Stress factors and changes in quality of life in the context of proton therapy for uveal melanoma

Einleitung: Das uveale Melanom ist der häufigste primär intraokuläre Tumor bei Erwachsenen. Zur Therapie des uvealen Melanoms ist die Protonentherapie als ein Verfahren der Strahlentherapie seit Jahren etabliert. Diese beinhaltet zwei wesentliche Therapieschritte: Zunächst werden in einer vorbereitenden Operation vier Tantal-Clips auf der Sklera des Auges platziert bevor in einem zweiten Schritt die eigentliche Bestrahlung durchgeführt werden kann. Die vorliegende Arbeit untersucht erstmalig detailliert die therapieassoziierten Auswirkungen dieser Behandlung auf die Lebensqualität und die psychische Belastung von Patienten mit einem uvealen Melanom. Methoden: Für die prospektive Studie wurden 131 Patienten mit einem uvealen Melanom rekrutiert und zu verschiedenen Zeitpunkten der Protonentherapie befragt: Prätherapeutisch (T0), vor der Protonentherapie/nach der Clip-Operation (T1), unmittelbar nach Abschluss der Protonentherapie (T2) und drei Monate nach der Protonentherapie (T3). Die Datenerhebung erfolgte mit dem EORTC QLQ-C30, dem EORTC QLQ-OPT30, dem Generalized Anxiety Disorder 7 (GAD-7) sowie einem für die vorliegende Arbeit entworfenen Fragebogen zur Erfragung der psychischen Belastung. Des Weiteren wurden soziodemographische Daten der Patienten erfasst. Ergebnisse: Nach Durchführung der Clip-Operation (T1) konnte eine signifikante Abnahme der Lebens-qualität sowie eine signifikante Abnahme der „Körperlichen Funktion“, der „Rollenfunktion“, der „Kognitiven Funktion“ und der „Sozialen Funktion“ im Vergleich zur prätherapeutischen Befragung (T0) beobachtet werden. Die Lebensqualität der Patienten zeigte im weiteren Therapieverlauf eine stetige Zunahme und entsprach drei Monate nach Abschluss der Therapie (T3) dem prätherapeutischen Niveau (T0). Angstsymptome und die emotionale Belastung waren peritherapeutisch für die untersuchten Patienten von hoher Relevanz. Hierbei konnte im Therapieverlauf eine signifikante Abnahme der „Rezidivangst“ und der „Psychischen Gesamtbelastung“ sowie eine Zunahme der „Emotionalen Funktion“ beobachtet werden. Einen besonders hohen Grad der Belastung wiesen hierbei Frauen und jüngere Patienten auf. Schlussfolgerungen: Im Rahmen einer Protonentherapie ist die Clip-Operation ein wesentlicher Belastungsfaktor für die Patienten. Alternative, nicht-invasive Positionierungsverfahren könnten somit die Lebens-qualität von Patienten mit einem uvealen Melanom bei Durchführung einer Protonentherapie verbessern. Über den Gesamtverlauf der Behandlung stellte sich insgesamt nur eine geringe Beeinträchtigung der Lebensqualität dar. Die ausgeprägte peritherapeutische emotionale Belastung weist jedoch auf den erhöhten Bedarf einer individualisierten psychoonkologischen Betreuung unter Berücksichtigung unterschiedlicher Risikogruppen hin.Introduction: Uveal melanoma is the most common primary intraocular tumor in adults. Proton beam therapy has been established for the treatment of uveal melanoma for many years. The procedure consists of two major steps: First, four tantalum clips are placed on the sclera of the eye in a preparatory surgery before the actual irradiation can be performed in a second step. The present study is the first to investigate in detail the therapy-associated effects of this treatment on quality of life and psychological distress of patients with uveal melanoma. Methods: For this prospective study, 131 patients with uveal melanoma were recruited and interviewed at different points of time during proton therapy: prior to treatment (T0), before proton beam radiation / post clip surgery (T1), immediately after completion of proton beam radiation (T2) and three months after proton beam radiation (T3). Data collection was performed using the EORTC QLQ-C30, the EORTC QLQ-OPT30, the Generalized Anxiety Disorder 7 (GAD-7) as well as a questionnaire designed for this study to assess psychological distress. Furthermore, sociodemographic data of the patients were recorded. Results: After clip surgery (T1), a significant decrease in quality of life as well as a significant decline in "physical function", "role function", "cognitive function" and "social function" could be observed compared to the pre-treatment assessment (T0). In the further course of therapy, the patients' quality of life showed a steady improvement and was equal to the pre-therapeutic quality of life (T0) three months after completion of proton beam radiation (T3). Anxiety symptoms and emotional distress were of high relevance to patients of the present study. During treatment, a significant decrease in "fear of recurrence" and "overall psychological distress" as well as an increase in "emotional function" could be observed. In this context, women and younger patients proved to be particularly burdened. Conclusions: In the course of proton therapy, clip surgery is a major stress factor for patients. Alternative, non-invasive positioning procedures could therefore improve the quality of life in patients with uveal melanoma undergoing proton therapy. Overall, there was only a slight impairment of quality of life during the entire course of treatment. However, the substantial peritherapeutic emotional distress indicates the need for intensified individualized psycho-oncological care with consideration of different risk groups

