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Driessen HPA, Bakker EM, Rietjens JAC, Luu KLN, Lugtenberg M, Witkamp FE, Kranenburg LW. A qualitative study on redefining normality in relatives of patients with advanced cancer. Cancer Med 2024; 13:e7211. [PMID: 38785201 PMCID: PMC11117454 DOI: 10.1002/cam4.7211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE To obtain insight into adaptation processes of redefining normality and its influencing factors in relatives of patients with advanced cancer. METHODS An exploratory qualitative study among relatives of patients with advanced cancer was conducted. Participants were purposively recruited. Ten in-depth individual (relative only) and 16 dyad (relative and patient together) interviews were conducted, transcribed verbatim, and analyzed by means of thematic analysis, drawing on elements of grounded theory, combining both inductive and deductive elements. RESULTS Two adaptation processes of (redefining) normality were identified: assimilation and accommodation. The latter was found to be the main way of adapting to new events. Assimilative coping strategies entailed "continuing to do the same activities as done before the disease," "difficulty accepting the situation," "avoiding to think about the disease," and "living in the short term." Accommodative strategies involved "arranging practical matters," "thinking about the future," "doing what is feasible," "engaging in new activities," "accepting the situation," "seeking distraction," "living in the short term," and "focusing on what truly matters in life." The interplay between the diagnosis and treatment of cancer, a deteriorating disease status, and the accompanying uncertainty about the future was of influence on the relatives' coping strategies. CONCLUSION When the new situation is too divergent to assimilate, accommodation may be necessary for relatives to cope with the growing complexity of the consequences of their loved one's illness. Accommodative coping then involves accepting the changing reality and actively making the necessary adjustments to build resilience and cope with the new circumstances.
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Affiliation(s)
- Helen P. A. Driessen
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Scientific Center for Care and Welfare (Tranzo), Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - Evi M. Bakker
- Research Center Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Judith A. C. Rietjens
- Research Center Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
- Erasmus MC Cancer InstituteErasmus MC, University Medical Center RotterdamRotterdamthe Netherlands
| | - Khanh L. N. Luu
- Research Center Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
| | - Marjolein Lugtenberg
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
- Department of Design, Organization, and Strategy, Faculty of Industrial Design EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Frederika E. Witkamp
- Research Center Innovations in CareRotterdam University of Applied SciencesRotterdamThe Netherlands
- Department of DermatologyErasmus MC, University Medical Center RotterdamRotterdamThe Netherlands
| | - Leonieke W. Kranenburg
- Department of Psychiatry, Section of Medical Psychology and Psychotherapy, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
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Abstract
The purposes of this study were to describe the coping processes and support needs of patients with incurable cancer. The study was conducted as a qualitative study. The research data were gathered by conducting thematic interviews with outpatients with incurable cancer (n = 16) and analyzed by means of inductive content analysis. The results of the study indicate that the lives of patients were temporarily interrupted by the incurable illness. A sympathetic family was perceived as strength, and after the initial shock, the patients began to rebuild their lives. They had conflicting thoughts about cancer treatment. The patients felt that they were courageous, but fragile, in the face of their illness. They prepared for the approaching death by discussing the issue with their family members and friends and planning their own palliative care. The patients expected to be approached holistically. The results of this study are applicable in circumstances in which health care professionals are preparing to approach an incurable cancer patient as an individual, instead of simply as a medical case. The results can also be utilized to develop evidence-based, family-oriented palliative nursing for cancer patients and to better identify the expectations and needs of the patients while receiving treatment.
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Kienle GS, Mussler M, Fuchs D, Kiene H. The Subjective Dimension of Integrative Cancer Care: A Qualitative Study Exploring the Perspectives, Themes, and Observations of Experienced Doctors from the Area of Anthroposophic Medicine. Explore (NY) 2018; 14:342-351. [PMID: 30181043 DOI: 10.1016/j.explore.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/06/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Integrative cancer care (ICC) is used by approximately 50% of cancer patients to complement oncologic treatments and to address unmet needs. One ICC practice is anthroposophic medicine, integrating conventional and complementary cancer care. It specifically provides mistletoe therapy (MT), but also intensive counselling, natural remedies, creative and movement therapies, nursing procedures, nutrition, and others. The objective of this study was to explore perceptions, themes, goals, procedures, and observations of experienced AM doctors with regard to the subjective dimensions of ICC. METHOD A guideline-based qualitative interview study was conducted with 35 AM doctors working in hospitals and office-based practices in Germany and other countries. Structured qualitative content analysis was applied to examine the data. Triangulation was done with published studies investigating patients' perspectives on AM and MT. RESULTS The interviewed doctors integrated conventional and holistic cancer concepts. Overarching therapeutic themes were: to enable patients to live with or overcome their disease, to find their own way through their disease, and to possibly reframe their situation. A broad variety of therapeutic goals were pursued, depending on the situation and priorities of the particular patient. Doctors described varying levels of patients' improved strength; increased vitality, thermal comfort, and recovery; relief from suffering, particularly in the areas of fatigue, appetite, sleep, pain, infections, and reactions to toxic anti-cancer therapies. The doctors also described how they perceived changes of patients' emotional level, their coping, autonomy, functional abilities, and finding their own way to deal with the disease. This is consistent with patients' perspectives described in published studies. CONCLUSION Themes, goals, and described benefit of ICC from doctors' and patients' perspective may be an important complementation of conventional cancer care, as it meets important needs, distresses and conditions of patients which often stay unmet and unrelieved. Further research should investigate these goals and procedures.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Breisacher Str. 115B, 79106 Freiburg, Germany.
