The unmet needs of patients with sarcoma

Post-treatment late and long-term effects in bone sarcoma: A scoping review

Despite the fact that chemotherapy for bone sarcomas (e.g. Ewing sarcoma, osteosarcoma) has well-reported toxicities and that surgical intervention is frequently life altering, follow-up care to monitor for late and long-term effects beyond that of oncological surveillance in former patients is variable. Anecdotal evidence suggests that inconsistent follow-up means some former bone sarcoma patients are left to cope with post-treatment late and long-term effects with limited support. Here, we performed a scoping review to provide a more empirical identification of the knowledge gaps and to provide an overview of the peer reviewed academic literature reporting the late and long-term effects of treatment for bone sarcoma. JBI Scoping Review Network guidelines for charting, analysis and data extraction were followed. Literature searches were conducted in Medline (Ovid), Cochrane CENTRAL, EMBASE (Ovid), CINAHL, PsycINFO, Proquest and Web of Science (Clarivate Analytics) from March 2024 to September 2024. Paper titles and abstracts were screened by two independent reviewers followed by full text analysis by the lead researcher. Seventy-four peer reviewed articles were included in the analysis. Most studies were of a retrospective study design, some up to 20 years of follow-up and included chemotherapy, surgery and sometimes radiotherapy as the treatment modality. Our analysis identified secondary malignancies, cardio- and nephrotoxicity, lower bone mineral density and microarchitectural deterioration, cancer related fatigue and motor neuropathies as the major physical late and long-term effects requiring dedicated follow-up. In some cases, follow-up may need to span decades, especially given the increasing population of former patients. Our results form the evidence-based foundations for future work that might include late and long-term effect follow-up service mapping exercises and expanded clinical recommendations.

Experiences and needs of patients with sarcoma: a qualitative meta-synthesis

PURPOSE

To systematically identify, summarize, and synthesize qualitative evidence on the experiences and needs of patients living with sarcoma, providing insights into their multidimensional challenges.

METHODS

This qualitative meta-synthesis follows the ENTREQ guidelines. Seven electronic databases (PubMed, Web of Science, Scopus, Embase, Cochrane Library, CINAHL, and PsycINFO) were searched up to November 2024. Two reviewers independently conducted the study screening and data extraction. The quality was evaluated using the Joanna Briggs Institute's Qualitative Research Standard Assessment tool. Thematic analysis was used for data synthesis.

RESULTS

Twenty-seven studies were included in this meta-synthesis. Three analytical themes emerged: (1) "Self-perceived health challenges after diagnosis" highlighting the physical and emotional challenges faced by patients; (2) "Mixed experiences during social interactions" reflecting the complex dynamics in relationships with friends, family, and healthcare providers; and (3) "Unfriendliness in the society towards sarcomas" emphasizing societal barriers such as employment limitations, financial burdens, and stigma.

CONCLUSIONS

Sarcoma patients face significant challenges that extend beyond the individual health condition, impacting their interpersonal relationships and social wellbeing. A comprehensive understanding of the experiences and needs of sarcoma patients on their disease journey can help provide effective management for patients with this rare disease. Addressing these challenges requires a holistic approach involving healthcare providers management, organizational change, community support, and public policy reform.

Factors influencing functional recovery after limb-salvage surgery for lower extremity musculoskeletal tumours: a qualitative study combining patients' and healthcare professionals' perspectives

PURPOSE

Survival rates of lower extremity musculoskeletal tumours (LEMTs) have been increasing. However, patients continue to experience functional limitations after LEMT followed by limb-salvage surgery (LSS). This study aimed to identify factors influencing functional recovery after LSS for LEMT.

METHODS

A qualitative study was conducted using semi-structured interviews with a purposive sample of adult patients who underwent LSS for LEMT (n=7) and healthcare professionals (HCPs) with expertise in orthopaedic oncology (n=7). Recruitment continued until data saturation. A combination of deductive and inductive qualitative content analysis was performed to analyse the transcribed data, producing subthemes under the main International Classification of Functioning, disability and health (ICF)-model domains.

