Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Cancer Med. 2023 Jun;12(12):13661-13674. doi: 10.1002/cam4.5985. Epub 2023 Apr 29.
Desmoid-type fibromatosis (DTF) has a highly variable clinical course with varying intensity of symptoms. The objectives of this study were to identify subgroups of DTF patients based on physical symptom burden and to compare symptom burden subgroups on health-related quality of life (HRQoL) and healthcare use (univariate and multivariate).
Desmoid-type fibromatosis patients from the United Kingdom and the Netherlands received cross-sectional questionnaires on HRQoL (EORTC QLQ-C30), DTF-specific HRQoL (DTF-QoL) and healthcare utilisation. Latent class cluster analysis was performed to identify subgroups based on patients' symptom burden using EORTC QLQ-C30 and DTF-QoL physical symptom items. Multivariate linear and logistic regression analyses were conducted to examine associations of symptom burden with HRQoL and healthcare utilisation, respectively.
Among 235 DTF patients, four symptom burden clusters were identified, with low symptom burden (24%), intermediate symptom burden-low pain (20%), intermediate symptom burden-high pain (25%) and high symptom burden (31%). DTF patients with high symptom burden had clinically relevant lower HRQoL scores compared to patients with low and intermediate symptom burden (p < 0.001) and reported more general and DTF-related visits to their general practitioner compared to the low symptom burden cluster (p < 0.01). In the multivariate analyses, symptom burden was independently associated with both HRQoL and healthcare utilisation.
This study identified four distinct subgroups of DTF patients based on their level of symptom burden, with a considerable number of patients being highly symptomatic. Knowledge of the level of symptom burden DTF patients experience can help to identify patients at risk of poorer outcomes and tailor supportive care to the individual needs of DTF patients.
韧带样纤维瘤病（DFT）的临床表现具有高度异质性，症状严重程度不一。本研究旨在根据患者的躯体症状负担，识别 DFT 患者的亚组，并比较不同躯体症状负担亚组的健康相关生活质量（HRQoL）和医疗保健利用（单变量和多变量）。
来自英国和荷兰的 DFT 患者接受了 HRQoL（EORTC QLQ-C30）、DFT 特异性 HRQoL（DFT-QoL）和医疗保健利用的横断面问卷调查。采用 EORTC QLQ-C30 和 DTF-QoL 躯体症状条目对患者的躯体症状负担进行潜在类别聚类分析，以识别不同的亚组。采用多变量线性和逻辑回归分析，分别检验症状负担与 HRQoL 和医疗保健利用的相关性。
在 235 例 DFT 患者中，确定了 4 个症状负担亚组，分别为低症状负担（24%）、中低症状负担-低疼痛（20%）、中高症状负担-高疼痛（25%）和高症状负担（31%）。与低和中症状负担亚组相比，高症状负担亚组 DFT 患者的 HRQoL 评分明显较低（p<0.001），且与低症状负担亚组相比，他们向全科医生报告的一般就诊和 DFT 相关就诊次数更多（p<0.01）。在多变量分析中，症状负担与 HRQoL 和医疗保健利用均独立相关。
本研究根据 DFT 患者的症状负担水平，识别出了 4 个不同的亚组，其中相当一部分患者症状较为严重。了解 DFT 患者的症状负担水平有助于识别预后较差的患者，并根据 DFT 患者的个体需求提供相应的支持性护理。
