Gender issues in patients with extremity soft-tissue sarcoma: a pilot study

Evaluating health perceptions of soft-tissue sarcoma patients using the Wilson-Cleary Model to identify key targets for improving outcomes and quality of care

INTRODUCTION

Soft-tissue sarcoma (STS) is a rare cancer of the connective tissues requiring invasive treatment. Due to the complexity of treatment, STS patients experience more functional impairment and disability than other oncologic populations. Given that extant literature is unclear and exclusively focused on physical function, the objectives of this study were to use the Wilson-Cleary Model of HRQL to evaluate the extent to which biological function (tumor site, depth and size), symptoms (fatigue, pain, anxiety/depression), and functional status are associated with the health perceptions of soft-tissue sarcoma patients 12 months post-op.

METHODS

Data were drawn from an inception cohort study at the McGill University Health Centre. Inclusion criteria included 18 years of age and a biopsy-confirmed diagnosis of STS. Those with evidence of metastasis at diagnosis or less than 12 months of follow-up were excluded. Statistical analyses included T-tests, Pearson correlations, and multiple linear regression.

RESULTS

331 patients were included (185 males, 146 females) with mean (SD) ages of 56 (17). Significantly more females reported pain and anxiety/depression. Self-reported function was significantly higher in males. Overall, the regression model explained 53 % of the variance in health perceptions in males, and 48 % in females. Only self-reported function was significantly associated with health perceptions in males (B = 0.34) and females (B = 0.48). Further, compared to females without pain, females with pain perceived their health as significantly worse.

CONCLUSION

Evaluating health perceptions with a multidimensional lens revealed new information about the STS patient experience. Findings suggest that key targets include routine psychosocial distress monitoring and addressing rectifiable disability-related barriers promptly.

Investigating readmission rates for patients undergoing oncologic resection and endoprosthetic reconstruction for primary sarcomas and tumors involving bone

BACKGROUND

Little is known about the drivers of readmission in patients undergoing Orthopaedic oncologic resection. The goal of this study was to identify factors independently associated with 90-day readmission for patients undergoing oncologic resection and subsequent prosthetic reconstruction for primary tumors involving bone.

METHODS

This was a retrospective comparative cohort study of patients treated from 2008 to 2019 who underwent endoprosthetic reconstruction for a primary bone tumor or soft tissue tumor involving bone, as well as those who underwent a revision endoprosthetic reconstruction if the primary endoprosthetic reconstruction was performed for an oncologic resection. The primary outcome measure was unplanned 90-day readmission.

RESULTS

A total of 149 patients were identified who underwent 191 surgeries were for a primary bone or soft tissue tumor. The 90-day readmission rate was 28.3%. Female gender, depression, higher tumor grade, vascular reconstruction, longer procedure duration, longer length of stay (LOS), multiple surgeries during an admission and disposition to a Skilled Nursing Facility were associated with readmission (p < 0.05). In a multivariate analysis, female sex, higher tumor grade and longer procedure duration were independently associated with risk of readmission (p < 0.05).

CONCLUSIONS

Readmission rates are high following endoprosthetic reconstruction for Orthopaedic oncologic resections. Further work is necessary to help minimize unplanned readmissions.

Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients

Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms.

Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics.

Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men.

Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being.

Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.

Patient Perceptions of the Impact of Treatment (Surgery and Radiotherapy) for Soft Tissue Sarcoma

BACKGROUND AND OBJECTIVES

Treatment for soft tissue sarcoma (STS) is challenging for patients. This study aimed to gain an in-depth understanding of patients' experiences of STS treatment, including whether the sequence of treatment (preoperative or postoperative radiotherapy) influences patient perceptions.

METHODS

Face-to-face semi-structured interviews were conducted with nineteen patients who had been treated for STS with surgery and radiotherapy between 2011 and 2016. Topics discussed included perceptions of treatment, social support, and coping mechanisms. Qualitative, inductive, thematic analysis was conducted and structured using the Framework approach.

RESULTS

Treatment sequence itself did not appear to cause concern, but uncertainty regarding treatment and side effects could negatively impact participants. Social relationships and individual coping strategies influenced participants' experiences of treatment.

