Depression in Choroidal Melanoma Patients Treated with Proton Beam Radiotherapy.

AIM: To determine depression in patients with choroidal melanoma (CM) treated with proton beam radiotherapy. PATIENTS AND METHODS: This was a cross-sectional study including 50 patients with CM (50% males, mean age=49.88±6.34 years) and 46 age- and sex-matched healthy controls (52% males, mean age=48.60±8.05 years). Participants completed the Patient Health Questionnaire-9 (PHQ-9) and the Zung Self-Rating Depression Scale (SDS) questionnaires. RESULTS: There was a considerable difference in visual acuity as logarithm of the minimum angle of resolution (logMAR) between the patient and control groups (1.16±0.97 and 0.04±0.05 logMAR, respectively, p<0.0001). Both PHQ-9 and SDS scores differed significantly between the two groups (10.18±4.68 and 8.07±4.90, p=0.04; and 47.94±12.56 and 39.91±8.80, p=0.004, respectively). Scores appeared to be positively correlated with logMAR visual acuity (Spearman rho=0.700, p<0.0001 for PHQ-9; and 0.767, p<0.0001 for SDS), and they were also correlated to each other (Spearman rho=0.759, p<0.0001). CONCLUSION: Patients with CM having undergone proton beam therapy seem to be more depressed compared to a sample of healthy individuals, and the level of depression is correlated with their visual acuity.

Patient-reported Outcomes and Quality of Life After Treatment of Choroidal Melanoma: A Comparison of Enucleation Versus Radiotherapy in 1596 Patients.

PURPOSE: To test the hypothesis that patients treated with radiotherapy for choroidal melanoma enjoy better quality of life (QoL) than patients who have undergone enucleation. METHODS: In this nonrandomized study, patients with choroidal melanoma treated at the Royal Liverpool University Hospital, Liverpool, UK, were invited to complete QoL questionnaires approximately 6 months postoperatively and then on each anniversary of their primary treatment. These instruments consisted of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-OPT30 questionnaire, Hospital Anxiety & Depression Scale, and the Functional Assessment of Cancer Treatment questionnaire. Patient-reported outcomes were correlated with demographics, ocular treatment, social factors, presenting tumor and ocular status, self-reported general health, marital status, and employment status. RESULTS: The 1596 patients were treated with radiotherapy (72.3%) or enucleation (27.7%). Enucleation was associated with male sex (χ2, P = .004), older age (t test, P < .001), larger tumor diameter (t test, P < .001), monosomy 3 (χ2, P < .001), depression (linear regression, 95% confidence interval [CI], .17 to 1.01), and reduced physical and functional well-being (linear regression, 95% CI, -1.14 to -0.12 and -1.96 to -0.47), respectively. Poor QoL was attributed to the ocular disease by 21% and 20% of enucleated and irradiated patients, respectively (χ2, P = .938). CONCLUSIONS: Patient-reported outcomes and QoL were worse in patients who had undergone primary enucleation for choroidal melanoma. These outcomes may partly have been caused by factors predisposing to enucleation rather than enucleation itself, because enucleated patients tended to be older, with more advanced disease at presentation, and a worse prognosis for survival. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Quality of life and cancer-related needs in patients with choroidal melanoma.

AIMS: To assess quality of life (QoL) indices and their associations with treatment modality, sociodemographics and cancer-related needs in choroidal melanoma patients. METHODS: Patients (N=99) treated at the University of California, Los Angeles, for choroidal melanoma within the prior 5 years (M=2.05) completed questionnaires assessing demographics, cancer-related needs, vision-specific QoL, depressive symptoms and concern about recurrence. Visual acuity, comorbidities, treatment modality (radiotherapy, enucleation) and years since diagnosis were gathered from medical records. Primary analyses were multiple regressions. RESULTS: Although concern about cancer recurrence was elevated, QoL was better than in other oncology samples and comparable with healthy samples on some outcomes. Enucleation was associated with worse vision-specific QoL, and presence of comorbid diseases was associated with worse vision-specific QoL, depressive symptoms and concern about cancer recurring (all p values<0.05). Patients who experienced at least one stressful life event in the past year (vs no events) reported more depressive symptoms (p<0.01). Report of more unmet cancer needs was associated with worse vision-specific QoL, depressive symptoms and more concern about recurrence (all p values<0.05), uniquely explaining 4%-12% of the variance. CONCLUSIONS: For choroidal melanoma patients, an average of 2 years after treatment, the number of physical comorbidities and unmet cancer needs were the strongest correlates of poorer QoL.

[Quality of life and psychological state in patients with choroidal melanoma: longitudinal study]. / Qualité de vie et état psychologique de patients atteints d'un mélanome de la choroïde : étude longitudinale.

