The association between partner bereavement and melanoma: cohort studies in the U.K. and Denmark

Abstract

Background Psychological stress is commonly cited as a risk factor for melanoma, but clinical evidence is limited. Objectives This study aimed to evaluate the association between partner bereavement and (i) first-time melanoma diagnosis and (ii) mortality in patients with melanoma. Methods We conducted two cohort studies using data from the U.K. Clinical Practice Research Datalink (1997-2017) and Danish nationwide registries (1997-2016). In study 1, we compared the risk of first melanoma diagnosis in bereaved vs. matched nonbereaved people using stratified Cox regression. In study 2 we estimated hazard ratios (HRs) for death from melanoma in bereaved compared with nonbereaved individuals with melanoma using Cox regression. We estimated HRs separately for the U.K. and for Denmark, and then pooled the data to perform a random-effects meta-analysis. Results In study 1, the pooled adjusted HR for the association between partner bereavement and melanoma diagnosis was 0Á88 [95% confidence interval (CI) 0Á84-0Á92] across the entire follow-up period. In study 2, we observed increased melanoma-specific mortality in people experiencing partner bereavement across the entire follow-up period (HR 1Á17, 95% CI 1Á06-1Á30), with the peak occurring during the first year of follow-up (HR 1Á31, 95% CI 1Á07-1Á60). Conclusions We found decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement. These findings may be partly explained by delayed detection resulting from the loss of a partner who could notice skin changes. Stress may play a role in melanoma progression. Our findings indicate the need for a low threshold for skin examination in individuals whose partners have died. What is already known about this topic? • Psychological stress has been proposed as a risk factor for the development and progression of cancer, including melanoma, but evidence is conflicting. • Clinical evidence is limited by small sample sizes, potential recall bias associated with self-report, and heterogeneous stress definitions. What does this study add? • We found a decreased risk of melanoma diagnosis, but increased mortality associated with partner bereavement.

Partner bereavement and risk of chronic urticaria, alopecia areata and vitiligo: cohort studies in the UK and Denmark

“…Psychological stress has been proposed to be associated with skin diseases, but the epidemiological evidence is limited . We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma . In this study, we further investigated whether partner bereavement was associated with urticaria, alopecia areata or vitiligo.…”

“…Clinical enthesitis, defined as pain elicited by local pressure at the enthesis, was assessed bilaterally at eight entheseal points (total 16 sites) according to the Spondyloarthritis Research Consortium of Canada (SPARCC) criteria. 3 Ultrasound examination was performed according to the Madrid Sonographic Enthesitis Index at six bilateral entheses and…”

“…1,2 We have recently reported the associations between partner bereavement (an extreme life stressor) and psoriasis, atopic eczema and melanoma. 3,4 In this study, we further investigated whether partner bereavement was associated with urticaria, alopecia areata or vitiligo. We conducted two cohort studies using data from the UK (1997-2017) and Denmark (1997-2016).…”

Stress and melanoma. Myth or reality?

“…In the current issue of the BJD, Polesie et al 5 used national healthcare data from Sweden to assess the putative association between CMM and prior exposure to MTX in patients with psoriasis. The study included 395 patients with psoriasis with first-time CMM, compared with 3950 patients with psoriasis without CMM.…”

Skin check partner assistance for melanoma skin self-examination by at-risk patients: it takes two to identify melanomas

“…In this case, for example, the concerning mole of the scalp was biopsied and was a stage IA melanoma. Further support for the role of the partner came from a study showing that there was increased melanoma mortality among bereaved melanoma survivors, whose partners died [20]. This may be partly explained by delayed detection resulting from the loss of a partner who checks difficult to see areas of the body.…”