CONCLUSIONS

Participants' perceptions of the treatment process varied; the experience was highly individual. It is important to ensure individual psychosocial and information needs are met. In particular, the removal of uncertainty regarding treatment is important in supporting patients undergoing treatment for soft tissue sarcoma.

Prognostic factors for soft tissue sarcoma patients with lung metastases only who are receiving first-line chemotherapy: An exploratory, retrospective analysis of the European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG)

The prognosis of adult soft tissue sarcoma (STS) patients with metastases is generally poor. As little is known about the impact of the involvement of different metastatic sites and the extent of pulmonary lesions on the outcome for patients receiving first‐line chemotherapy, we aimed to establish prognostic factors for STS patients with lung metastases only. A retrospective, exploratory analysis was performed on 2,913 metastatic STS patients who received first‐line chemotherapy. Detailed information from 580 patients who had lung metastases only, was used for prognostic factor analysis. Patients with lung metastases only were more often asymptomatic and had undergone complete primary tumor resection more frequently compared to patients with additional metastases outside the lung or without lung metastases. For extremity STS, the incidence of lung metastases only was much higher compared to non‐extremity STS. Lung involvement only was an independent favorable prognostic factor for overall survival (OS) with regard to metastatic site. Within this subgroup, in a multivariate model, other factors associated with improved OS included: good performance status (PS), no progression at primary site, low histological grade, younger age, long interval between initial diagnosis and trial registration, and smaller diameter of the largest lung lesion. This unique analysis on prognostic factors in STS patients with lung metastases confirms well‐known patient factors (such as age and PS), and tumor characteristics (including tumor grade, interval between primary diagnosis, and metastases), but also identifies diameter of the largest lung lesion as a new prognostic factor. Knowledge about these factors may support decision‐making within multidisciplinary tumor boards.

What's new?

About 25% of soft tissue sarcoma patients develop lung metastases but prognostic factors for those who cannot get operated remain scarce. Here the authors performed a retrospective study of datasets obtained from 580 patients where metastases have not spread beyond the lung and who received first‐line chemotherapy but no resection. Interestingly, the largest diameter of a lung lesion emerged as a new prognostic factor, a finding, which may influence clinical decisions in the future.

Quality of life (QOL) in patients with osteosarcoma

Patients with osteosarcoma undergo extensive treatment using aggressive chemotherapy and surgery and this can have substantial acute and long-term effects on patients. In particular, quality of life (QOL) can be affected. It is important that QOL be examined to see how it is influenced. It is also important to determine who is at highest risk for impaired QOL and develop appropriate interventions. QOL is one of several outcomes that are influenced by the diagnosis and treatment of osteosarcoma. Other outcomes include function, disability, and body image. Currently, gaps exist in our knowledge of QOL in osteosarcoma patients and prospective studies are needed.

Is it possible to identify patient's sex when reading blinded illness narratives? An experimental study about gender bias

Background

In many diseases men and women, for no apparent medical reason, are not offered the same investigations and treatment in health care. This may be due to staff's stereotypical preconceptions about men and women, i.e., gender bias. In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised on beforehand?

Methods

Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The success rates were analysed statistically. To illuminate the participants' reasoning the explanations of four letters were analysed qualitatively.

Results

The patient's sex was correctly identified in 62% of the cases, with significantly higher rates in male narratives. There were no differences between male and female participants. In the qualitative analysis the choice of a male writer was explained by: a short letter; formal language; a focus on facts and a lack of emotions. In contrast the reasons for the choice of a woman were: a long letter; vivid language; mention of emotions and interpersonal relationships. Furthermore, the same expressions were interpreted differently depending on whether the participant believed the writer to be male or female.

Conclusion

It was possible to detect gender differences in the blinded illness narratives. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.

Function, disability, and health-related quality of life after allograft-prosthesis composite reconstructions of the proximal femur

BACKGROUND

Factors affecting function, disability and health-related quality of life after allograft-prosthesis composite reconstructions have been poorly studied.

