Health related Quality of Life over time in German sarcoma patients. An analysis of associated factors - results of the PROSa study

Martin Eichler; Leopold Hentschel; Susanne Singer; Beate Hornemann; Stephan Richter; Christine Hofbauer; Peter Hohenberger; Bernd Kasper; Dimosthenis Andreou; Daniel Pink; Jens Jakob; Robert Grützmann; Stephen Fung; Eva Wardelmann; Karin Arndt; Kerstin Hermes-Moll; Olaf Schoffer; Marius Fried; Helena K Jambor; Jürgen Weitz; Klaus-Dieter Schaser; Martin Bornhäuser; Jochen Schmitt; Markus K Schuler

doi:10.3389/fendo.2023.1166838

Health related Quality of Life over time in German sarcoma patients. An analysis of associated factors - results of the PROSa study

Front Endocrinol (Lausanne). 2023 Aug 29:14:1166838. doi: 10.3389/fendo.2023.1166838. eCollection 2023.

Authors

Martin Eichler^{1

2

3

4

5}, Leopold Hentschel^{2

3

4

5}, Susanne Singer⁶, Beate Hornemann^{2

3

4

5}, Stephan Richter¹, Christine Hofbauer^{2

3

4

5

7}, Peter Hohenberger⁸, Bernd Kasper⁹, Dimosthenis Andreou^{10

11}, Daniel Pink^{12

13}, Jens Jakob^{8

14}, Robert Grützmann¹⁵, Stephen Fung¹⁶, Eva Wardelmann¹⁷, Karin Arndt¹⁸, Kerstin Hermes-Moll¹⁹, Olaf Schoffer^{2

3

4

5

20}, Marius Fried²¹, Helena K Jambor^{1

2

3

4

5}, Jürgen Weitz^{2

3

4

5

22}, Klaus-Dieter Schaser^{2

3

4

5

7}, Martin Bornhäuser^{1

2

3

4

5}, Jochen Schmitt^{2

3

4

5

20}, Markus K Schuler¹

Affiliations

¹ Clinic and Polyclinic for Internal Medicine I, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
² National Center for Tumor Diseases Dresden (NCT/UCC), Dresden, Germany.
³ German Cancer Research Center (DKFZ), Heidelberg, Germany.
⁴ Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
⁵ Helmholtz-Center Dresden-Rossendorf (HZDR), Dresden, Germany.
⁶ Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of Johannes Gutenberg University Mainz, Mainz, Germany.
⁷ University Center for Orthopedics and Trauma Surgery, Technical University Dresden, Dresden, Germany.
⁸ Division of Surgical Oncology & Thoracic Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
⁹ Sarcoma Unit, Mannheim Cancer Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany.
¹⁰ Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.
¹¹ Department of Orthopedics and Trauma, Medical University of Graz, Graz, Austria.
¹² Sarcoma Center Berlin-Brandenburg, Helios Hospital Bad Saarow, Bad Saarow, Germany.
¹³ Department of Internal Medicine C, University Hospital Greifswald, Greifswald, Germany.
¹⁴ Clinic for General, Visceral, and Pediatric Surgery, University Hospital Goettingen, Goettingen, Germany.
¹⁵ Clinic for Surgery, University Hospital Erlangen, Erlangen, Germany.
¹⁶ Clinic for General, Visceral, and Pediatric Surgery, University Hospital Dusseldorf, Dusseldorfn, Germany.
¹⁷ Gerhard-Domagk-Institute of Pathology, University Hospital Münster, Münster, Germany.
¹⁸ German Sarcoma Foundation, Woelfersheim, Germany.
¹⁹ Scientific Institute of Office-based Hematologists and Oncologists, Cologne, Germany.
²⁰ Center for Evidence-based Healthcare, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.
²¹ Clinic and Polyclinic for Internal Medicine III/University Cancer Center Mainz, University Hospital Mainz, Mainz, Germany.
²² Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany.

Abstract

Introduction: Sarcomas are rare cancers and very heterogeneous in their location, histological subtype, and treatment. Health-Related Quality of Life (HRQoL) of sarcoma patients has rarely been investigated in longitudinal studies.

Methods: Here, we assessed adult sarcoma patients and survivors between September 2017 and February 2020, and followed-up for one year in 39 study centers in Germany. Follow-up time points were 6 (t1) and 12 months (t2) after inclusion. We used a standardized, validated questionnaire (the European Organisation for Research and Treatment of Cancer Quality of Life Core Instrument (EORTC QLQ-C30) and explored predictors of HRQoL in two populations (all patients (Analysis 1), patients in ongoing complete remission (Analysis 2)) using generalized linear mixed models.

Results: In total we included up to 1111 patients at baseline (915 at t1, and 847 at t2), thereof 387 participants were in complete remission at baseline (334 at t1, and 200 at t2). When analyzing all patients, HRQoL differed with regard to tumor locations: patients with sarcoma in lower extremities reported lower HRQoL values than patients with sarcomas in the upper extremities. Treatment which included radiotherapy and/or systemic therapy was associated with lower HRQoL. For patients in complete remission, smoking was associated with worse HRQoL-outcomes. In both analyses, bone sarcomas were associated with the worst HRQoL values. Being female, in the age group 55-<65 years, having lower socioeconomic status, and comorbidities were all associated with a lower HRQoL, in both analyses.

Discussion: HRQoL increased partially over time since treatment and with sporting activities. HRQoL improved with time since treatment, although not in all domains, and was associated with lifestyle and socioeconomic factors. Bone sarcomas were the most affected subgroup. Methods to preserve and improve HRQoL should be developed for sarcoma patients.

Keywords: EORTC QLQ-C30; GIST; health-related quality of life; longitudinal observational cohort; patient reported outcomes; sarcoma.

Copyright © 2023 Eichler, Hentschel, Singer, Hornemann, Richter, Hofbauer, Hohenberger, Kasper, Andreou, Pink, Jakob, Grützmann, Fung, Wardelmann, Arndt, Hermes-Moll, Schoffer, Fried, Jambor, Weitz, Schaser, Bornhäuser, Schmitt and Schuler.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Bone Neoplasms* / therapy
Female
Humans
Male
Osteosarcoma*
Quality of Life
Sarcoma* / therapy
Soft Tissue Neoplasms* / epidemiology
Soft Tissue Neoplasms* / therapy

Grants and funding

The PROSa study was funded by the German Cancer Aid (No. 111713). ME, HJ, and MB received support by the German Cancer Aid, Mildred Scheel Early Career Center P². The Article Processing Charges (APC) were funded by the joint publication funds of the TU Dresden, including Carl Gustav Carus Faculty of Medicine, and the SLUB Dresden as well as the Open Access Publication Funding of the DFG.