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Generaal JD, Jansen MR, van Leeuwen GL, van Ginkel RJ, Been LB, van Leeuwen BL. Twenty-five years of experience with patient-reported outcome measures in soft-tissue sarcoma patients: a systematic review. Qual Life Res 2024:10.1007/s11136-024-03755-4. [PMID: 39259455 DOI: 10.1007/s11136-024-03755-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE As the importance of the patient's perspective on treatment outcome is becoming increasingly clear, the availability of patient-reported outcome measures (PROMs) has grown accordingly. There remains insufficient information regarding the quality of PROMs in patients with soft-tissue sarcomas (STSs). The objectives of this systematic review were (1) to identify all PROMs used in STS patients and (2) to critically appraise the methodological quality of these PROMs. METHODS Literature searches were performed in MEDLINE and Embase on April 22, 2024. PROMs were identified by including all studies that evaluate (an aspect of) health-related quality of life in STS patients by using a PROM. Second, studies that assessed measurement properties of the PROMs utilized in STS patients were included. Quality of PROMs was evaluated by performing a COSMIN analysis. RESULTS In 59 studies, 39 PROMs were identified, with the Toronto Extremity Salvage Score (TESS) being the most frequently utilized. Three studies evaluated methodological quality of PROMs in the STS population. Measurement properties of the TESS, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) and European Organization for Research and Treatment for Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were reported. None of the PROMs utilized in the STS population can be recommended for use based on the current evidence and COSMIN analysis. CONCLUSION To ensure collection of reliable outcomes, PROMs require methodological evaluation prior to utilization in the STS population. Research should prioritize on determining relevant content and subsequently selecting the most suitable PROM for assessment.
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Affiliation(s)
- Jasmijn D Generaal
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Marnix R Jansen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Goudje L van Leeuwen
- Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Robert J van Ginkel
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Lukas B Been
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Division of Surgical Oncology, Department of Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Fukushima T, Okita Y, Watanabe N, Yokota S, Nakano J, Kawai A. Evaluation of clinical factors associated with early postoperative physical function and lower extremity functional impairment in patients with soft tissue sarcoma. Disabil Rehabil 2024; 46:3426-3431. [PMID: 37622737 DOI: 10.1080/09638288.2023.2249413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/21/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE This study aimed to investigate the relationship between various clinical factors and physical function in the early postoperative period in patients with soft tissue sarcomas (STSs) by subjective and objective evaluations. MATERIALS AND METHODS The 90 patients enrolled in this study were classified into five groups according to tumor location: retroperitoneal, gluteal, groin, thigh, and lower leg. The Musculoskeletal Tumor Society (MSTS) score was evaluated at discharge; the timed up-and-go test (TUGT) was performed preoperatively and at discharge. Group comparisons by tumor location were performed. To identify significant factors associated with physical dysfunction, multivariate analysis was performed using an MSTS score of <80% and a change in pre and postoperative TUGT score. RESULTS There were no significant differences between the tumor location and physical function. The change in pre- and postoperative TUGT scores was significantly associated with an MSTS score of <80%. Quadriceps and tibialis anterior muscle resections were significantly associated with the change in pre- and post-operative TUGT scores. CONCLUSIONS The quadriceps and tibialis anterior muscles may affect physical dysfunction after surgery for STSs. Early postoperative rehabilitation should include the identification of resected muscles and functional improvement of residual muscles, possibly with orthotic support for knee extension and ankle dorsiflexion.
