1
|
Younger E, Jones RL, den Hollander D, Soomers VLMN, Desar IME, Benson C, Young RJ, Oosten AW, de Haan JJ, Miah A, Zaidi S, Gelderblom H, Steeghs N, Husson O, van der Graaf WTA. Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study. ESMO Open 2021; 6:100258. [PMID: 34509803 PMCID: PMC8441156 DOI: 10.1016/j.esmoop.2021.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions. PATIENTS AND METHODS The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing health-related quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences. RESULTS One hundred and thirty-seven patients with advanced STS participated (UK: n = 72, the Netherlands: n = 65). Median age was 62 (27-79) years. Preference for extended LoL (n = 66, 48%) was slightly more common than preference for QoL (n = 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n = 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged ≥65 years) felt that QoL was equally or more important than LoL (P = 0.020). Decisional conflict was most common in patients who prioritised QoL (P = 0.024). Most patients preferred an active (n = 45, 33%) or collaborative (n = 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n = 104, 76%). CONCLUSIONS Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.
Collapse
Affiliation(s)
- E Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - D den Hollander
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - V L M N Soomers
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - I M E Desar
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R J Young
- Academic Unit of Clinical Oncology, The University of Sheffield, Sheffield, UK
| | - A W Oosten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - J J de Haan
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - A Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - S Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - N Steeghs
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - O Husson
- Division of Clinical Studies, Institute of Cancer Research, London, UK; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Lidington E, Darlington AS, Vlooswijk C, Beardsworth S, McCaffrey S, Tang S, Stallard K, Younger E, Edwards P, Ali AI, Nandhabalan M, Din A, Starling N, Larkin J, Stanway S, Nobbenhuis M, Banerjee S, Szucs Z, Gonzalez M, Sirohi B, Husson O, van der Graaf WTA. Beyond Teenage and Young Adult Cancer Care: Care Experiences of Patients Aged 25-39 Years Old in the UK National Health Service. Clin Oncol (R Coll Radiol) 2021; 33:494-506. [PMID: 33722412 DOI: 10.1016/j.clon.2021.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/04/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
AIMS Adolescents and young adults aged 15-39 years with cancer face unique medical, practical and psychosocial issues. In the UK, principal treatment centres and programmes have been designed to care for teenage and young adult patients aged 13-24 years in an age-appropriate manner. However, for young adults (YAs) aged 25-39 years with cancer, little access to age-specific support is available. The aim of this study was to examine this possible gap by qualitatively exploring YA care experiences, involving patients as research partners in the analysis to ensure robust results. MATERIALS AND METHODS We conducted a phenomenological qualitative study with YAs diagnosed with any cancer type between ages 25 and 39 years old in the last 5 years. Participants took part in interviews or focus groups and data were analysed using inductive thematic analysis. Results were shaped in an iterative process with the initial coders and four YA patients who did not participate in the study to improve the rigor of the results. RESULTS Sixty-five YAs with a range of tumour types participated. We identified seven themes and 13 subthemes. YAs found navigating the healthcare system difficult and commonly experienced prolonged diagnostic pathways. Participants felt under-informed about clinical details and the long-term implications of side-effects on daily life. YAs found online resources overwhelming but also a source of information and treatment support. Some patients regretted not discussing fertility before cancer treatment or felt uninformed or rushed when making fertility preservation decisions. A lack of age-tailored content or age-specific groups deterred YAs from accessing psychological support and rehabilitation services. CONCLUSIONS YAs with cancer may miss some benefits provided to teenagers and young adults in age-tailored cancer services. Improving services for YAs in adult settings should focus on provision of age-specific information and access to existing relevant support.
Collapse
Affiliation(s)
- E Lidington
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - C Vlooswijk
- The Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | | | | | - S Tang
- Imperial College Healthcare NHS Trust, London, UK; Public Health England, London, UK
| | | | - E Younger
- Royal Marsden NHS Foundation Trust, London, UK; Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Edwards
- Royal Marsden NHS Foundation Trust, London, UK
| | - A I Ali
- St George's University Hospital NHS Foundation Trust, London, UK
| | | | - A Din
- University of Southampton, Southampton, UK
| | - N Starling
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - J Larkin
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - S Stanway
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - S Banerjee
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - Z Szucs
- East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - M Gonzalez
- Imperial College Healthcare NHS Trust, London, UK
| | - B Sirohi
- Barts Health NHS Trust, London, UK; Apollo Proton Cancer Centre, Chennai, India
| | - O Husson
- Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - W T A van der Graaf
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK; Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| |
Collapse
|
3
|
Younger E, Jones R, Den Hollander D, Soomers V, Desar I, Young R, Oosten A, Gelderblom H, De Haan J, Steeghs N, Husson O, Van Der Graaf W. 1626MO Treatment expectations and preferences for quality versus quantity of life in patients with advanced soft tissue sarcomas starting palliative 1st line chemotherapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
4
|
Younger E, Husson O, Desar I, Young R, Leahy M, Oosten A, Gelderblom H, de Haan J, Steeghs N, Jones R, van der Graaf W. Health-related quality of life in patients with advanced soft tissue sarcomas treated with chemotherapy: The HOLISTIC study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
5
|
Timbergen M, van der Graaf W, Grünhagen D, Younger E, Sleijfer S, Dunlop A, Dean L, Verhoef C, van de Poll-Franse L, Husson O. Health-related quality of life issues of patients affected by desmoid-type fibromatosis: Experiences from two countries. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
6
|
Drabbe C, Benson C, Younger E, Zaidi S, Jones RL, Judson I, Chisholm J, Mandeville H, Fisher C, Thway K, Al Muderis O, Messiou C, Strauss D, Husson O, Miah A, Van der Graaf WTA. Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre. Clin Oncol (R Coll Radiol) 2019; 32:e27-e35. [PMID: 31350181 DOI: 10.1016/j.clon.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
AIMS Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS. MATERIALS AND METHODS All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis. RESULTS Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors. CONCLUSION Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.
Collapse
Affiliation(s)
- C Drabbe
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands
| | - C Benson
- Royal Marsden Hospital, London, UK
| | | | - S Zaidi
- Royal Marsden Hospital, London, UK
| | - R L Jones
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - I Judson
- The Institute of Cancer Research, London, UK
| | - J Chisholm
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - H Mandeville
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - C Fisher
- The Institute of Cancer Research, London, UK
| | - K Thway
- Royal Marsden Hospital, London, UK
| | | | - C Messiou
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - O Husson
- Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Miah
- Royal Marsden Hospital, London, UK
| | - W T A Van der Graaf
- Royal Marsden Hospital, London, UK; Radboud University Medical Centre, Nijmegen, the Netherlands; The Institute of Cancer Research, London, UK.
| |
Collapse
|
7
|
Younger E, Whelan J, Jones R, Bennister L, van der Graaf W. Patient perspective of the diagnostic sarcoma pathway; results from a national sarcoma patient survey in England. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw388.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
8
|
Abstract
The flexor digitorum profundus tendon of the second medial toe of the hind foot was completely divided and repaired in zone II in 30 New Zealand white rabbits. Half of the animals received indomethacin solution (1 mg/kg/day) injected subcutaneously 2 hours before operation and daily for 4 weeks. The remaining 15 animals received daily injection of the same volume of saline solution. At 4 weeks the animals were killed and measurements were made of the angular motion of the distal interphalangeal joint and the excursion of the tendon. The animals treated with indomethacin had a greater tendon excursion and angular rotation of the joint than the control animals, implying a suppression of adhesions.
Collapse
Affiliation(s)
- R M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento
| | | |
Collapse
|