Quality of Life, Anxiety, and Depression in Patients With Early-Stage Mycosis Fungoides and the Effect of Oral Psoralen Plus UV-A (PUVA) Photochemotherapy on it

Thomas Graier, Regina Fink-Puches, Stephanie Porkert, Roland Lang, Sophie Pöchlauer, Gudrun Ratzinger, Adrian Tanew, Sylvia Selhofer, Paul-Gunther Sator, Angelika Hofer, Alexandra Gruber-Wackernagel, Franz J Legat, Pablo Augusto Vieyra-Garcia, Franz Quehenberger, Peter Wolf, Thomas Graier, Regina Fink-Puches, Stephanie Porkert, Roland Lang, Sophie Pöchlauer, Gudrun Ratzinger, Adrian Tanew, Sylvia Selhofer, Paul-Gunther Sator, Angelika Hofer, Alexandra Gruber-Wackernagel, Franz J Legat, Pablo Augusto Vieyra-Garcia, Franz Quehenberger, Peter Wolf

Abstract

Background: Little is known about psychological discomfort and quality of life (QoL) in early stage mycosis fungoides (MF) and the effect of psoralen plus UV-A (PUVA) on it. Objective: To evaluate QoL, anxiety, and depression with validated instruments in early stage MF patients and whether PUVA treatment improves it. Methods: Patients with stage IA to IIA MF were treated with PUVA twice weekly for 12-24 weeks, followed by maintenance treatment or not, in a prospective randomized clinical trial. Patients completed a questionnaire on DLQI as well as the Hospital Anxiety and Depression Scale (HADS) prior to therapy, after their last PUVA exposure, and after the PUVA maintenance or observance phase. Results: For 24 patients with early stage MF, completed questionnaires were available and analyzed. Prior to treatment, 17% reported strong (DLQI > 10) and 29% moderate impairment (DLQI 6-10) in QoL; 33% of patients reported HADS scores indicating anxiety, and 21% reported scores indicating depression. PUVA significantly improved overall QoL by reducing mean DLQI scores by 58.6% (p = 0.003), HADS-A by 30% (p = 0.045), and HADS-D by 44% (p = 0.002). Improvements in QoL and psychological well-being seemed to be sustained, irrespective of maintenance treatment or not. Limitations: Small sample size. Conclusions: PUVA sustainably improves QoL and psychological well-being in patients with early stage MF. Clinical trial registration: ClinicalTrials.gov identifier: NCT01686594.

Keywords: PUVA; anxiety; depression; mycosis fungoides; phototherapy; quality of life.

Copyright © 2020 Graier, Fink-Puches, Porkert, Lang, Pöchlauer, Ratzinger, Tanew, Selhofer, Sator, Hofer, Gruber-Wackernagel, Legat, Vieyra-Garcia, Quehenberger and Wolf.

Figures

Figure 1
Figure 1
Evolution of DLQI items. Individual values of the 10 Dermatology Life Quality Index (DLQI) items for the time points prior to (left side) and after (right side) Psoralen-UV-A (PUVA) treatment. Numbers in square boxes on top of the panels represent item number of DLQI: item 1 (itching, aching, stinging), item 2 (embarrassment), item 3 (shopping, home), item 4 (affection on clothing), item 5 (social activities), item 6 (sports), item 7 (working, studying), item 8 (interpersonal problems), item 9 (sexual difficulties), and item 10 (treatment difficulties). Each item can be categorized with zero to three points. Items marked as not relevant were awarded with zero points. Thickness of gray lines is proportional to the number of patients and their DLQI evoluting in a certain way. Statistical comparison was performed by Wilcoxon signed-rank test, and respective p-values are shown underneath plots. Evolution of mean value (m) is shown by the black line and the black circles.
Figure 2
Figure 2
DLQI and HADS scores. Individual overall values of Dermatology Life Quality Index (DLQI) (A) and the Hospital Anxiety and Depression scale HADS-A (B) and HADS-D (C) of the 24 patients prior to (left side) and after psoralen-UV-A (PUVA) induction (right side) and their specific evolution (gray line) are shown. Thickness of gray lines is proportional to the number of patients and their DLQI, HADS-A, or HADS-D evoluting in a certain way. Range of DLQI severity groups are colorized on the y-axis of the plot: no impairment (green; 0–1 points); slight (yellow; 2–5), moderate (orange; 6–10), and severe (red; >10 points) impairment. Range of HADS severity groups colorized on the y-axis of the plots: no signs of anxiety/depression (green; 0–7 points), borderline abnormal (yellow; 8–10), abnormal values (red; >10 points). Mean values (black dots), standard deviations (black intervals), and evolution of means (black lines) prior to (left side) and after (right side) PUVA treatment are plotted. Percentages of reduction comparing overall scores prior to and after PUVA treatment are depicted. Statistical significance was determined by Wilcoxon signed-rank test and respective p-values are plotted.

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