Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
Department of Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen, University of Duisburg-Essen, Essen, Germany.
BMC Psychol. 2020 Jan 31;8(1):8. doi: 10.1186/s40359-020-0371-3.
The risk of metastases in uveal melanoma can accurately be estimated through genetic analysis of the tumor. A growing number of patients decide to receive information on their prognosis, although this can be extremely burdensome. Studies on the psychosocial impact of testing are sparse. The objective of this study was to examine traits of patients opting for prognostication, to investigate its psychosocial impact and the use of psycho-oncological services over time. We further examined characteristics of patients utilizing these services and risk factors of prolonged psychological distress.
This study is a non-randomized controlled prospective clinical observational trial. Patients availing for prognostication formed the test group, while those who opted out constituted the observational group. The psychosocial impact of genetic testing was assessed with the following variables: resilience, social support, fear of tumor progression, depression, general distress, health-related quality of life, estimation of the perceived risk, and the utilization of psycho-oncological interventions. Data were assessed at five different time points over a period of 12 months. We applied binary logistic regression analysis, multiple linear regressions and a mixed model.
Of 175 patients, 63 decided to obtain prognostic information. Treatment method (enucleation > brachytherapy), lower social support and higher general distress could significantly predict patient's choice for prognostic testing. After result announcement, perceived risk of metastases was significantly increased in patients with poor prognosis, while it decreased in those with good prognosis. Overall, a significant decrease over time appeared concerning fear of progression, general distress, depression and anxiety. Mental quality of life increased over time. The utilization of psycho-oncological interventions increased significantly after prognostication; however, this was equivalent in the test and observational groups. Female sex, higher general distress and higher anxiety predicted greater use of psycho-oncological interventions.
Availing of prognostic testing is not associated with poorer subsequent psychological well-being. It rather may help to alleviate distress and promote a more realistic risk perception. However, psychological support should be available to all patients, independent of prognosis and treatment, especially considering that patients with low social support and high distress increasingly opt for prognostication.
通过对肿瘤的基因分析，可以准确估计葡萄膜黑色素瘤的转移风险。越来越多的患者决定了解自己的预后情况，尽管这可能会带来极大的负担。关于检测的心理社会影响的研究很少。本研究的目的是研究选择预后预测的患者的特征，探讨其心理社会影响以及随着时间的推移对心理肿瘤学服务的利用情况。我们进一步研究了利用这些服务的患者的特征和延长心理困扰的风险因素。
这是一项非随机对照前瞻性临床观察性试验。选择预后预测的患者为试验组，选择不进行预后预测的患者为观察组。采用以下变量评估遗传检测的心理社会影响：韧性、社会支持、对肿瘤进展的恐惧、抑郁、一般困扰、健康相关生活质量、对感知风险的估计以及心理肿瘤学干预的利用。在 12 个月的时间内，我们在 5 个不同时间点评估了数据。我们应用了二项逻辑回归分析、多元线性回归和混合模型。
在 175 名患者中，63 名决定获得预后信息。治疗方法（眼球摘除术>近距离放射治疗）、较低的社会支持和较高的一般困扰可以显著预测患者选择预后检测。结果公布后，预后不良患者的转移风险感知显著增加，而预后良好患者的转移风险感知降低。总体而言，随着时间的推移，对进展的恐惧、一般困扰、抑郁和焦虑显著下降，精神生活质量随着时间的推移而提高。预后预测后，心理肿瘤学干预的利用显著增加，但在试验组和观察组之间没有差异。女性、较高的一般困扰和较高的焦虑预测了更多的心理肿瘤学干预的利用。
接受预后检测与随后的心理健康状况不佳无关。它可能有助于减轻痛苦，促进更现实的风险感知。然而，应该为所有患者提供心理支持，而不考虑预后和治疗，特别是考虑到低社会支持和高困扰的患者越来越多地选择预后预测。