Impact of Adjuvant Ocular Interventions on the Quality of Life of Patients with Uveal Melanoma after Proton Beam Therapy

Introduction: Proton beam therapy is an established primary treatment for patients with nonmetastasized uveal melanoma. Adjuvant local interventions, like intravitreal injections or surgery, were shown to improve long-term eye preservation; however, their impact on the patient's quality of life (QOL) remains unknown. Methods: In a post-radiotherapeutic follow-up, we prospectively collected data on QOL, visual acuity, and interventional adjuvant procedures. QOL was measured with QOL-C30 questionnaire and quality of life questionnaire OPT30 at baseline, and at 3 and 12 months after proton therapy. Patients were grouped by the type of adjuvant treatment. The impact on QOL was analyzed by comparing changes in the mean score values and visual acuity for different interventional subgroups, with generalized linear mixed models and Wilcoxon signed-rank tests. Results: We received 108 (100%) and 95 (88.0%) questionnaires at 3 and 12 months post-therapy, respectively. Adjuvant interventions included observation (n = 61, 56.5%), intravitreal injections (n = 17, 15.7%), and an intraocular surgical procedure (n = 30, 27.8%). In the latter group, several QOL items significantly declined after the 3-month adjuvant interval, but they partially recovered at the 12-month follow-up. In all adjuvant-intervention groups, global QOL scores returned to baseline levels at 12 months. Conclusion: Posttreatment adjuvant interventions had no long-lasting effects on QOL in patients with uveal melanoma

Quality of life and treatment-related burden during ocular proton therapy: a prospective trial of 131 patients with uveal melanoma

Background: Proton beam therapy is a well-established treatment option for patients with uveal melanoma (UM). The treatment procedure, in general, includes placing radiopaque clips to ensure exact eye-positioning during radiotherapy, followed by the delivery of proton irradiation. The short-term burden associated with proton therapy in patients with UM has rarely been addressed. In this prospective study, we investigated the physiological and psychological aspects of proton therapy that might affect the well-being of patients during the different stages of treatment. Methods: During the treatment procedure, we conducted longitudinal assessments of the Quality of life (QOL), organ-specific symptoms, and psychological aspects in patients with UM with three questionnaires (EORTC QLQ-C30, EORTC QLQ-OPT30, and GAD-7). Patients completed questionnaires before clip surgery (T0), before proton therapy (T1), after completing treatment (T2), and three months after treatment completion (T3). We also collected data on tumor characteristics and socio-demographics to identify potential risk factors associated with high treatment burdens. Results: We prospectively included 131 consecutive patients. Questionnaire data showed a significant, temporary decline in global QOL and an increase in eye-related symptoms, as a result of the clip surgery (T0-T1). After treatment completion (T2), global QOL improved gradually, and none of the eye-related symptoms significantly deteriorated over the course of proton therapy. The global QOL returned to baseline levels three months after treatment (T3). We identified baseline anxiety as an independent risk factor for experiencing an acute treatment-related burden. Furthermore, we found interactions between GAD7 and patient sex showing that anxiety had a more pronounced effect on QOL outcome in female patients. Conclusion: The short-term treatment-related burden of ocular proton therapy appeared to be largely associated with the preceding clip surgery, rather than the irradiation procedure. We found that anxiety was strongly associated with experiencing QOL issues during the treatment procedure. Our findings could contribute to the development of future strategies for improving the treatment process and psycho-oncologic patient care