(1) Compare QoL of sample to normal population (from previously published data), (2) compare QoL in LSS versus primary (1o) Amp versus secondary (2o) Amp (amputation following failed LSS), (3) qualitatively assess decision making and adaptation to 2o Amp, (4) Identify determinants of QoL
Comparing against normal population. QoL for sarcoma survivors significantly lower (); emotional functioning and mental health scores equal; physical function, physical role function, and social function very significantly different (). Comparing LSS versus Amp. QoL equal; LSS less likely to use gait aids; LSS better “daily competence” (TESS), which is more clearly associated with QoL than compared to Amp. Authors conclude that this is because LSS have higher expectations, whilst Amp more resigned to limitations. Daily competence was inversely proportional to age and males reported better physical functioning compared to females. Qualitative study on 2o Amp. 80% did not regret initial LSS and felt that was time gained to allow psychological adaptation to diagnosis and subsequent surgery. This group was associated with reporting that they were involved in decision-making process regarding the decision to amputate, that is, they had a sense of control. Conversely, the group who were not satisfied reported that they had no input into decision to amputate that is, they lacked a sense of control over the situation.
(1) Evaluate function and QoL in patients with extremity STS, comparing PreRT (higher complication rate) versus PostRT (higher likelihood of fibrosis) for wound complication outcomes, (2) To compare cohort’s SF-36 scores with that of the general population
Comparing RT timing. PreRT more likely to have wound complications requiring intervention (). Otherwise, timing of radiotherapy has no significant impact on function. Trajectory of rehabilitation. Decrease in function from baseline up to 6 weeks, gradual increase up to 6 months. Mean scores returned to baseline at 1 year. SF-36 followed above trend, except for social function, role emotional, and mental health subscales that gradually improved over time, with mean scores at 2-year mark being higher than baseline. Comparing to general population. Physical function, role physical, and general health significantly lower at all timepoints. Vitality social and mental health subscales approximated the referenced normal population at the 2-year mark. Mental health significantly lower up to 6 month postoperation mark. Tumour characteristics as determinants of outcome. MSTS change scores negatively predicted by lower limb tumour, large resection specimen, and motor nerve sacrifice TESS, SF-36, and bodily pain change scores negatively predicted by lower limb tumour and prior incomplete excision. Wound complications had the largest association with low MSTS and TESS scores.
Compare LSS versus Amp. Specific items analysed. ability to ambulate, climb stairs, drive, employment, sports participation Anxiety, drug dependence, depression, sleep problems, limitation of sexual performance, number of children, menstrual problems
Gait and mobility. LSS more likely to report a limp (). The more proximal the surgery, the more likely the patients required gait aids. A third of patients found difficulty with stairs. Drive. Almost all patients able to drive, independent of surgery. Sport. Males more likely to engage in sports than females but sport participation rate independent of surgery. No contact sports except 1 (kickboxing). Employment and social function. Males more likely than females to be employed and within males, employment more likely in LSS than Amp (). Marriage in LSS = Amp. Menstrual irregularities in LSS > Amp (; 89% of women) (perhaps secondary to chemotherapy). Active sex life Amp > LSS (; Amp. 88%, LSS 75%). Amp > LSS to have children (; Amp. 52%, LSS. 19%). Erectile dysfunction independent of surgery.
Mental health. 26% of Amp, 17% of LSS reported feeling periodically depressed. 26% of Amp, 22% of LSS reported anxiety. LSS = Amp for sleep disturbance, analgesic requirements, satisfaction, physical function, psychosocial outcomes, and use of gait aids. Overall satisfaction. longer followup correlated with more satisfaction.
Assess QoL and socioeconomic status versus normal population
No decrease in psychosocial adaptation and life contentment compared to normal population (significance values not presented). 12 patients (54.5%) stated that the operation had not affected the choice of profession. Rotationplasty patients were less contented with job and income but, otherwise, no significant difference. This suggests that rotationplasty is superior over amputation if LSS it not possible (however, it did not actually compare with amputation).