RESULTS

Four themes were described: (1) bodily functions and structures, (2) activities and participation, (3) environmental factors, and (4) expectations. Physical aspects such as larger resection size and complications negatively affected recovery. The importance of communication strategies of tertiary HCPs and the unfamiliarity of the primary physical therapists with the disease, its surgical treatment, and related consequences were emphasised by both the interviewed patients and HCPs.

CONCLUSIONS

Functional recovery after LSS for LEMT is a multifactorial process. To improve patient care, improving (intercollegiate) communication strategies on treatment details and expectations about functional outcomes is warranted.

Examining unmet needs in older adults with lung cancer: A systematic review and narrative synthesis

INTRODUCTION

Unmet needs in the older population with cancer are complex due to aging-related health conditions. A review of unmet needs in older people with cancer showed that needs varied among different cancer types. In lung cancer, a higher incidence of geriatric syndromes and comorbidities exist compared to other cancer cohorts, impacting treatment tolerance and completion. Consequently, it is crucial to identify and understand unmet needs to address supportive care needs beyond cancer diagnosis and treatment. This systematic review aims to synthesise the available literature to analyse the number and nature of unmet needs experienced by older patients with lung cancer.

MATERIALS AND METHODS

We performed a systematic search following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, which was registered in PROSPERO(CRD42022311105). We searched CINAHL, Medline, Embase, and Scopus electronic databases for published literature (January 2002 to November 2023) on unmet needs of patients ≥65 years diagnosed with lung cancer. We used a narrative synthesis approach to summarise the results and identify themes.

RESULTS

The search yielded 1356 articles, of which 35 met the inclusion criteria. A significant portion of older patients with lung cancer reported experiencing unmet needs, ranging from 78 % to100 %. Compared to other cancer streams, older patients with lung cancer experienced a higher burden of unmet needs, with a mean of seven unmet needs per person. Most studies identified psychological and physical/daily living domains as having the greatest prevalence and highest burden of unmet need.

DISCUSSION

Increased psychological distress and poorer quality of life correlated with increased unmet needs. Identifying and addressing unmet needs is critical for patient wellbeing and should be prioritised when developing models of care and tailored interventions for older people with lung cancer.

Exploring patient experience of rehabilitation within the surgical pathway for lower limb soft tissue sarcoma in the UK: a single-centre study

PURPOSE

The primary treatment for localised soft tissue sarcoma (STS) is surgery. Surgery for lower limb sarcoma is associated with poorer functional outcomes than other anatomical sites. Rehabilitation is essential, yet provision is not standardised, and patient experience of current service delivery is unknown. This study therefore aimed to explore patients' experiences of rehabilitation in the surgical pathway for lower limb STS at a United Kingdom (UK) specialist centre.

METHODS

A qualitative, descriptive phenomenological study was undertaken to explore patients' rehabilitation experiences. Eight patients who had undergone lower limb STS surgery at a specialist centre were purposively sampled. Data were collected through semi-structured interviews and analysed using thematic analysis.

RESULTS

Three main themes were identified: (1) Accessing the right services at the right time. Participants described good access to inpatient rehabilitation post-operatively but delays and challenges in accessing local services affected continuity of care. Rehabilitation gaps pre-operatively, and in facilitating return to meaningful activities, were described; (2) "Communication is key" - providing knowledge and support to navigate uncertainty. Unclear and unrealistic expectations of recovery were challenging. Communication was key to patients feeling supported and facilitating access to rehabilitation; (3) The importance of person-centred rehabilitation. Collaborative, person-centred rehabilitation optimised motivation and engagement.

CONCLUSION

Participants experienced good access to inpatient rehabilitation post-operatively. In contrast, gaps and delays at other timepoints led to missed opportunities to support preparation for, and recovery from, surgery. A multidisciplinary approach across settings from diagnosis, to deliver person-centred rehabilitation, may improve access, expectation management and continuity of care.

