Psychological aspects of cytogenetic testing of uveal melanoma: preliminary findings and directions for future research

Abstract

Purpose
To determine the proportion of uveal melanoma patients who accept cytogenetic prognostication and to understand the reasons for their decision and the psychological impact of an adverse prognosis.

Methods
Patients treated by enucleation or local resection for uveal melanoma between 01 January 2003 and 31 December 2006 were identified and the proportion undergoing cytogenetic studies was determined. In-depth interviews of fourteen patients living near our centre were conducted to determine their reasons for accepting cytogenetic testing and their reactions to any results received.

Results
In total 97% of 298 eligible patients with uveal melanoma treated by enucleation or local resection accepted an offer of cytogenetic prognostication. None of the patients interviewed in detail expressed any regret about having this test and there was no evidence of any harm. The main benefit perceived by patients was that they would have greater control and that screening for metastatic disease and early treatment might enhance chances of survival. This was despite counselling that prognostication, screening, and treatment are unlikely to prolong life and that the main purpose of cytogenetic studies is to allow for life-planning.

Conclusions
Almost all patients with uveal melanoma desire cytogenetic prognostication, although not for the reasons intended by their medical practitioners. Further studies are needed to understand patients' reactions to cytogenetic testing, so that care can be optimised.