Psychological reactions and quality of life in patients with posterior uveal melanoma treated with ruthenium plaque therapy or enucleation: A one year follow-up study
作者:Yvonne Brandberg、Erik Kock、Kristi Oskar、Eva Af Trampe、Stefan Seregard
DOI:10.1038/eye.2000.233
日期:2000.11
Purpose To investigate psychological reactions and quality of life among patients with posterior uveal melanoma. Methods Consecutive patients with uveal malignant melanoma (99/106), referred to st Erik's Eye Hospital 1995â1996, treated with rutheniuim plaque radiotherapy (n = 50) or enucleation (n = 49), were included in this non-randomised prospective comparative study. Questionnaires were completed before treatment (Hospital Anxiety and Depression Scale, HAD scale) and 2 and 12 months after diagnosis including the HAD scale, the Impact of Event Scale and the EORTC QLQ-C30. A disease-specific questionnaire was included 12 months after diagnosis. Between-group differences were analysed by chi-square, Student's t-test and ANOVA. Results A majority of the patients reported reduced âQuality of Lifeâ (72â85%), âEmotional functioningâ (60â74%) and âCognitive functioningâ (51â61%). âFatigueâ was the most frequently reported symptom (61â72%) followed by âInsomniaâ (43â58%). Anxiety and depressive symptoms were relatively frequent up to 1 year after treatment, but the levels of anxiety decreased during the first year after treatment. Disease and treatment-related problems were reported in both treatment groups 1 year after diagnosis. Enucleated patients had more problems with appearance and judging distances, whereas those treated with radiotherapy reported vision impairment to a higher extent. Conclusion Enucleated patients reported high levels of emotional distress, problems with appearance and judging distances during the first year after treatment. Patients treated with radiotherapy reported similar levels of quality of life and emotional problems, but more problems with visual impairment. These differences in impact on disease-related functioning should be taken into account when treatment options are discussed.
目的:调查后葡萄膜黑色素瘤患者的心理反应和生活质量。方法:本研究纳入了1995年至1996年间转诊至St Erik's眼科医院的连续患者(99/106),患有恶性葡萄膜黑色素瘤,接受了铑 Plaque放射治疗(n = 50)或眼球摘除术(n = 49),为一项非随机前瞻性比较研究。患者在治疗前(医院焦虑与抑郁量表HAD)以及确诊后2个月和12个月完成问卷,包括HAD量表、创伤后应激影响量表(Impact of Event Scale)和EORTC QLQ-C30。在确诊后12个月还包括了一份疾病特定问卷。通过卡方检验、斯图dent的t检验和方差分析(ANOVA)分析组间差异。结果:大多数患者报告感到生活质量下降(72%–85%)、情感功能下降(60%–74%)和认知功能下降(51%–61%)。疲劳是最常报告的症状(61%–72%),其次是失眠(43%–58%)。焦虑和抑郁症状在治疗后的一年内相对频繁,但焦虑水平在治疗后的第一年内有所降低。确诊后一年,两个治疗组均报告了与疾病和治疗相关的问题。眼球摘除的患者在外貌和判断距离方面问题较多,而接受放疗的患者则在视力障碍方面报告得更为严重。结论:眼球摘除的患者在治疗后的第一年内报告了较高的情感痛苦、外貌和判断距离的问题。接受放疗的患者报告了类似的生活质量和情感问题,但在视力障碍方面问题更多。讨论治疗选项时,应考虑到这些对疾病相关功能的影响差异。