Pediatric Ewing Sarcoma Presentation, Treatment, and Outcomes Across Sociodemographic Groups

INTRODUCTION

In this study, we evaluate the association between sociodemographics and disease presentation, treatment, and survival for children, adolescents, and young adults with Ewing sarcoma.

METHODS

Case-level data were downloaded from The Surveillance, Epidemiology, and End Results database. Cases included patients ages 0-24 who were diagnosed with Ewing sarcoma between 2004 and 2020.

RESULTS

One thousand two hundred forty four patients were included in the analysis. When compared to non-Hispanic White (NHW) patients, Hispanic patients were more likely to present with tumors ≥8 cm (odds ratio (OR) = 1.71, 95% confidence interval (CI) = 1.24-2.36) and metastases (OR = 1.65, 95% CI = 1.23-2.20). Black patients were less likely to receive chemotherapy (OR = 0.25, 95% CI = 0.07-0.97). The 5-year disease-specific survival rate was 73% for NHW patients, 65% for Black patients, 67% for Asian patients and 66% for Hispanic patients. When accounting for confounding factors, Hispanic and Asian patients had higher probabilities of death due to cancer compared to NHW patients (HR = 1.41, 95% CI = 1.10-1.81; HR = 1.64, 95% CI = 1.09-2.48, respectively). Young adults and adolescents were significantly more likely to present with metastases, experience ≥1 month between diagnosis and treatment, and had lower survival.

CONCLUSIONS

Significant differences in Ewing sarcoma presentation, treatment, and survival were observed across age groups and race/ethnicity. Future work should focus on expanding access to care in underserved groups. Further qualitative studies could assist in determining the exact factors that prevent patients from accessing care or examine how genetic factors that contribute to Ewing sarcoma severity differ across demographic groups.

Promise and Perils of Precision Oncology for Patients With Pediatric and Young Adult Sarcomas

The completion of multiple national pediatric precision oncology platform trials and the incorporation of standardized molecular profiling into the diagnostic care of pediatric and young adult patients with sarcomas have proven the feasibility and potential of the approach. In this work, we explore the current state of the art of precision oncology for pediatric and young adults with sarcoma. We highlight important lessons learned and the challenges that should be addressed in the next generation of trials. The chapter outlines current efforts to improve standardization of molecular assays, harmonization of data collection, and novel molecular tools such as cell-free DNA analyses. Finally, we discuss the impacts and psychosocial outcomes experienced by patients and communication strategies for providers.

Oxford Spine Buddies: an acceptability and feasibility project for peer-to-peer support in a spine sarcoma service

BACKGROUND

Primary bone and soft tissue sarcoma of the spine are rare and account for less than 0.2% of all neoplasm incidences. Following a patient and public involvement event, the need to explore patient support pathways was identified, which initiated this service evaluation project.

AIM

To determine the acceptability and feasibility of a peer-to-peer support project among people using the spine sarcoma service.

METHODS

Users were paired and introduced via Microsoft Teams. Quantitative and qualitative data both pre- and post-introduction of a buddy were collected.

FINDINGS

Service users felt that, although they would have preferred having a buddy at the time of their diagnosis, being allocated a buddy made them feel reassured and better supported.

CONCLUSION

The project was well received and preliminary data are encouraging. Therefore, due to early findings from the first participants, the service is continuing to roll out the buddy programme.

Understanding quality of life's challenges in sarcoma patients: A mixed-methods study

PURPOSE

Sarcoma, a highly aggressive form of cancer, profoundly affects patients both physically and psychologically. This study aimed to assess sarcoma patients' health-related quality of life and explore their experiences of living with the disease and their specific care requirements.

METHODS

This research employed a convergent parallel mixed-methods design. Fifty-two sarcoma patients completed the European Portuguese version of the EORTC QLQ-C30 questionnaire, and seven of them participated in semi-structured interviews. Descriptive measures, Cronbach alpha for internal consistency, t-teste-Anova and stepwise regression were employed in the quantitative analysis. Qualitative data was analysed thematically.