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, D-79098 Freiburg, Germany.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
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Asiedu GB, Carroll K, Griffin JM, Hurt RT, Mundi M. Home enteral nutrition: Use of photo-elicitation to capture patient and caregiver experiences. Health Sci Rep 2018; 1:e56. [PMID: 30623092 PMCID: PMC6266361 DOI: 10.1002/hsr2.56] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/01/2018] [Accepted: 05/15/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the importance of home enteral nutrition (HEN), there is a lack of understanding within the medical and general community of how HEN impacts the lives of patients and caregivers. Using a theoretical orientation that attends to the materiality of both everyday and medical objects, we explored patients' and family caregivers' everyday experiences of administering feeds during HEN. METHODS Using the photo-elicitation interviewing method, patients on HEN and their family caregivers were asked to take up to 10 photographs to portray material items and activities that they considered foundational to HEN. They subsequently narrated their experiences and the participant-generated photographs in an interview. Participant-generated photographs (126) and accompanying narratives were analyzed using layered analysis, and results were theorized with attention to both social and material significance of HEN. RESULTS Patients and caregivers detailed overcoming misconceptions of HEN, and through their use of photographs, they conveyed their expertise in developing their own HEN feeding systems and practices, that used both the material artifacts provided by the hospital (the tube, syringe, and formula) as well as everyday material items found in the patient's home. More than this, photographs and patient narratives depicted intimate involvement of patients' families in tube feeding. This yielded a more comprehensive understanding of the material and experiential realities of HEN. CONCLUSION Home enteral nutrition was found to be a shared familial experience, that in addition to requiring medical equipment also incorporated ordinary material artifacts within the social setting of the home and family life. To more accurately convey the material, experiential, and social realities of HEN to future patients, our findings underscore the importance of drawing on both visual and textual forms of patient-produced information in the development of HEN patient educational materials.
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Affiliation(s)
- Gladys B. Asiedu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Katherine Carroll
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
- College of Arts and Social SciencesAustralian National UniversityCanberraAustralia
| | - Joan M. Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery and the Department of Health Sciences ResearchMayo ClinicRochesterMNUSA
| | - Ryan T. Hurt
- Division of Endocrinology, Diabetes, Metabolism, and NutritionMayo ClinicRochesterMNUSA
| | - Manpreet Mundi
- Division of Endocrinology, Diabetes, Metabolism, and NutritionMayo ClinicRochesterMNUSA
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Ammari ABH, Hendriksen C, Rydahl-Hansen S. Results from the family and coping oriented palliative homecare intervention study (FamCope)-A randomized controlled trial. J Psychosoc Oncol 2018; 36:557-581. [PMID: 29995589 DOI: 10.1080/07347332.2018.1460003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We tested if a family-and-coping-oriented basic palliative homecare intervention (six visits within 15 weeks) could improve quality-of-life and reduce anxiety and depression of advanced cancer patients and their closest relative, and reduce acute hospital admissions of patients. Fifty-seven families were randomized, but patient enrollment was terminated before reaching target sample due to a low recruitment rate. We found no evidence of effect of the FamCope-intervention, but further investigation of effective methods to support how families cope with advanced cancer at home is needed as levels of distress is as high in relatives as it is in patients. However, duration of interventions to support family-coping may need a considerable time-span to show effect on quality-of-life. We recommend that recruitment is undertaken in close collaboration with the hospital clinics, and that complexity of problems is used as inclusion criterion to decide when a family-coping intervention is needed based on the level of problems and distress in the family.
