Quality of Life and Its Drivers in Patients With Uveal Melanoma: A Systematic Review

OBJECTIVES: Uveal melanoma, the most common primary intraocular malignancy in adults, affects about 5 per million people annually worldwide. Despite its rarity, it leads to significant consequences, including vision loss and a 15-year disease-specific mortality rate of 45%. Understanding quality of life (QoL) and its determinants is crucial for patient care. This systematic review synthesizes current knowledge on QoL in uveal melanoma patients and identifies key influencing factors.

METHODS: We systematically searched Embase^® and MEDLINE^® databases via Embase.com to identify English-language articles, published after 2010, reporting QoL data for adult patients with uveal melanoma.

RESULTS: Among 159 studies screened, 17 studies were included. Most studies utilized QoL/patient-reported outcome measures (PROMs) such as the EORTC QLQ-C30, EORTC QLQ-OPT30, NEI VFQ-25, and FACT-G. The overall QoL in uveal melanoma patients was reported to be moderate to low, with significant impairments in vision-related functions, emotional well-being, and social interactions. Key drivers of QoL included visual acuity, psychological distress (such as anxiety and depression), treatment type (e.g. enucleation, brachytherapy), and disease stage. For instance, in a study using the PROM-UM scale, drivers such as vision loss, worry, and discomfort significantly impacted QoL scores. Another study highlighted that those undergoing proton beam radiotherapy reported better QoL scores related to vision compared to those undergoing enucleation, but experienced higher levels of psychological distress. Patients with metastatic disease had worse overall QoL, emphasizing the need for targeted psychological and palliative care. Furthermore, interventions focused on psychological support and rehabilitation services were found to be effective in improving overall QoL.

CONCLUSIONS: Uveal melanoma substantially impacts patients' QoL, driven by vision loss and psychological distress. Tailored interventions to preserve visual function and provide psychological support are crucial. Further research is essential to develop comprehensive care models that effectively address these critical aspects.