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  • Ocular Pathology/Oncology

    A new patient-reported outcomes (PROs) instrument shows potential for assessing factors related to a patient’s symptoms, worry, and discomfort after plaque radiation therapy for uveal melanoma.

    Study design

    This study evaluated the psychometric properties of a new patient-reported outcome (PRO) questionnaire for use with patients being treated with brachytherapy for uveal melanoma. The analysis was conducted on a convenience sample of 439 participants from 3 high-volume North American clinical centers. Test acceptability was examined using the percentage of missing data and the percentage of items receiving the highest possible score (maximum endorsement). Reliability was evaluated using Cronbach’s alpha and Pearson correlation.


    Exploratory factor analysis disclosed 3 key domains assessed in the PRO instrument: “Symptom Impairment” (visual function, mental health, activities of daily living), “Worry” (concern for cancer recurrence or metastasis), and “Discomfort” (pain and pressure). The PRO instrument showed high acceptability, with missing data percentage and maximum endorsement both less than 2%. Reliability was also high; items in all three domains showed medium to very high ability to discriminate between affected and unaffected patients. Two question items from the Symptom Impairment domain were too difficult to measure, but all other items across the 3 domains were of appropriate difficulty level for assessment.


    This was a small sampling of patients from 3 centers focused specifically on patients with uveal melanoma managed with brachytherapy. More than half of the patients were recruited from a single center, which could bias study results and limit generalizability. The convenience sampling method could also introduce bias over a randomized sampling of patients. For future use, the PRO instrument may require refinement of some items in the Symptom Impairment domain, which were too difficult to adequately assess.

    Clinical significance

    Patient-reported outcome instruments can assist in the accurate and efficient evaluation of symptoms from the patient’s perspective, and validated instruments can improve standardization of PRO measures for use in clinical practice and multicenter trials. Patient-reported outcomes have helped to improve clinical outcomes for several types of cancers. Having validated instruments for use in ocular oncology could help provide important, patient-centered advancement in eye cancer care.

    Financial Disclosures: Dr. Lauren Dalvin discloses no financial relationships.