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

Abstract

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.

Depression and anxiety in patients with uveal melanoma undergoing curative proton treatment—A prospective study

“…Most of those patients were treated with proton beam therapy. In addition, in a preliminary study, we reported declines in fear of recurrence immediately and 3 months after proton beam therapy, compared to pre‐therapeutic assessments 23 . Apparently, for most patients, anxiety promptly and significantly recedes after completing a primary treatment, and it continues to decline over time 13 …”

“…In addition, in a preliminary study, we reported declines in fear of recurrence immediately and 3 months after proton beam therapy, compared to pretherapeutic assessments. 23 Apparently, for most patients, anxiety promptly and significantly recedes after completing a primary treatment, and it continues to decline over time. 13 However, previous studies reported persistently high anxiety over the long term, after primary treatment, in a particular sub-cohort of patients.…”

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

“…In contrast, previous studies consistently reported improvements in anxiety issues for patients with uveal melanoma within the 1st 2 years after a primary treatment, compared to pretreatment assessments [19, 21, 22]. However, another study found that anxiety receded, to a large extent, immediately after PT and remained relatively stable thereafter [23].…”

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 ].…”

“…Multivariate analyses showed independent prediction by 6-month depression and decreasing QOL over 6–12 months and 12–24 months. Gollrad et al (2021) [ 46 ] Surgery + Radiotherapy ( n = 131) a) 131 b) 66/65 a) QOL, anxiety b) EORTC QLQ-C30, QLQ-OPT30, GAD-7 Before clip-surgery, between clip-surgery and proton therapy, after proton therapy, and three months after treatment Yes at short-term, no at long-term Global QOL was similar to that in Germany before treatment, and returned to baseline levels three months after treatment. Compared with clip-surgery and three months after treatment, there was no change, but three months after treatment had more eye-specific symptoms than clip-surgery ( P < 0.001).…”