(1) Compare QoL of LSS versus Amp, (2) identify discriminants of Qol
QoL in LSS = Amp, MSTS scores better with LSS versus Amp; worse with increasing anatomical level of surgery (though significance not reported). Determinants of QoL. LSS. physical performance status with sports and recreational activities (the authors hypothesize that this is because in LSS the disability may not be apparent and, therefore, participation restriction and reintegration plays a key role in determinants of QoL); Amp: social acceptability (the authors hypothesize that this is due to the visible mutilation, there is a greater emphasis on facets of relationships and social support network) and good self-reported health.
Skaliczki 2005
Correlate function and QoL to type of resection, length of resection, type of prosthesis, and tumour site
No correlation between functional outcome and QoL with type of implant and length of resected bone. Patients with tumour in distal femur had significantly better functional and QoL outcomes than those with proximal tibial sarcoma. All patients displayed at least “good” emotional acceptance (“Enthusiastic” ) Most common complication was infection (11%).
Compare long-term physical function and psychological outcome between LSS versus Amp at 4 different anatomical levels (groups). Below knee (BK), above knee (AK), and hip and pelvis
Prevalence of depression and anxiety. BK group—depression. 17.6% (Amp) and 30.8% (LSS); anxiety. 11.8% (Amp) and 29.2% (LSS). AK group—depression. 40.9% (Amp) and 17.4% (LSS). Prevalence of unemployment and no participation in sport. BK group—unemployment. 47.4% (Amp) and 23.3% (LSS); no sport participation. 55% (Amp) and 46.7% (LSS). AK group—unemployment. 42.9% (Amp) and 33.6% (LSS); no sport participation. 61.3% (Amp), 60% (LSS). Comparing LSS and Amp. Equal functional and psychological outcomes at BK level. At AK level, anxiety in Amp > LSS 2.4 times (); Amp > LSS for limp (), use of walking aid () and ability to drive (0.05). Amp < LSS in terms of subjective muscle weakness (0/009). Amp = LSS for perception of good health, depression, and cosmetic deformity. The more proximal the level of LSS, the more subjective weakness was likely to be reported (), the more likely was a limp reported () and the less likely was a prosthetic used (0.033).
Evaluate how functional disability impacts on HRQoL at 1-year postoperative mark by assigning tools to the categories of (1) impairment (MSTS87), (2) activity limitation (TESS), and (3) participation restriction (RNL), using HRQoL as the outcome (EQ-VAS). Sample was adjusted for demographic and clinical variables and subject to further analysis
Mean MSTS = 30.5 (=87.3%), TESS = 88.4, RNL = 97.7, EQ-VAS = 80.5; reexcision rate = 37%. All tools correlated with each other. Determinants of QoL. when unadjusted for demographic and clinical variables, for example, complications (wound or nerve/vessel—not graded), MSTS most impact on EQ-VAS. When adjusted. gender significantly impacted on participation restriction; complications impacted on activity limitation and participation and restriction. MSTS not significantly associated with EQ-VAS; RNL (participation restriction) was only factor that was significantly associated with EQ-VAS. Concluded that whilst impairment and activity limitations affect activities of daily living, restriction in participation of life roles and situations (e.g., employment or leisure activities) has the greatest effect on HRQoL No association found between radiotherapy (not specified if neoadjuvant or adjuvant) and functional outcome. Personality factors on self-reported QoL. Level of optimism did not significantly predict QoL.
(1) QoL in STS survivors versus normal population (age matched 2006 Dutch population); (2) identify determinants of QoL and posttraumatic stress symptoms (PTSS)
Comparing to normal population. STS < normal for physical function () and role limitation due to physical problems (). Employment associated with less pain (). Educational level and having a partner not related to QoL or PTSS. Amp versus LSS. Amp < LSS for physical and social function (, ), more role limitations due to physical and emotional problems (, ) Otherwise, Amp = LSS. Prevalence of PTSS. No Amp patients displayed clinically significant PTSS compared to 26.7% of LSS patients (20.5% of total cohort). Role of tumour characteristics. Patients who developed metastases had worse physical functioning (), more role limitations due to physical () and emotional () problems. Role of involvement in decision making process. Patients who indicated that choice of treatment was dictated by the surgeon only showed significantly decreased social functioning (), more role limitation and intrusion (). Higher satisfaction significantly associated with less intrusion () and lower IES scores (), with better social functioning (), more vitality (), and better health perception (). Determinants of satisfaction. (1) Matching of preoperative expectation with postoperative outcomes, (2) outcomes better than expected, or (3) Absence of pain.
