The Health-Related Quality of Life of Sarcoma Patients and Survivors in Germany-Cross-Sectional Results of a Nationwide Observational Study (PROSa).

Martin Eichler,Jürgen Weitz,Jens Jakob,Vitali Heidt,Daniel Pink,Christine Hofbauer,Bernd Kasper,Jochen Schmitt,Stephen Fung,Martin Bornhäuser,Dimosthenis Andreou,Eva Wardelmann,Marius Fried,Karin Arndt,Leopold Hentschel,Karl Verpoort,Stephan Richter,Verena I Gaidzik,Peter Hohenberger,Marit Ahrens,Robert Grützmann,Susanne Schnittger ,Klaus‐Dieter Schaser ,Markus Schüler

doi:10.3390/cancers12123590

Abstract

Simple SummarySarcomas are a rare cancer with many different subtypes. They can occur anywhere in the body and are treated in a multi-disciplinary manner. Large studies on the quality of life of sarcoma patients are rare, so little is known about how patients are doing compared to the general population and which groups of sarcoma patients are particularly affected by quality of life limitations. We assessed the quality of life of 1113 sarcoma patients from Germany. The majority were particularly restricted in their emotional functioning, physical functioning, and the exercise of everyday demands (role function). Many of them experienced pain (56%) and fatigue (51%). We found that patients with leg or bone sarcomas were especially affected by quality of life limitations. We also found that patients who received a retirement pension were less affected by quality of life restrictions than patients who had not retired.Sarcomas are rare cancers with high heterogeneity in terms of type, location, and treatment. The health-related quality of life (HRQoL) of sarcoma patients has rarely been investigated and is the subject of this analysis. Adult sarcoma patients and survivors were assessed between September 2017 and February 2019 in 39 study centers in Germany using standardized, validated questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)). Associated factors were analyzed exploratively using multivariable linear regressions. Among 1113 patients, clinically important limitations and symptoms were most pronounced in emotional (63%, 95% CI 60–66%), physical (60%, 95% CI 57–62%), role functioning (51%, 95% CI 48–54%), and pain (56%, 95% CI 53–59%) and fatigue (51%, 95% CI 48–54%). HRQoL differed between tumor locations with lower extremities performing the worst and sarcoma types with bone sarcoma types being most affected. Additionally, female gender, higher age, lower socioeconomic status, recurrent disease, not being in retirement, comorbidities, and being in treatment were associated with lower HRQoL. Sarcoma patients are severely restricted in their HRQoL, especially in functioning scales. The heterogeneity of sarcomas with regard to type and location is reflected in HRQoL outcomes. During treatment and follow-up, close attention has to be paid to the reintegration of the patients into daily life as well as to their physical abilities and emotional distress.

Highlights

IntroductionWith about 7000 new cases per year in Germany [1] and an incidence of around 5 per 100,000 in Europe [2]
Sarcomas are rare cancers, with about 7000 new cases per year in Germany [1] and an incidence of around 5 per 100,000 in Europe [2]
We reported stratified by sarcoma type and treatment intention the proportion of patients with clinically important symptoms and limitations (CIS + L) in the health-related quality of life (HRQoL) domains using the thresholds of Giesinger et al According to Giesinger et al the concept of clinically important symptoms and limitations was developed to meet “the need for well-defined, valid thresholds for the absolute scores on the EORTC QLQ-C30 based on external criteria reflecting the clinical importance of a health problem

Summary

Introduction

With about 7000 new cases per year in Germany [1] and an incidence of around 5 per 100,000 in Europe [2]. Preferred treatment modality for localized soft tissue sarcomas is surgery, often combined with (neo)adjuvant radiotherapy and/or (neo)adjuvant chemotherapy, depending on a variety of factors like tumor grade, histology and tumor location [4]. For bone sarcomas surgery is the first choice of treatment as well, in a variety of cases combined with chemotherapy and/ or radiotherapy [5]. For gastrointestinal stromal tumors (GIST) surgery and a variety of tyrosine kinase inhibitors (TKI) are the preferred treatment options, depending on type of mutation, tumor size and other factors [6]. For locally advanced or marginally resectable extremity soft tissue sarcomas isolated limb perfusion (ILP) can be considered [7]. Regional hyperthermia is an option for localized high-risk soft tissue sarcomas in addition to neoadjuvant chemotherapy [8]. Un-resectable metastatic sarcomas are often treated with palliative chemotherapy and/or radiotherapy [4]

Results

Discussion

Conclusion