The role of specialist nurses in delivering effective care in a tertiary sarcoma referral service

Increasing Awareness of Soft-Tissue Sarcoma: Podcast of a Patient-HCP Discussion

Soft-tissue sarcoma is a rare cancer, making up less than 1% of new cancer diagnoses. They comprise tumours of the connective tissue, and as such can arise in any part of the body and can mimic other conditions. In addition, there are over 80 subtypes of sarcoma which, combined with the fact that most general practitioners may only see one case of sarcoma in their working lifetime, makes them difficult to diagnose. Sarcoma UK's national sarcoma survey (2020) showed that 23% of patients started their treatment for an incorrect diagnosis before receiving their correct sarcoma diagnosis. Given the rarity of sarcoma, it is critical that patients are seen by a specialised sarcoma service as soon as possible so that all appropriate treatment pathways can be made available. However, 13% of patients never get to see a specialist multidisciplinary team. It is clear that many challenges remain in identifying patients with sarcoma and ensuring that they receive the best care possible. In this podcast a patient with sarcoma and a specialist sarcoma nurse discuss the patient's journey from initial diagnosis through to treatment and recovery. They will also discuss the physiological, emotional and mental impact that sarcoma had, as well as the critical role of the cancer nurse specialist within the treatment plan, alongside a patient support group. Listeners to the podcast will gain a better understanding of the challenges in diagnosing soft-tissue sarcoma, the tools that are already available to assist physicians in diagnosis, and the importance of providing patients with clear information throughout the treatment journey. Podcast Audio (MP4 804666 KB).

Exploring the Potential of Electronic Patient-Reported Outcome Measures to Inform and Assess Care in Sarcoma Centers: A Longitudinal Multicenter Pilot Study

BACKGROUND

Electronic patient-reported outcome measures (ePROMs) are useful tools to assess care needs of patients diagnosed with cancer and to monitor their symptoms along the illness trajectory. Studies regarding the application of ePROMs by advanced practice nurses (APNs) specialized in sarcoma care and the use of such electronic measures for care planning and assessing quality of care are lacking.

OBJECTIVE

To explore the potential of ePROMs in clinical practice for assessing the patient's quality of life, physical functionality, needs, and fear of progression, as well as distress and the quality of care in sarcoma centers.

METHODS

A multicenter longitudinal pilot study design was chosen. Three sarcoma centers with and without APN service located in Switzerland were included. The instruments EQ-5D-5L, Pearman Mayo Survey of Needs, the National Comprehensive Cancer Network Distress Thermometer, PA-F12, and Toronto Extremity Salvage Score were used as ePROMs. Data were analyzed descriptively.

RESULTS

Overall, 55 patients participated in the pilot study; 33 (60%) received an intervention by an APN, and 22 (40%) did not. Patients in sarcoma centers with APN service reported overall higher scores in quality of life and functional outcome. The number of needs and distress level were lower in sarcoma centers with APN service. No differences were found with respect to patients' fear of progression.

CONCLUSIONS

Most of the ePROMs proved to be reasonable in clinical practice. PA-F12 has shown low clinical relevance.

IMPLICATIONS FOR PRACTICE

Using ePROMs appears to be reasonable to obtain clinically relevant patient information and to evaluate the quality of care in sarcoma centers.

"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.