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      Soft Tissue Sarcoma of Lower Extremity: Functional Outcome and Quality of Life

      research-article
      , MD 1 , 2 , 3 , , , MD, PhD 2 , , MD, PhD 1 , , MD, PhD 4 , 5 , , MD, PhD 1
      Annals of Surgical Oncology
      Springer International Publishing

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          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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          Most cited references39

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          The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

          In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient > or = .70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials.
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            Interpreting the significance of changes in health-related quality-of-life scores.

            To determine the significance to patients of changes in health-related quality-of-life (HLQ) scores assessed by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30).
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              The 15D instrument of health-related quality of life: properties and applications.

              The 15D is a generic, comprehensive, 15-dimensional, standardized, self-administered measure of health-related quality of life (HRQoL) that can be used both as a profile and single index score measure. This paper examines the acceptability, reliability, validity, discriminatory power and responsiveness to change of its health state descriptive system and valuation system and presents some examples of applications. As a profile measure on roughly comparable dimensions the 15D performs equally well as the Nottingham Health Profile (NHP) and SF-20, in some respects even better, and clearly better than EQ-5D. The remaining nine to ten dimensions of the 15D provide a large reserve in terms of discriminatory power and responsiveness to change. The valuation system is based on an application of the multiattribute utility theory. The single index score (15D score) on a 0-1 scale, representing the overall HRQoL, is calculated from the health state descriptive system by using a set of population-based preference or utility weights. The 15D scores are shown to be highly reliable, sensitive and responsive to change, generalisable at least in Western-type societies, and particularly valid for deriving quality-adjusted life years (QALYs) gained for resource allocation purposes. The instrument is recommended by the Washington Panel and is available in several languages for clinical economic evaluation and population studies.
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                Author and article information

                Contributors
                gilber.kask@hus.fi
                mrjussirepo@gmail.com
                erkki.tukiainen@hus.fi
                Carl.Blomqvist@hus.fi
                ian.barner-rasmussen@hus.fi
                Journal
                Ann Surg Oncol
                Ann Surg Oncol
                Annals of Surgical Oncology
                Springer International Publishing (Cham )
                1068-9265
                1534-4681
                19 March 2021
                19 March 2021
                2021
                : 28
                : 11
                : 6892-6905
                Affiliations
                [1 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Department of Plastic Surgery, , Helsinki University Hospital and University of Helsinki, HUS, ; Helsinki, Finland
                [2 ]GRID grid.412330.7, ISNI 0000 0004 0628 2985, Tampere University Hospital, Department of Orthopaedics and Traumatology, , Unit of Musculoskeletal Surgery, ; Tampere, Finland
                [3 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Department of Orthopaedics and Traumatology, , Helsinki University Hospital and University of Helsinki, ; Helsinki, Finland
                [4 ]GRID grid.15485.3d, ISNI 0000 0000 9950 5666, Comprehensive Cancer Center, , Helsinki University Hospital and University of Helsinki, HUS, ; Helsinki, Finland
                [5 ]GRID grid.412367.5, ISNI 0000 0001 0123 6208, Department of Oncology, , Örebro University Hospital, ; Örebro, Sweden
                Author information
                http://orcid.org/0000-0001-8533-6272
                http://orcid.org/0000-0002-4688-5698
                http://orcid.org/0000-0001-6294-4988
                Article
                9774
                10.1245/s10434-021-09774-6
                8460521
                33740199
                0c66d6b5-b8e3-4ea9-82db-238c11c73c56
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 14 October 2020
                : 24 January 2021
                Funding
                Funded by: University of Helsinki including Helsinki University Central Hospital
                Categories
                Sarcoma
                Custom metadata
                © Society of Surgical Oncology 2021

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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