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Affiliation(s)
- Anne Birgitte Hjuler Ammari
- a Research Unit of Clinical Nursing, Palliative Medical Department , Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark
| | - Carsten Hendriksen
- b Institute of Public Health, University of Copenhagen , Copenhagen , Denmark.,c Department of Integrated Health Care , Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark
| | - Susan Rydahl-Hansen
- d Research Unit of Clinical Nursing, Bispebjerg and Frederiksberg University Hospital , Copenhagen , Denmark.,e Department of Nursing Science , University of Aarhus , Aarhus , Denmark
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Kienle GS, Mussler M, Fuchs D, Kiene H. On caring and sharing-Addressing psychological, biographical, and spiritual aspects in integrative cancer care: A qualitative interview study on physicians' perspectives. Complement Ther Med 2018; 40:126-132. [PMID: 30219437 DOI: 10.1016/j.ctim.2018.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Patients confronted with a cancer diagnosis experience a variety of existential needs encompassing emotional, psychological, and spiritual areas of being. A patient-centered care approach addressing such existential issues is recognized as an essential aspect of health care. The aim of this study is to explore what role psychological, biographical, and spiritual factors play for experienced doctors working in integrative cancer care. METHOD The qualitative study was based on in-depth interviews with 35 purposively sampled doctors, all practicing integrative oncology in the field of anthroposophic medicine in hospitals and/or office-based practices in Germany and other countries. Data were analyzed using structured content analysis. RESULTS Psychological, biographical, and spiritual factors are important issues in integrative cancer care. Prevailing themes identified in this study were enabling patients to participate in life, promoting autonomy and coping, stabilizing patients emotionally and cognitively, overcoming the disease, and-primarily if addressed by patients-integrating spiritual issues. Doctors offered conversation, counseling, and time, but also referred to art, music, literature, and nature, so that patients' ongoing emotional, psychological, and spiritual needs could be explored and addressed. Doctors' attitudes with regard to existential issues were seen as important, as was maintaining an attitude of openness towards existential issues. CONCLUSION Doctors in integrative cancer care utilize different methods to explore the needs of patients and employ a variety of treatment methods that address not just patients' medical issues but their existential concerns as well.
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Affiliation(s)
- Gunver S Kienle
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany; Center for Complementary Medicine, Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Faculty of Medicine, Breisacher Str. 115B, 79106, Germany.
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, D-79098 Freiburg, Germany.
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology at the University of Witten Herdecke, Zechenweg 6, D-79111 Freiburg, Germany.
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Mardani-Hamooleh M, Heidari H. Cancer patients' effort to return to normal life: a hermeneutic study. Scand J Caring Sci 2016; 31:351-358. [DOI: 10.1111/scs.12354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marjan Mardani-Hamooleh
- School of Nursing and Midwifery; Department of Nursing; Iran University of Medical Sciences; Tehran Iran
| | - Haydeh Heidari
- Faculty of Nursing and Midwifery; Modeling in Health Research Center; Shahrekord University of Medical Sciences; Shahrekord Iran
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Kienle GS, Mussler M, Fuchs D, Kiene H. Intravenous Mistletoe Treatment in Integrative Cancer Care: A Qualitative Study Exploring the Procedures, Concepts, and Observations of Expert Doctors. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2016; 2016:4628287. [PMID: 27239209 PMCID: PMC4860234 DOI: 10.1155/2016/4628287] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/07/2016] [Indexed: 11/20/2022]
Abstract
Background. Mistletoe therapy (MT) is widely used in patient-centered integrative cancer care. The objective of this study was to explore the concepts, procedures, and observations of expert doctors, with a focus on intravenous MT. Method. A qualitative interview study was conducted with 35 highly experienced doctors specialized in integrative and anthroposophic medicine. Structured qualitative content analysis was applied. For triangulation, the results were compared with external evidence that was systematically collected, reviewed, and presented. Results. Doctors perform individualized patient assessments that lead to multimodal treatment approaches. The underlying goal is to help patients to live with and overcome disease. Mistletoe infusions are a means of accomplishing this goal. They are applied to stabilize disease, achieve responsiveness, induce fever, improve quality of life, and improve the tolerability of conventional cancer treatments. The doctors reported long-term disease stability and improvements in patients' general condition, vitality, strength, thermal comfort, appetite, sleep, pain from bone metastases, dyspnea in pulmonary lymphangitis carcinomatosa, fatigue, and cachexia; chemotherapy was better tolerated. Also patients' emotional and mental condition was reported to have improved. Conclusion. Individualized integrative cancer treatment including MT aims to help cancer patients to live well with their disease. Further research should investigate the reported observations.