RESULTS

The most affected Quality of life (QoL) dimensions were role functioning and global health, areas of functioning that were also described as impacted in patients' experiences. Symptoms like insomnia, pain, and fatigue were frequently reported. Symptoms such as fatigue, pain, and financial difficulty explain QoL variance. No significant differences in QoL were found according to the different forms of treatment. Analysis of the interviews revealed three overarching themes: (1) disruption of daily life, (2) adaptation to life with sarcoma, and (3) the demand for more personalized care, allowing to gain a deeper understanding of living with sarcoma.

CONCLUSION

The results underscore the significance of delivering care that enhances the quality of life for sarcoma patients, addressing both their physical and psychosocial needs, and providing personalized support throughout all stages of the disease.

The experience of a program combining two complementary therapies for women with breast cancer: An IPSE qualitative study

INTRODUCTION

The use of complementary therapies within oncology is a clinical issue, and their evaluation a methodological challenge. This paper reports the findings of a qualitative study exploring the lived experience of a French program of complementary therapies combining structured physical activity and MBSR among women with breast cancer.

METHODS

This French exploratory qualitative study followed the five stages of the Inductive Process to analyze the Structure of lived Experience (IPSE) approach. Data was collected from February to April 2021 through semi structured interviews. Participants, purposively selected until data saturation. Inclusion criteria were: being an adult woman with breast cancer whatever the stage who had completed their treatment and were part of the program of complementary therapies.

RESULTS

29 participants were included. Data analysis produced a structure of experience based on two central axes: 1) the experience these women hoped for, with two principal expectations, that is to take care of their bodies and themselves, and to become actors in their own care; and 2) an experience of discovery, first of themselves and also in their relationship with the exterior, whether with others, or in society, and in the relationships with health-care providers.

CONCLUSIONS

Our results from this French study reinforce the data described in other western countries about the needs of women receiving care in oncology departments for breast cancer: they need to be informed of the existence of supportive care in cancer by the health-care professionals themselves, to be listened to, and to receive support care. A systematic work of reflexivity about this redundancy in our results and in the qualitative literature, led us to question what impeded the exploration of more complex aspects of the experience of this women-the inherently emotional and anxiety-inducing experience of cancer, especially anxiety about its recurrence and of death-and to suggest new research perspectives to overcome these methodological and theoretical obstacles.

Development and preliminary testing of a questionnaire to measure mobile health information-seeking behaviour in people with cancer

AIM

The aim of the study was to develop and psychologically test the mobile health information-seeking behaviour (MHISB) questionnaire in people with cancer.

DESIGN

Instrument development.

METHODS

The study was conducted in three phases in a southeastern city of China from May 2017 to April 2018. In phase one, an item pool was constructed based on a literature review and semistructured interviews. In phase two, expert evaluation and cognitive interviews were used to evaluate the content validity of the questionnaire. In phase three, a cross-sectional study was conducted with people with cancer. Cronbach's α was calculated for reliability analysis. Validity evaluation included content validity and construct validity.

RESULTS

The developed MHISB questionnaire has four dimensions (information-seeking frequency, information-seeking self-efficacy, health information evaluation and information-seeking willingness) and 25 items. Psychometric findings were satisfactory and supported the questionnaire's reliability.

CONCLUSIONS

The construction process of the MHISB questionnaire was scientific and feasible. The MHISB questionnaire had acceptable validity and reliability, and it requires further improvement in future studies.

