Aggressive treatment of non-metastatic osteosarcoma improves health-related quality of life in children and adolescents

Abstract

Background

Health-related quality of life (HRQOL) of paediatric patients with osteosarcoma has not been documented longitudinally during treatment. Aims of this prospective study were to assess treatment effects on patients’ HRQOL at diagnosis, during therapy and after completion of therapy, to assess sex- and age-related differences in HRQOL ratings and to assess differences between patients’ and parents’ reports.

Patients and methods

Sixty-six patients (median age, 13.4 years) with newly diagnosed, localised disease completed three HRQOL instruments, and their parents completed two of the same instruments at diagnosis, before surgery (Week 12), at Week 23 and a median of 20 weeks after treatment completion.

Results

Significant improvements in most domains and worsening of nausea were reported by patients and parents from diagnosis to Weeks 12 and 23. Symptom distress decreased from diagnosis to Weeks 12 and 23 in 81% and 64% of patients, respectively. There were no sex- and few age-related differences in scores. Scores from patients and parents achieved good agreement.

Conclusions

The HRQOL of patients improves during aggressive treatment for non-metastatic osteosarcoma, except in the domain of nausea. Clinicians can use these findings to prepare their patients for the distressing symptoms that they will likely experience at certain time points and to provide reassurance that these will significantly improve.

Introduction

Advances in sarcoma treatments have improved disease outcomes, control of treatment-related symptoms and functional mobility.1, 2, 3, 4, 5 The 5-year survival rate for patients with sarcoma in general has improved from 50% for the reporting period of 1975–1984 to 63% for the period of 1985–1994.¹ The current 6-year survival rate for patients with localised osteosarcoma, the most common malignant bone tumour in children, is approximately 70%.⁶ These improved survival rates have facilitated the study of outcomes beyond disease response and treatment-induced toxicity to include aspects of the patient’s life that have meaning to the patient, i.e. the health-related quality of life (HRQOL). Incorporating HRQOL findings into treatment is theorised to improve patient/family–physician communication and satisfaction with care, to identify hidden morbidities in the treatment of paediatric illnesses and to facilitate treatment decision making.7, 8 Previous HRQOL research reports have not been specific to the illness or treatment experience of paediatric patients with osteosarcoma and have not followed patients through treatment. Instead, they have focused on adults with sarcoma or survivors of childhood sarcoma at a single time point,5, 9, 10, 11 combined data from adult and paediatric patients with osteosarcoma12, 13, 14, 15, 16 or summarised HRQOL data from patients with other types of sarcoma.2, 10, 17 Only one report included both patients’ and parents’ proxy HRQOL ratings¹⁸ and only two had longitudinal assessments of HRQOL (one based on maternal reports at the time of diagnosis and after completion of therapy,¹⁹ and the other based on patient reporting at the time of surgery and then annually for an average of 3 years²⁰). The aims of this prospective study were to assess the effect of treatment on patients’ HRQOL at the time of diagnosis, during therapy and after the completion of therapy; to assess whether differences in HRQOL ratings are associated with differences in sex and age and to compare patients’ and parents’ HRQOL reports.