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Affiliation(s)
- Takuya Fukushima
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yusuke Okita
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Noriko Watanabe
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Shota Yokota
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
| | - Jiro Nakano
- Faculty of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center Hospital, Tokyo, Japan
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Low CE, Loke S, Pang GE, Sim B, Yang VS. Psychological outcomes in patients with rare cancers: a systematic review and meta-analysis. EClinicalMedicine 2024; 72:102631. [PMID: 38726223 PMCID: PMC11079476 DOI: 10.1016/j.eclinm.2024.102631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Background Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers. Methods This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis. Findings We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes. Interpretation We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative. Funding This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Sean Loke
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ga Eun Pang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ben Sim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), A∗STAR, 61 Biopolis Dr, Proteos, Singapore, 138673, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
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Franzoi IG, Granieri A, Sauta MD, Agnesone M, Gonella M, Grimaldi C, Vallauri I, Boglione A, Vana F, Bergnolo P, Comandone A. The psychological impact of sarcoma on affected patients. Psychooncology 2023; 32:1787-1797. [PMID: 37930090 DOI: 10.1002/pon.6240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE Sarcoma diagnosis and its treatment trajectory may deeply affect the somatopsychic balance of patients and their caregivers. This systematic review aimed at deepening the understanding of sarcoma's impact on the entire family unit involved in the illness experience on a physical (e.g. fatigue), psychological (e.g. mental health, affective regulation, defense mechanisms), and interpersonal (e.g. social isolation, loneliness) level. METHODS The systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification and subsequent inclusion of 44 articles focused on sarcoma patients. Results were classified into seven categories: Quality of Life, worries and distress, anxiety and depression, suicide ideation, financial and occupational consequences, unmet needs, and coping strategies. Our search identified only one study focusing on informal caregivers, thus we could not perform a systematic review on these results. RESULTS Our findings underlined the traumatic impact of the sarcoma diagnosis. Patients can experience an impoverished emotional life, somatization, social withdrawal, difficulty in decision-making, increased feelings of discouragement and demoralization, and profound experiences of helplessness and vulnerability. Moreover, they seemed to display anxiety and depression and might present a higher suicide incidence than the general population. CONCLUSION Our review highlighted that the psychosocial aftermath of sarcoma patients should guide institutions and healthcare professionals toward the design of assessment and intervention models that could contemplate the different dimensions of their suffering. Furthermore, it points out that there is still a lack of evidence regarding the psychosocial impact affecting sarcoma patients' caregivers.
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Affiliation(s)
| | | | | | - Monica Agnesone
- S.S Psychology, Local Health Authority "Città di Torino", Turin, Italy
| | - Marco Gonella
- Department of Psychology, University of Turin, Turin, Italy
- S.S Psychology, Local Health Authority "Città di Torino", Turin, Italy
| | | | - Irene Vallauri
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Federica Vana
- Department of Oncology, San Giovanni Bosco Hospital, Turin, Italy
| | - Paola Bergnolo
- Department of Oncology, San Giovanni Bosco Hospital, Turin, Italy
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Tanaka A, Okamoto M, Kito M, Yoshimura Y, Aoki K, Suzuki S, Takazawa A, Komatsu Y, Ideta H, Ishida T, Takahashi J. Muscle strength and functional recovery for soft-tissue sarcoma of the thigh: a prospective study. Int J Clin Oncol 2023:10.1007/s10147-023-02348-4. [PMID: 37133781 DOI: 10.1007/s10147-023-02348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/25/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND This study aimed to investigate changes in muscle strength and functional outcome before and after surgery for soft-tissue sarcoma of the thigh and to examine the timing of recovery. METHODS From 2014 to 2019, 15 patients who underwent multiple resections of the thigh muscle for soft-tissue sarcoma of the thigh were included in this study. The muscle strength was measured with an isokinetic dynamometer for the knee joint and with a hand-held dynamometer for the hip joint. The functional outcome assessment was based on the Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), European Quality of Life-5 Dimensions (EQ-5D), and maximum walking speed (MWS). All measurements were conducted preoperatively and at 3, 6, 12, 18, and 24 months postoperatively, and the ratio of postoperative to preoperative value was used. A repeated-measures analysis of variance was performed to compare changes over time and to investigate the recovery plateau. Correlations between changes in muscle strength and functional outcomes were also examined. RESULTS The muscle strength of the affected limb, MSTS score, TESS, EQ-5D, and MWS were significantly decreased at 3 months postoperatively. The recovery plateau was subsequently reached at 12 months postoperatively. The changes in muscle strength of the affected limb and functional outcome showed a significant correlation. CONCLUSIONS The estimated postoperative recovery for soft-tissue sarcoma of the thigh is 12 months after surgery.
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Affiliation(s)
- Atsushi Tanaka
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Munehisa Kito
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yasuo Yoshimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shuichiro Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Takazawa
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yukiko Komatsu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirokazu Ideta
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takaaki Ishida
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Lese I, Baesu C, Hoyos IA, Pais MA, Klenke F, Kollar A, Ionescu C, Constantinescu M, Olariu R. Flap Reconstruction Outcome Following Surgical Resection of Soft Tissue and Bone Sarcoma in the Setting of (Neo)adjuvant Therapy: A Sarcoma Center Experience. Cancers (Basel) 2023; 15:cancers15092423. [PMID: 37173890 PMCID: PMC10177579 DOI: 10.3390/cancers15092423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Soft tissue and bone sarcomas are heterogeneous groups of malignant tumors. The shift in their management, with an emphasis on limb salvage, has deemed the involvement of reconstructive surgeons an integral part of their multidisciplinary treatment. We present our experience with free and pedicled flaps in the reconstruction of sarcomas at a tertiary referral university hospital and major sarcoma center. MATERIALS AND METHODS All patients undergoing flap reconstruction after sarcoma resection over a 5-year period have been included in the study. Patient-related data and postoperative complications were collected retrospectively, ensuring a minimum follow-up of 3 years. RESULTS A total of 90 patients underwent treatment with 26 free flaps and 64 pedicled flaps. Postoperative complications occurred in 37.7% of patients, and the flap failure rate was 4.4%. Diabetes, alcohol consumption and male gender were associated with increased early necrosis of the flap. Preoperative chemotherapy significantly increased the occurrence of early infection and late dehiscence, while preoperative radiotherapy was associated with a higher incidence of lymphedema. Intraoperative radiotherapy was associated with late seromas and lymphedema. CONCLUSIONS Reconstructive surgery with either pedicled or free flaps is reliable, but it can be demanding in the setting of sarcoma surgery. A higher complication rate is to be expected with neoadjuvant therapy and with certain comorbidities.