[Care provided by an advanced practice nurse: Experiences of patients with sarcoma and family members. A qualitative study]

Care provided by an advanced practice nurse: Experiences of patients with sarcoma and family members. A qualitative study Abstract. Background: Sarcomas are a rare, heterogeneous group of malignant tumors with different trajectories, which cause significant burden to patients and families. Due to the complex nature of treatment, an interprofessional team at the sarcoma center of a Swiss university hospital provides care to affected individuals. This interprofessional team includes an advanced practice nurse (APN) who cares for patients and family members throughout the trajectory of the disease. To date, there are limited descriptions within literature of APN care from the perspective of patients with sarcoma and their family members. Aim: To investigate how patients with sarcoma and their family members experienced APN care. Methods: The study was guided by the qualitative research methodology "Interpretive Description". Individual interviews with seven patients and five family members were conducted and analyzed in an iterative process. Results: For patients and family members, the time from diagnosis to therapy and follow-up was very stressful. They experienced the APN's care during this time as a great support and described her as a compassionate, trustworthy and continuous contact person who expertly provided information and advice while acting as a coordinator. Conclusions: Patients with sarcoma and their family members require continuous contact with a person who is compassionate, while also professional, confident and competent. Providing APN care can meet all of these essential requirements.

Understanding Patient Experience with Outpatient Cancer Rehabilitation Care

BACKGROUND

Understanding patient experience is key to optimize access and quality of outpatient cancer rehabilitation (physical or occupational therapy, PT/OT) services.

METHODS

We performed a retrospective mixed-method analysis of rehabilitation medical record data to better understand patient experience and aspects of care that influenced experience. From the medical record, we extracted case characteristics, patient experience data (Net Promoter Survey^®, NPS) and patient-reported outcome (PRO) data. We categorized cases as 'promoters' (i.e., highly likely to recommend rehabilitation) or 'detractors', then calculated NPS score (-100 [worst] to 100 [best]). We identified key themes from NPS free-text comments using inductive content analysis, then used Pearson [r] or Spearman [ρ] correlation to explore relationships between NPS, characteristics, and PRO improvement.

RESULTS

Patients (n = 383) were 60.51 ± 12.02 years old, predominantly women with breast cancer (69.2%), and attended 14.23 ± 12.37 visits. Most were 'promoters' (92%); NPS score was 91.4. Patients described two experiences (themes) that influenced their likelihood to recommend rehabilitation: (1) feeling comfortable with the process and (2) observable improvement in health/functioning, and described attributes of clinic staff, environment and clinical care that influenced themes. Likelihood to recommend rehabilitation was associated with achieving the minimal clinical important difference on a PRO (ρ = 0.21, p < 0.001) and cancer type (ρ = 0.10, p < 0.001).

CONCLUSION

Patients who received specialized cancer PT/OT were highly likely to recommend rehabilitation. Feeling comfortable with the rehabilitation process and making observable improvements in health and/or functioning influenced likelihood to recommend. Rehabilitation providers should leverage the findings of this study optimize access to and quality of cancer rehab services.

"You either sink or you swim, and you're better off swimming": A qualitative study exploring the self-management experiences of soft tissue sarcoma survivors

PURPOSE

To qualitatively explore the consequences of soft tissue sarcoma and its treatment experienced by survivors, the self-management strategies they use to deal with these consequences, and any factors that may act as barriers or facilitators to their self-management.

METHODS

Semi-structured interviews were conducted with seven soft tissue sarcoma survivors who had completed their primary treatment. Interviews were audio-recorded, transcribed and thematically analysed.

RESULTS

Physical, psychological and social consequences of soft tissue sarcoma and its treatment were identified, with side-effects, physical restrictions, body image issues, fear of recurrence, feeling depressed, familial relationships and sexual activity being the most frequently reported. Nine different types of self-management strategy encompassing eighteen specific strategies were identified, including cognitive strategies, lifestyle changes and utilisation of resources. Personal, social and environmental facilitators of self-management were identified; being in a relationship, being at an appropriate life stage, and having support from family, friends and medical staff were most commonly reported. Finally, personal and environmental barriers to self-management included the adaptation period, ongoing complications, rareness of sarcoma and poor patient-healthcare provider communication.

CONCLUSIONS

The findings of this study suggest that soft tissue sarcoma survivors, especially those who are younger and experience physical limitations, may find the immediate post-treatment period particularly challenging and may benefit from nurse-led self-management support.

