Quality of Life, Anxiety, and Depression in Patients With Early-Stage Mycosis Fungoides and the Effect of Oral Psoralen Plus UV-A (PUVA) Photochemotherapy on it.

Thomas Graier,Regina Fink-Puches,Pablo Augusto Vieyra-Garcia,Paul-Gunther Sator,Sylvia Selhofer,Adrian Tanew,Gudrun Ratzinger,Stephanie Porkert,Peter Wolf,Sophie Pöchlauer,Roland Lang,Franz J Legat,Franz Quehenberger,Angelika Hofer,Alexandra Gruber-Wackernagel

doi:10.3389/fmed.2020.00330

Abstract

Background: Little is known about psychological discomfort and quality of life (QoL) in early stage mycosis fungoides (MF) and the effect of psoralen plus UV-A (PUVA) on it.Objective: To evaluate QoL, anxiety, and depression with validated instruments in early stage MF patients and whether PUVA treatment improves it.Methods: Patients with stage IA to IIA MF were treated with PUVA twice weekly for 12–24 weeks, followed by maintenance treatment or not, in a prospective randomized clinical trial. Patients completed a questionnaire on DLQI as well as the Hospital Anxiety and Depression Scale (HADS) prior to therapy, after their last PUVA exposure, and after the PUVA maintenance or observance phase.Results: For 24 patients with early stage MF, completed questionnaires were available and analyzed. Prior to treatment, 17% reported strong (DLQI > 10) and 29% moderate impairment (DLQI 6–10) in QoL; 33% of patients reported HADS scores indicating anxiety, and 21% reported scores indicating depression. PUVA significantly improved overall QoL by reducing mean DLQI scores by 58.6% (p = 0.003), HADS-A by 30% (p = 0.045), and HADS-D by 44% (p = 0.002). Improvements in QoL and psychological well-being seemed to be sustained, irrespective of maintenance treatment or not.Limitations: Small sample size.Conclusions: PUVA sustainably improves QoL and psychological well-being in patients with early stage MF.Clinical trial registration: ClinicalTrials.gov identifier: NCT01686594.

Highlights

Studies show that mycosis fungoides (MF) leads to impaired quality of life (QoL) [1,2,3] and a higher risk for depression and anxiety in affected patients [2, 4]
plus UV-A (PUVA) significantly improved overall QoL by reducing mean Dermatology Life Quality Index (DLQI) scores by 58.6% (p = 0.003), Hospital Anxiety and Depression Scale (HADS)-A by 30% (p = 0.045), and HADS-D by 44% (p = 0.002)
While recent work from the Prospective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) study has enlightened the impact of MF on health-related Qol [2], anxiety and depression have been hardly assessed in clinical trials and, if so, most often using questionnaires not specific and not validated for these conditions

Summary

Introduction

Studies show that MF leads to impaired quality of life (QoL) [1,2,3] and a higher risk for depression and anxiety in affected patients [2, 4]. This accounts especially for late-stage MF [2, 5], alopecia within MF lesions, and female gender as a recent study suggests by observing a significantly worse health-related QoL in these patients [2]. Interest in the potential beneficial effect of therapeutic strategies on patients’ QoL increases [11,12,13], but the effect on psychological comfort remains unknown This accounts especially for early stage MF and treatment with phototherapy. Little is known about psychological discomfort and quality of life (QoL) in early stage mycosis fungoides (MF) and the effect of psoralen plus UV-A (PUVA) on it

Methods

Results

Conclusion