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Affiliation(s)
- Gunver S. Kienle
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
- Center for Complementary Medicine, Institute for Environmental Health Sciences and Hospital Infection Control, University Medical Center Freiburg, Breisacher Strasse 115B, 79106 Freiburg, Germany
| | - Milena Mussler
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
| | - Dieter Fuchs
- Department of Theology, Caritas Sciences, University of Freiburg, Werthmannplatz 3, 79098 Freiburg, Germany
| | - Helmut Kiene
- Institute for Applied Epistemology and Medical Methodology, University of Witten/Herdecke, Zechenweg 6, 79111 Freiburg, Germany
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Ammari ABH, Hendriksen C, Rydahl-Hansen S. Recruitment and Reasons for Non-Participation in a Family-Coping-Orientated Palliative Home Care Trial (FamCope). J Psychosoc Oncol 2015; 33:655-74. [DOI: 10.1080/07347332.2015.1082168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Balmer C, Griffiths F, Dunn J. A 'new normal': Exploring the disruption of a poor prognostic cancer diagnosis using interviews and participant-produced photographs. Health (London) 2014; 19:451-72. [PMID: 25323052 DOI: 10.1177/1363459314554319] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer survival is increasing, and many people are living years after cancer treatment. For example, it is predicted that 46 per cent of men and 56 per cent of women diagnosed in 2007 in England and Wales will survive their cancer for 5 years or more. However, 'survivors' may be living with significant physical, psychological and social disruption caused by their illness. Furthermore, huge disparities exist in the outcomes for different cancer 'types', and there has been little investigation of those living with 'poor prognostic' cancers. Our aim was to explore the experience of living after the diagnosis of a poor prognostic cancer. Data were gathered from 30 people via interviews and participants' own photographs. Our findings suggest that a full 'recovery' may be impossible after a cancer diagnosis. Such diagnoses will continue to threaten biographical trajectory and self-identity forever. 'Returning to normal' was considered highly important for participants, but a changed normality had to be accepted in which lives were managed carefully and a constant fear of recurrence created liminality and made 'survivorship' ambiguous. Experience was often complicated by the social response associated with cancer that hindered communication and increased isolation. Participant-produced photographs, used here for the first time specifically by a sample of people with poor prognosis cancer, proved to be an acceptable data collection method and have added a poignancy and 'completeness' to the data that have arguably led to a more comprehensive understanding.
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Soelver L, Rydahl-Hansen S, Oestergaard B, Wagner L. Identifying factors significant to continuity in basic palliative hospital care-from the perspective of patients with advanced cancer. J Psychosoc Oncol 2014; 32:167-88. [PMID: 24364876 DOI: 10.1080/07347332.2013.873999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Based on the research method grounded theory and semistructured patient interviews at home following hospitalization, the aim was to provide information on issues relating to the identification and alleviation of patients' physical and emotional problems, understood as continuity in palliative care. The interviews were based on selected problems that patients found significant. The results are distilled into the core category disheartening interactions and four categories: falling outside the professional framework, not being seen as a person, unidentified/unmet need for guidance and involvement, and patient strategy-minimizing conflict. The categories are significant in generating and maintaining continuity in basic palliative care.
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Affiliation(s)
- Lisbeth Soelver
- a Research Unit of Nursing, Institute of Clinical Research, Faculty of Health Sciences , University of Southern Denmark , Odense , Denmark
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Rydahl-Hansen S. Conditions That Are Significant for Advanced Cancer Patients’ Coping with Their Suffering—as Experienced by Relatives. J Psychosoc Oncol 2013; 31:334-55. [DOI: 10.1080/07347332.2013.778933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ipach I, Mittag F, Kopp HG, Kunze B, Wolf P, Kluba T. Clear-cell sarcoma of the soft tissue--a rare diagnosis with a fatal outcome. Eur J Cancer Care (Engl) 2011; 21:412-20. [PMID: 22150806 DOI: 10.1111/j.1365-2354.2011.01318.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clear-cell sarcomas account for less than 1% of all soft tissue tumours. They most often occur in middle-aged adults as a deeply located lesion with predilection to the tendons and aponeuroses. The aim of the present study was to show possible influencing factors on the outcome after surgical treatment in a detailed case series. We reviewed the medical records of 11 patients with the diagnosis of a clear-cell sarcoma of the soft tissue. These cases were analysed with regard to age, gender, localisation, tumour size, recurrence free survival and overall survival. A minimum follow up of 12 months was achieved. The mean age at the point of diagnosis was 47.9 years. Metastases occurred after a mean of 19.2 months. In the cases with a tumour diameter >5 cm, metastases occurred earlier. When treated in a specialist centre, metastases occurred later. Patients died a mean of 18.4 months after developing metastatic disease. Patients with tumour size >5 cm at the point of primary diagnosis died earlier than patients with a tumour size <5 cm. It is important to detect clear-cell sarcomas as soon as possible and the final surgical treatment should be performed in a centre familiar with the treatment of soft tissue tumours not only to prolong overall survival, but also to treat the patient in a multiprofessional team.
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Affiliation(s)
- I Ipach
- Department of Orthopaedic Surgery, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, Tübingen, Germany
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