Unmet supportive care needs of patients with rare cancer: A systematic review

OBJECTIVE

Patients with rare cancers may experience different unmet needs than those with common cancer. The objective of this systematic review was to (1) investigate unmet supportive care needs of rare cancer patients throughout the disease trajectory and (2) identify predictive factors for these unmet needs.

METHODS

PubMed, PsycINFO and CINAHL were searched for publications (January 2011 to March 2021) focusing on unmet needs of patients with rare cancer. Two reviewers independently selected studies, extracted data and performed quality assessment. Findings were synthesised.

RESULTS

The search yielded 4,598 articles, of which 59 articles met eligibility criteria and 57 were of medium or high quality. Rare cancer patients most frequently reported unmet needs in the healthcare system and information domain (up to 95%), followed by the psychological domain (up to 93%) and the physical and daily living domain (up to 80%). Unmet needs were mainly reported in the posttreatment phase. The most frequently identified predictors were higher anxiety, younger age and higher neuroticism.

CONCLUSION

Patients with rare cancer have unmet needs throughout their disease trajectory. Supportive care needs of rare cancer patients should be addressed individually, depending on the rare cancer subdomain and phase of disease and from diagnosis onwards.

"We're on a Merry-Go-Round": Reflections of Patients and Carers after Completing Treatment for Sarcoma

Sarcoma is a rare cancer that has a significant impact on patients’ and carers’ quality of life. Despite this, there has been a paucity of research exploring the diverse experiences of patients and carers following sarcoma treatment. The aim of this study was to explore patients’ and carers’ reflections on life after treatment for sarcoma. A qualitative research design with a social constructionist epistemology was used. Participants included patients previously treated for sarcoma (n = 21) and family carers of patients treated for sarcoma (n = 16). Participants completed semi-structured interviews which were analysed using thematic analysis. Three primary themes were identified: “This journey is never going to be over”, “But what happens when I am better?”, and finding a silver lining. Participants represented sarcoma as having a long-term, and sometimes indefinite, threat on their life that they had limited control over. Conclusions: This study highlight the heterogeneous and ongoing needs of sarcoma survivors and their families. Patients and carers strove to translate their experiences in a meaningful way, such as by improving outcomes for other people affected by sarcoma. Parental carers in particular attempted to protect the patient from the ongoing stress of managing the disease.

Financial toxicity in sarcoma patients and survivors in Germany: results from the multicenter PROSa study

Purpose

Cancer patients have been shown to frequently suffer from financial burden before, during, and after treatment. However, the financial toxicity of patients with sarcoma has seldom been assessed. Therefore, the aim of this study was to evaluate whether financial toxicity is a problem for sarcoma patients in Germany and identify associated risk factors.

Methods

Patients for this analysis were obtained from a multicenter prospective cohort study conducted in Germany. Using the financial difficulties scale of the EORTC QLQ-C30, financial toxicity was considered to be present if the score exceeded a pre-defined threshold for clinical importance. Comparisons to an age- and sex-matched norm population were performed. A multivariate logistic regression using stepwise backward selection was used to identify factors associated with financial toxicity.

Results

We included 1103 sarcoma patients treated in 39 centers and clinics; 498 (44.7%) patients reported financial toxicity. Sarcoma patients had 2.5 times the odds of reporting financial difficulties compared to an age- and sex-matched norm population. Patient age < 40 and > 52.5 years, higher education status, higher income, and disease progression (compared to patients with complete remission) were associated with lower odds of reporting financial toxicity. Receiving a disability pension, being currently on sick leave, and having a disability pass were statistically significantly associated with higher odds of reporting financial toxicity.

Conclusion

Financial toxicity is present in about half of German sarcoma patients, making it a relevant quality of life topic for patients and decision-makers.