UNLABELLED: Treatments for choroidal melanoma (CM) generate largely unknown consequences on the level of the quality of life (QoL) and psychological state. Prospective published work is relatively rare and their results are not consistent. The objective of this study is to describe the QoL and psychological state's evolution in patients treated by conservative treatment for CM. POPULATION: Sixty-nine patients treated for CM by conservative treatment (proton beam irradiation or iodine plaques). QoL (EORTC-QLQ-C30 + QLQ-OPT-30), anxiety and depression (HADS, STAI-B-trait). DATA COLLECTION: Prospective study comprising four evaluations T0: before the beginning of the treatment, T1: one month, T2: six month, T3: one year after the treatment. The preliminary results of the first two evaluations showed that the level of the QoL remained relatively good and stable with an exception for the social functioning, which decreased after the treatment. More than half of the patients had a moderated rate of anxiety before the beginning of the treatment, which decreased significantly a month later. The depressive symptoms were lower and remained stable one month after the treatment. These results confirmed the importance of exploration and screening the fear of cancer recurrence among choroidal melanoma patients.

The impact of diagnosis and plaque radiotherapy treatment of malignant choroidal melanoma on patients' quality of life.

Quality of life (QOL) has become an important outcome criterion of medical interventions, but the impact of diagnosis and radiotherapy on QOL in patients with malignant choroidal melanoma (MCM) has rarely been studied. Inventories covering global (SF-36) and disease-specific QOL (NEI-VFQ), mental distress (SCL-90-R), and social support (K-22, German) were applied to a consecutive sample of MCM-patients scheduled for plaque radiotherapy. Data were gathered preoperatively (t(0)) and 3 months postoperatively (t(1), except for the K-22, which was applied at t(0) only). Fifty-four patients took part in both surveys, the number of patients with visual impairment increased from 21 preoperatively to 34 postoperatively. Global QOL of MCM-patients was significantly reduced compared to the healthy norm and other ophthalmological patients both at t(0) and t(1). Clinically relevant distress was present in every second patient at t(0) and every third patient at t(1), social support was not impaired. Global and disease-specific QOL declined significantly from t(1) to t(0). The MCM diagnosis compromises QOL, which is additionally impaired by radiotherapy. Regular QOL assessment can help to identify patients at risk, facilitate provision of psychosocial treatment and may thus improve patient satisfaction.

Development and validation of disease-specific measures for choroidal melanoma: COMS-QOLS report No. 2.

OBJECTIVE: To develop and validate scales measuring common concerns of patients with choroidal melanoma: perception of appearance, concern about cancer recurrence, and difficulty with vision-dependent activities requiring stereopsis or binocularity. DESIGN: Cross-sectional study within a randomized multicenter clinical trial. METHODS: Eight-hundred forty-two of 1317 patients with choroidal melanoma enrolled in the Collaborative Ocular Melanoma Study (COMS) for medium-sized tumors and randomized to receive iodine 125 brachytherapy or enucleation were interviewed. Scale reliability was evaluated using Cronbach's alpha, and validity was investigated through correlation with existing scales and with data collected during COMS clinical examinations. RESULTS: All 3 proposed scales had good internal consistency reliability. The appearance and recurrence scales had low to moderate correlation with the 36-Item Short-Form Health Survey mental health scale (r = 0.26 and 0.31, respectively) and with the the Hospital Anxiety and Depression Scale depression (r = -0.22 and -0.19) and anxiety (r = -0.27 and -0.42) scales. Appearance scores were significantly associated with occurrence of appearance-altering complications and conditions, recurrence scores were associated with recent removal of the brachytherapy-treated eye, and stereopsis/binocularity scores were higher in patients with good visual acuity in both eyes than in those with good visual acuity in one eye and an enucleated fellow eye. CONCLUSIONS: All 3 proposed scales have good internal consistency, range, and SDs of measurement in the tested population. Based on clinical data, there is evidence of good construct validity for all 3 scales, although there also is evidence that the stereopsis/binocularity scale is sensitive to other aspects of vision in addition to stereopsis and binocularity. The appearance and recurrence scales capture clinically relevant information not available from standard mental health scales.

Quality of life in patients with malignant choroidal melanoma after radiotherapy.