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Affiliation(s)
- Ioana Lese
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Crinu Baesu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Isabel Arenas Hoyos
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Michael-Alexander Pais
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Frank Klenke
- Department of Orthopedic Surgery, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Attila Kollar
- Department of Medical Oncology, Inselspital, Bern University Hospital, 3012 Bern, Switzerland
| | - Codruta Ionescu
- Department of Radiation Oncology, Inselspital, Bern University Hospital, 3012 Bern, Switzerland
| | - Mihai Constantinescu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, 3008 Bern, Switzerland
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Mosku N, Heesen P, Christen S, Scaglioni MF, Bode B, Studer G, Fuchs B. The Sarcoma-Specific Instrument to Longitudinally Assess Health-Related Outcomes of the Routine Care Cycle. Diagnostics (Basel) 2023; 13:diagnostics13061206. [PMID: 36980513 PMCID: PMC10047519 DOI: 10.3390/diagnostics13061206] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/12/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Patient-based health related quality of life (HRQoL) measurements are associated with an improvement in quality of care and outcomes. For a complex disease such as sarcoma, there is no disease-specific questionnaire available which covers all clinically relevant dimensions. Herein, we report on the development of an electronically implemented, sarcoma-specific instrument to assess health-related outcomes, which encompasses a combination of generic questionnaires tailored to the respective disease and treatment status covering the entire longitudinal care cycle. An interoperable digital platform was designed to provide a node between patients and physicians and to integrate the sarcoma-specific HRQoL instrument with patient and physician-based quality indicators to allow longitudinal structured real-world-time data evidence analytics. This approach enables the prediction modeling of disease, and by attributing cost tags to quality indicators, treatment effectiveness for a given disease will be directly correlated with financial expenses, which may ultimately lead to a more sustainable healthcare system.
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Affiliation(s)
- Nasian Mosku
- Department of Plastic & Reconstructive Surgery, University of Grenoble, 38000 Grenoble, France
| | - Philip Heesen
- Department of Plastic & Reconstructive Surgery, University of Zurich, 8091 Zurich, Switzerland
| | - Salome Christen
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
| | - Mario F Scaglioni
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
| | - Beata Bode
- Patho Enge, University of Zurich, 8000 Zurich, Switzerland
| | - Gabriela Studer
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
| | - Bruno Fuchs
- Department of Health Sciences and Medicine, University of Lucerne, 6000 Lucerne, Switzerland
- University Teaching Hospital LUKS Lucerne Sarcoma Surgery, University of Lucerne, 6000 Lucerne, Switzerland
- Kantonsspital Winterthur (KSW), 8400 Winterthur, Switzerland
- University Hospital Zurich (USZ), 8000 Zurich, Switzerland
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8
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Tamiya H, Imura Y, Wakamatsu T, Takenaka S. Comorbidity, body mass index, and performance status as prognostic factors in older patients with soft-tissue sarcoma. J Geriatr Oncol 2022; 13:673-681. [DOI: 10.1016/j.jgo.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/31/2022] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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Reijers SJM, Husson O, Soomers VLMN, Been LB, Bonenkamp JJ, van de Sande MAJ, Verhoef C, van der Graaf WTA, van Houdt WJ. Health-related quality of life after isolated limb perfusion compared to extended resection, or amputation for locally advanced extremity sarcoma: Is a limb salvage strategy worth the effort? Eur J Surg Oncol 2021; 48:500-507. [PMID: 34389213 DOI: 10.1016/j.ejso.2021.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to compare long-term patient reported outcomes (PROs) in patients with locally advanced extremity soft tissue sarcoma (eSTS) after isolated limb perfusion followed by resection (IR), compared to extended resection (ER), primary amputation (A) or secondary amputation after IR (IR-A). METHODS Patients were selected from the respondents of a multi-institutional cross-sectional cohort survivorship study (SURVSARC) conducted among sarcoma survivors registered in the Netherlands Cancer Registry (NCR), 2-10 years after diagnosis. Used PROs were the EORTC QLQ-C30, the Cancer worry scale (CWS), the Hospital Anxiety and Depression Scale (HADS), and the Toronto Extremity Salvage Score (TESS). RESULTS We identified 97 eSTS survivors: IR = 20, ER = 49, A = 20, IR-A = 8. While there were no differences in PROs between IR and ER, results showed better functioning and