METHODS

Retrospective study of eighteen patients who underwent reconstruction with proximal femoral allograft-prosthesis composites and answered questionnaires to assess hip function (Postel and Merle d'Aubigné, self-reported Harris Hip Score), disability (Toronto Extremity Salvage Score), and health-related quality of life (SF-36).

RESULTS

The median Toronto Extremity Salvage Score was 76 (IQR: 48-85), the median self-reported Harris Hip Score was 90 (IQR: 48-95) and the median Postel and Merle d'Aubigné score was 17 (IQR: 12-17). Older age, female gender, and presentation with a pathologic fracture were associated with increased disability and poorest function. The median Physical Component Summary score was 44 (IQR: 39-45) and Mental Component Summary scores were 49 (IQR: 46-56). Male gender and recurrence of disease were associated with poorer health-related quality of life. There was a high degree of correlation between function, disability scores and Physical Component Summary score.

CONCLUSIONS

Patients' characteristics at presentation such as age, gender, and occurrence of a pathologic fracture play an important role in determining disability, function, and health-related quality of life after allograft-prosthesis composite reconstruction of the proximal femur.

Recurrence of Ovarian Cancer-Living in Limbo

Few studies have shed light on women's life situation after being informed of having recurrent ovarian cancer. The present study aimed to elucidate women's experiences of living with this knowledge. Interviews were conducted with 12 women who were undergoing or had just completed chemotherapy, 5 to 10 months after learning of the recurrence. Data were collected and analyzed based on a life world perspective using a descriptive phenomenological method. The women's experiences are described via 3 key constituents: being denied one's future while simultaneously hoping to be able to delay the cancer's advancement, feeling alienated from both oneself and one's surroundings, and being responsible. The key constituents were integrated into the structure "living in limbo." The women lived on the threshold to the unknown. They were preparing themselves both for a continued life and for death. "Living in limbo" can be described as a phase of a health-illness transition characterized by loneliness. The vulnerable position and existential struggle of these women should be focused upon in nursing. The sensitive dialogue is essential in these cases.

Information-seeking behaviour of men newly diagnosed with cancer: a qualitative study

AIM

This paper reports the findings of a study, which explored the information-seeking behaviour of men newly diagnosed with cancer.

BACKGROUND

There is worldwide recognition that there are significant differences in the way men and women react to and cope with illness, yet there seems to be a lack of research into men's information-seeking behaviours and how they get their information needs met. The needs of men with cancer has so far received less research attention than women.

METHODS

A qualitative approach, consisting of in-depth interviews, was used. A convenient sample of 13 men newly diagnosed with cancer and five healthcare professionals and four lay sources were recruited for this study.

RESULTS

Five themes emerged from the data. These were: 'experiencing discomfort in the healthcare setting', 'reliance on partners as information gatherers', 'reluctance to explore a range of information sources and support', 'unmet information needs' and 'getting back to normal'. Together, they provide a perspective on men's information needs and information-seeking behaviour.

CONCLUSIONS

Healthcare professionals should be aware that there may be gender differences in how patients cope with their cancer, how they seek information and what information needs they have. Further training and preparation in 'men's health' is recommended for all those working with men in cancer care.

RELEVANCE TO CLINICAL PRACTICE

Understanding how, when and in what circumstances men express their information needs will help healthcare professionals to develop strategies to meet these needs and other support needs of men with cancer.

Evaluating function and health related quality of life in patients treated for extremity soft tissue sarcoma

OBJECTIVE

To evaluate how functional disability impacts on health related quality of life (HRQOL) of patients with extremity soft tissue sarcoma (STS) at 1 year post-surgery.

DESIGN AND SETTING

Survey of extremity STS patients pre-surgery and one-year post-treatment.

PARTICIPANTS

100 participants who were treated for extremity STS between 2001 and 2003 at four Canadian hospitals. Patients were over 16 years, non-metastatic at diagnosis, and had limb salvage surgery.

