Seven-year distress trajectories in uveal melanoma survivors.

Abstract

Objective: Severe or persistent distress is associated with poorer quality of life in cancer survivors. Distress follows distinct trajectories within different population subgroups. Identifying characteristics and causes of trajectories can assist intervention development and targeting. In a 7-year study of uveal melanoma survivors, we aimed to characterize anxiety, depression, and fear of cancer recurrence (FCR) trajectories, and identify whether concerns about symptoms and functional problems over the first 3 years of survivorship predict memberships of high distress trajectories. Method: In a closed cohort study, we used growth mixture modeling (GMM) to identify statistically optimal trajectories over 6-, 12-, 24-, 36-, 48-, 60-, 72-, and 84-month time point posttreatment in 475 patients. We then regressed trajectory memberships onto a 3-year series of measures of concerns about symptoms and functional problems, controlling demographic, clinical, and 6-month anxiety, depression, or FCR indicators. Results: Anxiety, depression, and FCR were represented by two-class linear GMMs. The majority scored consistently low, but 17.5% showed consistently elevated anxiety, 10.9% consistently elevated depression, and 19.4% consistently elevated FCR. Higher anxiety trajectory membership was predicted by greater concerns about symptoms at 6 and 24 months, higher depression trajectory membership by symptoms at 24 months, and higher FCR trajectory membership by symptoms at 6 and 24 months and functional problems at 12 months. Conclusions: Much of the burden of persistent distress in cancer patients falls on a small proportion of survivors. Concerns about symptoms and functional problems are potential risk factors for distress.

Psychosocial impacts of being nil‐by‐mouth as an adult: A scoping review

“…Adjustment to being NBM is a process for both the patient and their family members as levels of distress associated with long-term conditions may change over time (Brown et al, 2023). The reference to 'bereavement' by Walker (2005) It seems likely that psychosocial impacts associated with being NBM also have trajectories which change over time.…”

“…underdefined and under researched. A broader investigation into other psychological and social impact would provide a more balanced and in depth understanding of the short and long-term psychological impacts of being NBM(Brown et al, 2023;Hughes et al, 2021).Current outcome measures may not capture or measure the complex psychosocial impact of being NBM by patients and their caregivers. Development of a robust outcome measure tailored to this population would enable both better understanding of the psychosocial impacts of being NBM non-ephemerally, in both the short term and long term, as well as evaluating the effectiveness of interventions to relieve psychosocial distress.Several recommendations for future research have been identified to address gaps in the current evidence base.…”