Abstract
Interest in functional outcome (FO) and health-related quality of life (HRQL) in extremity soft-tissue sarcoma (STS) patients has increased. The aim of this study was to validate two FO questionnaires for upper extremity STS patients: the Toronto Extremity Salvage Score (TESS) and short version of the Disability of Arm, Shoulder and Hand (QuickDASH), based on Finnish population data. A multi-center study was conducted at two academic sarcoma centers. Surgically treated upper extremity STS patients were invited to participate. Patients completed the TESS and the QuickDASH with HRQL questionnaires the 15D and the QLQ-C30. The scores were analyzed and compared. Fifty-five patients with a mean follow-up period of 4.7 years were included. Mean age was 63 years (standard deviation [SD] 14.6). The mean score for TESS was 88.5 (SD 15.1) and for QuickDASH 17.8 (SD 19.6). The QuickDASH had a statistically significantly better score coverage. A ceiling effect was noted, 27% and 20% for TESS and QuickDASH, respectively. The TESS and QuickDASH scores were strongly correlated (r= -0.89). The TESS score strongly correlated with the QLQ-C30 (r=0.79) and the 15D score (r=0.70). The QuickDASH score correlated strongly with the QLQ-C30 score (r=-0.71) and moderately with the 15D score (r= -0.56). The TESS score had a statistically significantly stronger correlation with the 15D score than QuickDASH (p<0.005). Both the TESS and the QuickDASH provide reliable scores for assessing FO in upper extremity STS patients. The QuickDASH has a better coverage, whereas TESS showed a stronger correlation to HRQL scores.
Highlights
Soft-tissue sarcomas (STS) are rare mesenchymal malignant soft-tissue tumors, representing approximately 1% of all solid malignant tumors in adults.[1,2] STS can occur almost at any anatomical site, the most common sites being the limbs.[3]
As no difference has been found between limb-salvage surgery and amputation in terms of survival or local recurrence, limb-salvage surgery is considered the gold standard of treatment for limb sarcoma.9
The aim of this study is to validate the Finnish translations of the Toronto Extremity Salvage Score (TESS) and the QuickDASH for upper extremity sarcoma patients by comparing them to physical scores of two health-related quality of life (HRQL) patient-reported outcome (PRO) instruments; and to evaluate how the TESS and the QuickDASH reflect HRQL aspect of these patients
Summary
Soft-tissue sarcomas (STS) are rare mesenchymal malignant soft-tissue tumors, representing approximately 1% of all solid malignant tumors in adults.[1,2] STS can occur almost at any anatomical site, the most common sites being the limbs.[3]. Soft-tissue sarcomas (STS) are rare mesenchymal malignant soft-tissue tumors, representing approximately 1% of all solid malignant tumors in adults.[1,2]. STS can occur almost at any anatomical site, the most common sites being the limbs.[3]. Ageadjusted incidence for STS in Finland is approximately 4.25 cases per 100,000 person-years with 243 new STS cases annually (ICD-10 codes C47-C49).[5]. Treatment of STS involves surgical excision with reconstructive surgery when required, frequently combined with radiotherapy, and in select cases with chemotherapy.[6–8]. As no difference has been found between limb-salvage surgery and amputation in terms of survival or local recurrence, limb-salvage surgery is considered the gold standard of treatment for limb sarcoma.9,.10. Limb-salvage surgery preserves more function than amputation.[10]. The importance of FO in the treatment has been increasingly recognized.[6]. Evidence-based medical practice has increased interest in measuring FOs.[11]
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