The national comprehensive cancer network distress thermometer as a screening tool for the evaluation of quality of life in uveal melanoma patients.

Annemarie Klingenstein,Siegfried G Priglinger,Paul I Foerster,Christina Miller,Raffael G Liegl,Aylin Garip‐Kuebler,Christina Samel

doi:10.1111/aos.14277

Abstract

To assess quality of life (QoL) status via the National Comprehensive Cancer Network (NCCN) distress thermometer as a psychooncological screening tool in uveal melanoma patients. One hundred and six consecutive patients suffering from uveal melanoma completed the distress thermometer between 04/2018 and 12/2018. Practical, emotional, family concerned, spiritual, physical and overall distress levels, distribution of distress and subgroup analyses defining groups of potential high distress levels in need of intervention were assessed. Descriptive statistics, cross-tabulations, chi-square and Fisher's exact test as well as correlation coefficients (Spearman's rho) and receiver operating characteristic (ROC) were used for analysis. Patients with higher T-category had significantly more emotional problems and spiritual concerns (p=0.046 and p=0.023, respectively). Female patients accounted for higher rates of physical issues (p=0.034). Lower best corrected visual acuity (BCVA) was correlated with higher distress levels (p=0.037). Patients resulting in loss of BCVA of ≥3 lines reported higher distress levels (p=0.029). A distress threshold of 5 on the basis of ROC analysis showed a corresponding sensitivity of 100% and specificity of 76%. The NCCN distress thermometer could be integrated well into our clinical routine and proved to be a rapid, yet sensible screening tool for emotional and physical distress in patients with uveal melanoma. Special attention should be paid to patients with higher T-category and patients resulting in lower levels of BCVA. As in patients with different tumour entities, the established distress threshold of ≥5 proposing intervention proved to be adequate for uveal melanoma patients.

Highlights

Uveal melanoma is the most frequent primary intraocular tumour in adults (Singh & Topham 2003) with a reported incidence of 5–7 per million (Hu et al 2005) and must be considered as a severe ocular and, due to the risk of the development of metastases, possibly life-threatening condition (Lane et al 2018)
Could prove no survival difference between globe-preserving treatment and enucleation in the long-term follow-up (COMS Group 2001), the effect of the treatment chosen on the quality of life (QoL) of the patients should be considered for treatment planning (Foss et al 2000)
Due e381 to the patients’ confrontation with an invasive and potentially metastatic malignancy, their psychological distress during and after local therapy should not be underestimated: the presence of a serious disease by itself can cause depression (Raison & Miller 2003) and high proportions of uveal melanoma patients report reduced QoL and substantial emotional problems compared with other cancer diagnoses and normative data (Brandberg et al 1995, 2000; Hjermstad et al 1998)

Summary

Introduction

Uveal melanoma is the most frequent primary intraocular tumour in adults (Singh & Topham 2003) with a reported incidence of 5–7 per million (Hu et al 2005) and must be considered as a severe ocular and, due to the risk of the development of metastases, possibly life-threatening condition (Lane et al 2018). Could prove no survival difference between globe-preserving treatment and enucleation in the long-term follow-up (COMS Group 2001), the effect of the treatment chosen on the quality of life (QoL) of the patients should be considered for treatment planning (Foss et al 2000). Due e381 to the patients’ confrontation with an invasive and potentially metastatic malignancy, their psychological distress during and after local therapy should not be underestimated: the presence of a serious disease by itself can cause depression (Raison & Miller 2003) and high proportions of uveal melanoma patients report reduced QoL and substantial emotional problems compared with other cancer diagnoses and normative data (Brandberg et al 1995, 2000; Hjermstad et al 1998). Different physiological and psychological effects on the patients after enucleation and globe-preserving therapy have been reported in the literature reflecting on their QoL (COMS Quality of Life Study Group 1999; Chabert et al 2004)

Methods

Results

Conclusion