BACKGROUND: Patient-orientated endpoints have attracted little attention in patients with malignant choroidal melanoma. This study was conducted to explore the long-term effects of malignant choroidal melanoma and radiotherapy on QOL by means of a differentiated and modular QOL approach, including global QOL, social support, and mental health, in comparison with sociodemographically matched healthy controls. METHODS: A random sample of 100 outpatients treated by radiotherapy were asked by mail to take part in a psychodiagnostic study [instruments: Short-Form 36 Health-Survey (SF-36), Symptom Checklist-90-Revised, German Social Support Questionnaire]. The same instruments were applied to a healthy control group, which was matched to patients with regard to age, gender, and vocational situation. RESULTS: 93 patients (average age 61.2 years) responded at an average of 5.5 years (+/-3.7) after diagnosis. Visual acuity in the affected eye decreased considerably from diagnosis (0.49+/-0.30) to participation in the study (0.09+/-0.21). Compared with healthy controls, patients reported on average statistically significantly lower global QOL (SF-36), whereas social support and mental distress did not differ. Frequencies of clinically relevant mental distress were significantly higher in patients than in controls (35.5% vs. 16.1%). Mental distress was associated with poorer visual acuity, but not with the extent of loss of visual acuity or number of follow-up treatments. CONCLUSION: Patients with choroidal melanoma suffer from low long-term global QOL, and every third patient suffers from relevant mental distress. Regular screening for mental distress should be implemented along with psychological counseling. Additional follow-up treatment does not seem to induce mental distress.

Quality of life assessment in the collaborative ocular melanoma study: design and methods. COMS-QOLS Report No. 1. COMS Quality of Life Study Group.

The Collaborative Ocular Melanoma Study (COMS) is a set of randomized clinical trials sponsored by the National Eye Institute of the National Institutes of Health. The COMS is being conducted to evaluate the role of radiotherapy in the treatment of patients with choroidal melanoma. Primary choroidal melanoma can enlarge or metastasize and eventually cause death in a significant percentage of cases. The primary COMS trial is designed to determine whether enucleation (removal of the eye) or radiotherapy without removal of the eye provides the patient with the longest remaining lifespan. More than 40 clinical centers in the United States and Canada are participating in the COMS. The objective of the COMS is to assess the effect of treatment upon 5-year and 10-year survival and the reduction or elimination of the disease process in patients randomly assigned to receive either radiation or enucleation. An ancillary component of the COMS, referred to as the COMS-QOLS, was designed to measure the impact of disease and its treatment on quality of life. The two treatment approaches being investigated, enucleation and radiation therapy, are likely to have different psychological and physiological effects on the patients receiving them. The COMS-QOLS assessments include the SF-36 Health Survey, the Activities of Daily Vision Scale (ADVS), the Visual Functioning Questionnaire (VFQ), and the Hospital Anxiety and Depression Scale (HADS). Patients are interviewed at selected intervals during follow-up; in addition, 200 patients will be interviewed before randomization and have repeat interviews at six months and annually after randomization. The patient's quality of life after treatment will become an important consideration in determining the best form of therapy, particularly in the event that no survival difference between treatment groups is found.

Quality of life in patients with choroidal melanoma: a pilot study.

PURPOSE: To assess the internal consistency of a short, widely-used health-related quality of life instrument in patients with choroidal melanoma, its appropriateness for use in a large clinical trial in patients with that disease, and the feasibility of various methods of instrument administration. METHODS: The SF-36 was administered to 31 choroidal melanoma patients identified from two ocular oncology practices. Fifteen patients were interviewed by telephone, 4 were interviewed in person at the clinic, and 12 patients completed the instrument themselves while at the clinic. RESULTS: Twenty-three patients had already been treated for choroidal melanoma; 20 patients were treated with some form of radiation. The remaining 8 patients had not yet been treated. Metastasis had not been diagnosed in any of the patients. Patient age ranged from 37 to 85 years with a median of 59 years; 55% of the patients were female. The in-person and telephone interviews performed better than self-administered interviews in terms of missing items due to non-response (0% vs. 3.2%). The overall SF-36 health profile for the choroidal melanoma patients was similar in shape to that expected for a general U.S. population sample with the same age and gender distribution, although the choroidal melanoma patients averaged 4 to 11 points higher, indicating better health-related quality of life, for all scales except the role functioning-emotional scale. CONCLUSIONS: The results supported the internal consistency of the SF-36 in this population. Interviewer administration of the SF-36 either in-person or by telephone was acceptable to the patients and provided more complete data.

Human responses to the diagnosis of choroidal melanoma.

Patient responses to the diagnosis of choroidal melanoma are individual and sometimes unexpected. Nurses are in a perfect position to ascertain a cancer patient's feelings, to listen, and to provide emotional support. Patient reactions to the diagnosis of choroidal melanoma can range from fear of blindness to concern for their children.

Teaching aids for patients diagnosed with choroidal melanoma.

Patients who are diagnosed with choroidal melanoma are frequently devastated and overwhelmed. Simple and creative teaching aids including photographs, visual fields, eye models with clay tumors, actual prostheses, business cards, post-operative teaching sheets, and an example of a support book are discussed as methods to assist in patient teaching.