Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study

Younger, E.; Jones, R.L.; Hollander, D. den; Soomers, V.L.M.N.; Desar, I.M.E.; Benson, C.; ... ; Graaf, W.T.A. van der (2021)

Article / Letter to editor

Introduction: Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions.Patients and methods: The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing health-related quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences.Results: One hundred and thirty-seven patients with advanced STS participated (UK: n = 72, the Netherlands: n = 65). Median age was 62 (27-79) years. Preference for extended LoL (n = 66, 48%) was slightly more common than preference for QoL (n = 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n = 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged >= 65 years) felt that QoL was equally or more important than LoL (P = 0.020). Decisional conflict was most common in patients who prioritised QoL (P = 0.024). Most patients preferred an active (n = 45, 33%) or collaborative (n = 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n = 104, 76%).Conclusions: Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.

• sarcoma
• preferences
• priorities
• quality of life

• All authors: Younger, E.; Jones, R.L.; Hollander, D. den; Soomers, V.L.M.N.; Desar, I.M.E.; Benson, C.; Young, R.J.; Oosten, A.W.; Haan, J.J. de; Miah, A.; Zaidi, S.; Gelderblom, H.; Steeghs, N.; Husson, O.; Graaf, W.T.A. van der
• Date: 2021-10-01
• Journal: ESMO Open
• Volume: 6
• Issue: 5
• DOI: doi:10.1016/j.esmoop.2021.100258