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

Abstract

Introduction Proton beam therapy is an established primary treatment for patients with non-metastasized 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 and QLQ-OPT30 questionnaires at baseline, and at three and twelve months after proton therapy. Patients were grouped by the type of adjuvant treatment. Impact on QOL was analyzed by comparing changes in 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 three and twelve 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 Post-treatment adjuvant interventions had no long-lasting effects on QOL in patients with uveal melanoma.

Quality of life among people with eye cancer: a systematic review from 2012 to 2022

“…Most of the included studies (15), investigated UM [ 5 , 17 , 28 , 30 , 37 , 40 – 48 ] with three studies on RB [ 16 , 33 , 49 ]. Among the included articles, one [ 49 ] study was carried out in a low- or middle-income country (China) and 16 studies were conducted in high-income countries: the US (9) [ 16 , 17 , 28 , 30 , 33 , 40 – 42 , 47 ], Germany (4) [ 37 , 43 , 46 , 48 ], Ireland (1) [ 5 ], Israel (1) [ 44 ], and the Netherlands (1) [ 45 ]. In relation to study design, there are ten cohort studies [ 28 , 30 , 33 , 37 , 40 , 41 , 44 – 46 , 48 ], five cross-sectional studies [ 5 , 16 , 17 , 47 , 49 ], and two longitudinal studies [ 42 , 43 ].…”

“…Among the included articles, one [ 49 ] study was carried out in a low- or middle-income country (China) and 16 studies were conducted in high-income countries: the US (9) [ 16 , 17 , 28 , 30 , 33 , 40 – 42 , 47 ], Germany (4) [ 37 , 43 , 46 , 48 ], Ireland (1) [ 5 ], Israel (1) [ 44 ], and the Netherlands (1) [ 45 ]. In relation to study design, there are ten cohort studies [ 28 , 30 , 33 , 37 , 40 , 41 , 44 – 46 , 48 ], five cross-sectional studies [ 5 , 16 , 17 , 47 , 49 ], and two longitudinal studies [ 42 , 43 ]. The characteristics of the included studies are summarised in Table 2 .…”

“…Six studies showed that the overall QOL scores of patients with UM or RB were higher than or similar to those of the healthy general population [ 5 , 16 , 17 , 40 , 42 , 49 ]. However, 11 studies indicated that these patients had a poorer QOL than the healthy general population [ 28 , 30 , 33 , 37 , 41 , 43 – 48 ]. Three studies investigated QOL in patients with RB [ 16 , 33 , 49 ], two of which concluded that the overall QOL was better than that in non-cancer controls [ 16 , 49 ], and one concluded that QOL was affected by vision-targeted HRQOL in some aspects; for example, subdomains of visual function such as peripheral vision, especially in bilateral survivors of disease ( P < 0.001) or with enucleation ( P = 0.002) [ 33 ].…”

“…Three studies investigated QOL in patients with RB [ 16 , 33 , 49 ], two of which concluded that the overall QOL was better than that in non-cancer controls [ 16 , 49 ], and one concluded that QOL was affected by vision-targeted HRQOL in some aspects; for example, subdomains of visual function such as peripheral vision, especially in bilateral survivors of disease ( P < 0.001) or with enucleation ( P = 0.002) [ 33 ]. There were 14 articles investigating the overall QOL of UM patients, 4 out of 14 reported that there is no difference between QOL of these patients and the general population [ 5 , 17 , 40 , 42 ], 6 out of 14 reported that the QOL was affected and decreased [ 30 , 37 , 41 , 43 , 44 , 47 ], and 4 out of 14 indicated that the QOL decreased first and then there was no difference with time [ 28 , 45 , 46 , 48 ]. Six articles [ 28 , 37 , 40 , 45 , 46 , 48 ] noted poorer QOL at the start of treatment but at the 3 [ 46 ], 6 [ 28 , 40 ],12 [ 28 , 40 , 48 ], 24 [ 28 , 40 ], 36 [ 37 ] and 48 months [ 45 ] follow-ups, there were no differences when compared to the general healthy population.…”

“…After treatment completion, global QOL improved gradually, and none of the eye-related symptoms significantly deteriorated over the course of proton therapy. Gollrad et al (2022) [ 48 ] PBT ( n = 108), observation ( n = 61), intravitreal injections ( n = 17), intraocular surgical procedure ( n = 30). a) 108 b) 52/56 a) QOL b) EORTC QLQ-C30, QLQ-OPT30 At baseline, and at 3 and 12 months Yes at short-term, no at long-term All have a stable global health scores in the short term.…”