clin Oncol. 2007;25 (36 ):5698‐5703. doi:10.1200/JCO.2007.10.8894 18089864 44 Boesen E , Boesen S , Christensen S , Johansen C . Comparison of participants and non‐participants in a randomized psychosocial intervention study among patients with malignant melanoma. Psychosomatics. 2007;48 (6 ):510‐516. doi:10.1176/appi.psy.48.6.510 18071098 45 Bowen DJ , Hay JL , Mayer J , et al. Predictors of recruited melanoma families into a behavioral intervention project. Contemp Clin Trials. 2012;33 (1 ):85‐92. doi:10.1016/j.cct.2011.09.016 22001361 46 Bowen DJ , Hay J , Meischke H , Mayer JA , Harris‐Wai J , Burke W . Randomized trial of a web‐based survivor intervention on melanoma prevention behaviors of first‐degree relatives. Cancer Causes Control. 2019;30 (3 ):225‐233. doi:10.1007/s10552-018-1096-y 30483971 47 Brandberg Y , Bergenmar M , Michelson H , Månsson‐Brahme E , Sjödén P‐O . Six‐month follow‐up of effects of an information programme for patients with malignant melanoma. Patient Educ Couns. 1996;28 (2 ):201‐208. doi:10.1016/0738-3991(96)00894-4 8852095 48 Dieng M , Kasparian N , Mireskandari S , et al. Psychoeducational intervention for people at high risk of developing another melanoma: a pilot randomised controlled trial. BMJ Open. 2017;7 (10 ):e015195. doi:10.1136/bmjopen-2016-015195 49 Dieng M , Khanna N , Kasparian NA , et al. Cost‐effectiveness of a psycho‐educational intervention targeting fear of cancer recurrence in people treated for early‐stage melanoma. Appl Health Econ Health Policy. 2019;17 (5 ):669‐681. doi:10.1007/s40258-019-00483-6 31228015 50 Dieng M , Morton R , Costa D , et al. Benefits of a brief psychological intervention targeting fear of cancer recurrence in people at high risk of developing another melanoma: 12‐month follow‐up results of a randomized controlled trial. Br J Dermatol. 2020;182 (4 ):860‐868. doi:10.1111/bjd.17990 30965384 51 Kan JM , Dieng M , Butow PN , et al. Identifying the ‘active ingredients' of an effective psychological intervention to reduce fear of cancer recurrence: a process evaluation. Front Psychol. 2021;12 :e2058. doi:10.3389/fpsyg.2021.661190 52 Thompson JR , Smith AL , Lo SN , et al. Protocol for the implementation of a stepped‐care model to address fear of cancer recurrence in patients previously diagnosed with early‐stage (0–II) melanoma. BMJ Open. 2022;12 (3 ):e054337. doi:10.1136/bmjopen-2021-054337 53 Fawzy FI , Fawzy NW , Hyun CS , et al. Malignant melanoma: effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Arch Gen Psychiatry. 1993;50 (9 ):681‐689. doi:10.1001/archpsyc.1993.01820210015002 8357293 54 Fawzy FI , Fawzy NW . Malignant melanoma: effects of a brief, structured psychiatric intervention on survival and recurrence at 10‐year follow‐up. Arch Gen Psychiatry. 2003;60 (1 ):100‐103. doi:10.1001/archpsyc.60.1.100 12511177 55 Turrisi R , Hultgren B , Mallett KA , Martini M , Robinson JK . Comparison of efficacy of differing partner‐assisted skin examination interventions for melanoma patients: a randomized clinical trial. JAMA Dermatol. 2015;151 (9 ):945‐951. doi:10.1001/jamadermatol.2015.0690 26049533 56 Hultgren BA , Turrisi R , Mallett KA , Ackerman S , Robinson JK . Influence of quality of relationship between patient with melanoma and partner on partner‐assisted skin examination education: a randomized clinical trial. JAMA Dermatol. 2016;152 (2 ):184‐190. doi:10.1001/jamadermatol.2015.2819.26422745 57 Robinson JK , Wayne JD , Martini MC , Hultgren BA , Mallett KA , Turrisi R . Early detection of new melanomas by patients with melanoma and their partners using a structured skin self‐examination skills training intervention: a randomized clinical trial. JAMA Dermatol. 2016;152 (9 ):979‐985. doi:10.1001/jamadermatol.2016.1985 27367303 58 Lacey J , Lomax AJ , McNeil C , et al. A supportive care intervention for people with metastatic melanoma being treated with immunotherapy: a pilot study assessing feasibility, perceived benefit, and acceptability. Support Care Cancer. 2019;27 :1497‐1507. doi:10.1007/s00520-018-4524-3 30392112 59 Charles C , Bardet A , Ibrahimi N , et al. Delivering adapted physical activity by videoconference to patients with fatigue under immune checkpoint inhibitors: lessons learned from the PACTIMe‐FEAS feasibility study. J Telemed Telecare. 