"It's Always Been a Second Class Cancer": An Exploration of the Experiences and Journeys of Bereaved Family Carers of People with Sarcoma

Sarcomas are a group of rare and aggressive cancers, which develop in bones and connective tissue throughout the body. Sarcomas account for only 1-2% of all cancers worldwide; however, mortality rates for sarcoma are high with approximately two in four sarcoma patients dying following a diagnosis. Delays in diagnosis, poor management of symptoms, patients' high symptom loads and high carer burden are all associated with carer distress, which may lead to complications after bereavement. The experience of having a family member referred for palliative care is also distressing for carers, with the realisation that their family member is dying. This study aimed to explore the experiences of bereaved family carers of people diagnosed with sarcoma. A qualitative descriptive design using a social constructionist framework was adopted. Interviews were conducted with sixteen participants, and thematic analysis was used to identify patterns in the data. Four overarching themes emerged: beginning the journey; moving through treatment; transitioning to palliative care; and experiencing bereavement. The narratives were coherent and potent, and people reflected on their journeys. Interventions and supports for bereaved carers could include opportunities for counselling to support reflections, supports for developing a narrative such as writing therapy, and preparation for the death of the family member.

The unmet needs of carers of patients diagnosed with sarcoma: A qualitative study

OBJECTIVE

Sarcoma is a rare cancer that may result in reduced mobility, social isolation, poorer mental health, and ongoing medical issues for patients. Family carers play a crucial role in supporting patients throughout their sarcoma journey. Despite the aggressive and debilitating nature of the disease, the unmet needs of these carers are yet to be explored. The aim of this study was to explore the unmet needs of carers of patients diagnosed with sarcoma.

METHODS

An exploratory qualitative research design with a social constructionist epistemology was used. Participants were carers of patients diagnosed with a sarcoma (n = 33). Semi-structured interviews were conducted with carers of patients who completed treatment for sarcoma and also bereaved carers (BC). Interviews were transcribed verbatim and analysed using thematic analysis.

FINDINGS

Four overarching themes were identified: support with medical aspects of caregiving, support for self, needing information about the patient, and financial support. Participants recognised that they needed psychosocial support, however, many were reluctant to access support as they perceived this to be prioritising their own needs instead of the patients'. They also needed more information about the patients' disease and how to navigate the health system.

CONCLUSIONS

Family carers for patients with sarcoma have onerous responsibilities that affect their ability to access care for themselves and their family. Providing more holistic patient care and carer-specific information and training could reduce carer burden. Establishing support groups specific to carers and BC of patients diagnosed with sarcoma could provide opportunities for social interaction and psychosocial support.

The complexity of diagnosing sarcoma in a timely manner: perspectives of health professionals, patients, and carers in Australia

Background

Prolonged diagnosis intervals occur more often in rare cancers, such as sarcoma. Patients with a delayed diagnosis may require more radical surgery and have a reduced chance of survival. Previous research has focused on quantifying the time taken to achieve a diagnosis without exploring the reasons for potential delays. The aim of this study was to explore patients’, carers’, and health professionals’ perceived barriers to timely diagnosis and referral for treatment for sarcoma.

Methods

Semi-structured interviews were conducted with: health professionals working with sarcoma (n = 21); patients who have been diagnosed with sarcoma (n = 22); and carers of patients diagnosed with sarcoma (n = 17). Interview transcripts were analysed using thematic analysis.

Results

Four overarching themes were identified: patient perception of symptoms, difficulties of diagnosis, lack of experience, and availability of health services. Diagnosis was prolonged by the limited availability of health services, lack of prompt referrals to a sarcoma specialist centre, and diagnostic challenges. Intervals also occurred when patients underestimated the severity of their symptoms and did not seek prompt medical consultation.

Conclusions

Patients with a potential sarcoma need to be promptly referred to a sarcoma specialist centre and additional diagnosis pathways need to be developed to reduce the rate of patients being referred to wrong specialists. Sarcoma education must be embedded in medical courses and professional development curricula. A public health approach should be taken to improve sarcoma knowledge and health seeking behaviours in the community.