OUTCOME MEASURES

Musculoskeletal Tumor Society Rating Scale (MSTS), a measure of impairment; Toronto Extremity Salvage Score (TESS), a measure of activity limitations; Reintegration to Normal Living Index (RNL), a measure of participation restrictions; and EQ-VAS, a measure of HRQOL.

RESULTS

After adjusting for demographic and clinical variables, impairment explained 54%, activity limitations explained 48%, and participation restrictions explained 61% of the variation in HRQOL. After adjustment, when all three functional measures were included in the model, only participation restrictions had a significant impact on HRQOL explaining 63% of the variation.

CONCLUSION

Impairment and activity limitations affect the daily activities a patient can perform, but it is the restriction in participation of life roles and situations that has the greatest effect on patient's HRQOL.

Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing's sarcoma: the Childhood Cancer Survivor Study

Limb-sparing surgeries have been performed more frequently than amputation based on the belief that limb-sparing surgeries provide improved function and quality-of-life (QOL). However, this has not been extensively studied in the paediatric population, which has unique characteristics that have implications for function and QOL. Using the Childhood Cancer Survivor Study, 528 adult long-term survivors of pediatric lower extremity bone tumours, diagnosed between 1970 and 1986, were contacted and completed questionnaries assessing function and QOL. Survivors were an average of 21 years from diagnosis with an average age of 35 years. Overall they reported excellent function and QOL. Compared to those who had a limb-sparing procedure, amputees were not more likely to have lower function and QOL scores and self-perception of disability included general health status, lower educational attainment, older age and female gender. Findings from this study suggest that, over time, amputees do as well as those who underwent limb-sparing surgeries between 1970 and 1986. However, female gender, lower educational attainment and older current age appear to influence function, QOL and disability.

Motives for becoming and remaining member of patient associations: a study of 1,810 Swedish individuals with cancer associations

Patient associations for cancer patients (PACPs) are increasing in number as well as in the number of members. We utilised a questionnaire to investigate how members of 13 PACPs motivated their memberships. The study included 1,810 individuals who had been treated for breast cancer, gynaecological cancer, or prostate cancer. Through questionnaires these individuals were asked to articulate why they became and chose to remain members. Descriptive statistics and content analyses were used to analyse the open and structured questions. Motives for membership reflected both benefits for the individuals and the welfare of others; themes such as 'needs related to having cancer' (reported by 33% as motives for becoming members; 14% for remaining members), 'wanted to use the PACP's information and activities' (24%; 38%) and 'wanted to support the PACP and its possibilities to have an impact' (9%; 20%) were dominant. The theme 'needs and experiences related to having cancer' was more common among members with breast cancer (38%) and ovarian cancer (36%) than among members with prostate cancer (25%), whereas 53% of men with prostate cancer reported 'wanted to use the PACP's information and activities' compared to 19-9% among female members. The motives showed that needs related to having cancer and that activities and information offered by the PACPs were important to the members, as were their beliefs that the PACP prompted issues that were important to the members.

Gender differences in patients' written narratives about being diagnosed with cancer

The medical field has shown a growing interest in gender and gender differences. In psychosocial oncology, for example, some studies suggest that men and women cope differently with cancer; e.g. women express their emotions more readily than men do, and men rely more on their healthy spouse. Using a qualitative perspective, this study examines 83 narratives written by male and female cancer patients who were asked to write down how they experienced receiving their cancer diagnosis. The narratives were analyzed both as to structure and content. The women wrote longer, more personally, and more emotionally than the men, and to a greater extent they included family members and other relatives in their stories. When the men mentioned relatives, they mainly referred to their spouse. Men and women commented differently as to their experiences of 'reception'; i.e. how their psychological needs were addressed and 'connection'; i.e. whether they felt in sufficient contact with medical staff. Although the women described good reception, they complained a lot about bad connection. Among the men, it was just as common to report about positive as negative experiences in both categories. There are reasons to be cautious when evaluating these findings. The found differences may be due to different ways of reacting to similar situations or different willingness and ways of commenting on similar situations, but also to different reception and connection for men and women. Further research should focus on the basic question: Are men and women without medical reasons being treated differently during their oncological treatment?