2021. doi:10.1177/1357633X211021743. Online ahead of print. 60 Roberts S , Black C , Todd K . The living with cancer education programme. II. Evaluation of an Australian education and support programme for cancer patients and their family and friends. Eur J Cancer Care. 2002;11 (4 ):280‐289. doi:10.1046/j.1365-2354.2002.00317.x 61 Hilfiker R , Meichtry A , Eicher M , et al. Exercise and other non‐pharmaceutical interventions for cancer‐related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect‐comparisons meta‐analysis. Br J Sports Med. 2018;52 (10 ):651‐658. doi:10.1136/bjsports-2016-096422 28501804 62 Popescu RA , Roila F , Arends J , Metro G , Lustberg M . Supportive care: low cost, high value. Am Soc Clin Oncol Educ Book. 2021;41 :240‐250. doi:10.1200/EDBK_320041 63 González‐Fernández S , Fernández‐Rodríguez C , Paz‐Caballero MD , Pérez‐Álvarez M . Treating anxiety and depression of cancer survivors: behavioral activation versus acceptance and commitment therapy. Psicothema. 2018;30 (1 ):14‐20. doi:10.7334/psicothema2017.396 29363465 64 Mathew A , Doorenbos AZ , Jang MK , Hershberger PE . Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model. J Cancer Surviv. 2021;15 (3 ):427‐451. doi:10.1007/s11764-020-00938-z 32949353 65 Kasparian NA , Bartula I . Melanoma. In: William B , Butow P , Jacobsen P , Lam W , Lazenby M , Loscalzo M eds. Psycho‐Oncology. 4th ed. Oxford University Press; 2021:155‐161. doi:10.1093/med/9780190097653.001.0001 66 Saw RPM , Bartula I , Winstanley JB , et al. Melanoma and quality of life. In: Kassianos AP , ed. Handbook of Quality of Life in Cancer. Springer; 2022:439‐439. 67 Harris R . ACT Made Simple: Aan Easy‐to‐Read Primer on Acceptance and Commitment Therapy. New Harbinger Publications; 2019. 68 Lindsay T . The Cancer Companion: How to Navigate your Way from Diagnosis to Treatment and Bbeyond. Exisle Publishing; 2021. 69 Thomas EE , Haydon HM , Mehrotra A , et al. Building on the momentum: sustaining telehealth beyond COVID‐19. J Telemed Telecare. 2022;28 (4 ):301‐308. doi:10.1177/1357633X20960638 32985380 70 Marthick M , McGregor D , Alison J , Cheema B , Dhillon H , Shaw T . Supportive care interventions for people with cancer assisted by digital technology: systematic review. J Med Internet Res. 2021;23 (10 ):e24722. doi:10.2196/24722 34714246 71 Adelson P , Eckert M . Skin cancer in regional, rural and remote Australia; opportunities for service improvement through technological advances and interdisciplinary care. Aust J Adv Nurs. 2020;37 (2 ):25‐30. doi:10.3316/informit.259892701735826 72 Licitra L , Keilholz U , Tahara M , et al. Evaluation of the benefit and use of multidisciplinary teams in the treatment of head and neck cancer. Oral Oncol. 2016;59 :73‐79. doi:10.1016/j.oraloncology.2016.06.002 27424185 73 Farrow NE , Turner MC , Salama AK , Beasley GM . Overall survival improved for contemporary patients with melanoma: a 2004–2015 national cancer database analysis. Oncol Ther. 2020;8 (2 ):261‐275. doi:10.1007/s40487-020-00117-1 32700043 74 Christofyllakis K , Pföhler C , Bewarder M , et al. Adjuvant therapy of high‐risk (stages IIC–IV) malignant melanoma in the post interferon‐alpha era: a systematic review and meta‐analysis. Front Oncol. 2021;10 :e637161. doi:10.3389/fonc.2020.637161 75 Wang T , Molassiotis A , Chung BPM , Tan J‐Y . Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17 (1 ):1‐29. doi:10.1186/s12904-018-0346-9 76 Treanor CJ . Psychosocial support interventions for cancer caregivers: reducing caregiver burden. Curr Opin Support Palliat Care. 2020;14 (3 ):247‐262. doi:10.1097/SPC.0000000000000508 32769618 77 Luo X , Gao L , Li J , Lin Y , Zhao J , Li Q . A critical literature review of dyadic web‐based interventions to support cancer patients and their caregivers, and directions for future research. Psychooncology. 2020;29 (1 ):38‐48. doi:10.1002/pon.5278 31702839 78 American Cancer Society . Types of Cancers That Develop in Young Adults . Accessed April 3, 2023. https://cancer.org/cancer/cancer‐in‐young‐adults 79 Australian Institute of Health and Welfare . Cancer in Adolescents and Young Adults in Australia . Accessed April 3, 2024. https://aihw.gov.au/reports/cancer/cancer‐adolescents‐young‐adults