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

Johannes Gollrad,Ute Goerling,Aline-Isabel Riechardt,Volker Budach,Dirk Boehmer,Antonia Joussen,Christopher Rabsahl,Jens Heufelder,Andrea Stroux

doi:10.1186/s13014-021-01902-6

Johannes Gollrad, Ute Goerling + Show 7 more

Open Access

https://doi.org/10.1186/s13014-021-01902-6

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Abstract

BackgroundProton 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.MethodsDuring 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.ResultsWe 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.ConclusionThe 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.

Highlights

Uveal melanoma (UM) is a rare disease, with a maximum incidence of 8 per million in Europe, but it represents the most common primary cancer of the eye [1].Gollrad et al Radiat Oncol (2021) 16:174For decades, proton beam therapy has been widely used as the primary treatment for non-metastasized uveal melanoma (UM)
After treatment completion (T2), global quality of life (QOL) improved gradually, and none of the eye-related symptoms significantly deteriorated over the course of proton therapy
Further‐ more, we found interactions between general anxiety disorder 7 questionnaire (GAD7) and patient sex showing that anxiety had a more pronounced effect on QOL outcome in female patients

Summary

Introduction

Proton beam therapy has been widely used as the primary treatment for non-metastasized UM. This treatment is highly effective in terms of local control and long-term globe preservation [2, 3]. Proton beam therapy is a well-established treatment option for patients with uveal melanoma (UM). The short-term burden associated with proton therapy in patients with UM has rarely been addressed. In this prospec‐ tive study, we investigated the physiological and psychological aspects of proton therapy that might affect the wellbeing of patients during the different stages of treatment

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Conclusion