(1) Identify prevalence of psychological distress and PTSS in long-term survivors, (2) compare prevalence of psychological distress with that in the normal reference population according to published data in 1993
77% of the cohort displayed significant psychological distress. 12% of the cohort met criteria for PTSD. IES correlated with GSI. Male gender = risk factor for untreated psychological distress. Compared to women, men more likely to display significant psychological distress, have higher IES and avoidance scores (, , 0 < 0.01, resp.). Compared to normal population, men had higher GSI scores and displayed more intrusion (, ). GSI scores similar to psychiatric patients. Reintegration and its association with long-term psychological distress. 24% of participants reported trouble with keeping up with school/job requirements following treatment. They scored higher on GSI, PST, and avoidance (all ). Employment. 65% employment rate. Unemployed people more likely to score higher on GSI (). Effect of tumour characteristics on mental health. Recurrence showed a trend towards higher GSI scores (86% versus 56%). Age, stage of disease, and time since diagnosis were independent of psychological distress. Cognitive adaptation. 94% of participants stated that they felt they were a better person today as a result of the experience of sarcoma. Social adaptation. Patients who had difficulty maintaining friendships during treatment reported more intrusion () and avoidance ().
(1) Evaluate long-term functional outcome following surgery for osteosarcoma or Ewing’s sarcoma. (2) Identification of determinants of QoL, for example, by examining if impaired function influenced QoL and ability to work. (3) Compare QoL and psychological distress with normal population
Median MSTS = 70% (17–100%); Amp < LSS; ; median TESS = 89% (43–100%); LSS = Amp; . Resection level. Above knee amputees lower MSTS and TESS; , , respectively, compared to below knee tumours. Comparing Amp with LSS. Amp = LSS except for physical functioning, bodily pain, and physical component summary scale. Correlates with MSTS ≤ 50%. Lower scores in physical components of SF-36 () and emotional role functioning (). Employment. 31% involved in a physically demanding job. Half of the patients believed that the cancer had influenced their choice of education or job. Controlling for age at diagnosis and type of surgical treatment, these people had poorer MSTS, TESS, and SF-36 scores ( and , resp.). Activity participation. 84% considered physically active. LSS = Amp and independent of MSTS score. Chronic muscular pain or stiffness people more likely to be physically inactive; .
(1) To examine the impact of preoperative outcome expectations on postoperative function and QoL. (2) To identify determinants of outcome expectations
Complications (Grade 3 and above) occurred in 23%, of which, 91% were wound-related complications. Role of expectations. A significant proportion of people did not know what to expect regarding length of recovery (28%), complications (27%), and difficulties with daily activities (20%). Uncertain expectations were associated with poorer outcome () Pessimism and low educational attainment were associated with uncertain outcomes This may be mediated through self-efficacy beliefs versus underlying cognitive processing underpinning the two versus external confounders, for example, psychological distress affecting both.
(1) Describe prevalence of depression and anxiety according to phase of treatment in a cross-sectional study, (2) identify determinants of adjustments in different phases of disease
Majority of patients had limb sparing surgery
. 23.8% in treatment group and 8.3% in follow-up group had amputation. Moderate to severe anxiety most prevalent in the Dx (29.3%), followed by Rx (25%) and Fx (21.3%). Difference not significant between groups. Patients diagnosed for a longer time and patients who terminated treatments for a longer time had showed lower anxiety levels (perhaps reflecting that the emotional distress is normal transitory and allows for adjustment). Moderate to severe depression most prevalent in Rx (19.4%)—females had an increased depression score, followed by Diagnosis phase (19%) and Follow-up phase (6.6%). Difference was not significant between groups. Older patients had higher levels of depression (perhaps reflecting other stressors), whilst depressive symptoms abated with time since treatment. Determinants of psychological distress. Dx—presenting status ( for depression, for anxiety); recurrence of disease ( for anxiety, for depression). Rx—females more likely to have depression (). Fx—time since diagnosis and time since completion of treatment were negatively correlated with anxiety (, , resp.), whilst older age and less time since completion were associated with depression (, , resp.).