functionality in both groups versus the amputation groups. The amputation groups scored significantly lower on physical functioning (A = 62.7, IR-A = 65.7 versus IR = 78.0, ER = 82.7, p = 0.001) and role functioning (A = 67.5, IR-A = 52.8 versus IR = 79.2, ER = 80.6, p = 0.039), both EORTC QLQ-C30 scales. Also for the TESS, the scores were significantly lower for the amputation groups compared to the limb sparing groups (upper extremity p = 0.007 with A = 68.9, IR-A = 71.6 versus IR = 93.3, ER = 91.1; lower extremity p < 0.001 with A = 72.2, IR-A50.9 versus IR = 84.5 and ER = 85.5). There were no significant differences between the groups on cancer worry, anxiety and depression. CONCLUSION HRQoL in eSTS survivors treated with IR or ER is equal; for maintenance of physical functioning and functionality IR and ER outperform an amputation.
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Affiliation(s)
- Sophie J M Reijers
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Vicky L M N Soomers
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lukas B Been
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Johannes J Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Winan J van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
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Miwa S, Yamamoto N, Tsuchiya H. Bone and Soft Tissue Tumors: New Treatment Approaches. Cancers (Basel) 2021; 13:cancers13081832. [PMID: 33921299 PMCID: PMC8069035 DOI: 10.3390/cancers13081832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
Bone and soft tissue sarcomas require intensive treatments, including chemotherapy, surgical resection with safe margin, and radiotherapy [...].
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11
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Kask G, Repo JP, Tukiainen EJ, Blomqvist C, Barner-Rasmussen I. Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life. Ann Surg Oncol 2021; 28:6892-6905. [PMID: 33740199 PMCID: PMC8460521 DOI: 10.1245/s10434-021-09774-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023]
Abstract
Background Few studies have focused on patient-related factors in analyzing long-term functional outcome and health-related quality of life (HRQoL) in patients with postoperative lower extremity soft tissue sarcoma (STS). Objective The purpose of this study was to investigate factors associated with postoperative functional outcome and HRQoL in patients with lower extremity STS. Methods This cross-sectional study was performed in a tertiary referral center using the Toronto Extremity Salvage Score (TESS), Quality-of-Life Questionnaire (QLQ)-C30 and 15 Dimension (15D) measures. Functional outcome and HRQoL data were collected prospectively. All patients were treated by a multidisciplinary team according to a written treatment protocol. Results A total of 141 patients who had undergone limb-salvage surgery were included. Depending on the outcome measure used, 19–51% of patients were completely asymptomatic and 13–14% of patients had an unimpaired HRQoL. The mean score for TESS, 15D mobility score, and QLQ-C30 Physical Functioning scale were 86, 0.83, and 75, respectively, while the mean score for 15D was 0.88, and 73 for QLQ-C30 QoL. Lower functional outcome was statistically significantly associated with higher age, higher body mass index (BMI), and the need for reconstructive surgery and radiotherapy, while lower HRQoL was statistically significantly associated with higher age, higher BMI, and reconstructive surgery. Conclusion Functional outcome and HRQoL were generally high in this cross-sectional study of patients with STS in the lower extremity. Both tumor- and treatment-related factors had an impact but patient-related factors such as age and BMI were the major determinants of both functional outcome and HRQoL. Supplementary Information The online version of this article (10.1245/s10434-021-09774-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gilber Kask
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland. .,Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland. .,Department of Orthopaedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Jussi P Repo
- Tampere University Hospital, Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere, Finland
| | - Erkki J Tukiainen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland.,Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, Helsinki University Hospital and University of Helsinki, HUS, Helsinki, Finland
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The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas. Cancers (Basel) 2020; 12:cancers12123534. [PMID: 33256182 PMCID: PMC7760015 DOI: 10.3390/cancers12123534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital's Comprehensive Cancer Center, focusing on the role of reconstructive surgery. METHODS We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. RESULTS Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. CONCLUSION Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.
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