Quality of Life and Patient-Reported Outcomes in Patients With Osteosarcoma: A Systematic Review

Abstract

Patients diagnosed with osteosarcoma undergo intensive multimodality treatment that can lead to long-term adverse effects, significantly impacting various aspects of daily living. To objectively assess the Health-Related Quality of Life (HR-QoL) in pediatric and adult populations, several Patient-Reported Outcome Measurements (PROMs) are available. However, these questionnaires often exhibit substantial variability in the domains and items they encompass, frequently failing to address aspects that are particularly important after osteosarcoma treatment. A systematic review was conducted to identify the most frequently used questionnaires concerning QoL in pediatric and adult patients with osteosarcoma and to examine the diverse domains and subdomains of QoL assessed by these questionnaires to identify gaps in their coverage, to recommend suitable instruments for an upcoming European trial within the Fighting Osteosarcoma Through European Research (FOSTER) Consortium. English-language literature published since 1980 in PubMed was reviewed. One hundred twenty-eight articles were initially screened for eligibility. Sixty-three original articles were included in the qualitative synthesis. An overview from review articles was given. Selected studies displayed substantial heterogeneity in terms of their objectives, target populations, age ranges, follow-up time, and number of patients included. None of the questionnaires covered all age groups and addressed all important aspects following osteosarcoma treatment. To comprehensively address as many relevant aspects as possible, a combination of questionnaires is suggested. For the adult population, it is recommended to use the EORTC-QLQ-C30 questionnaire together with the Body Image Scale (BIS), while for pediatric patients, the PedsQl-generic and PedsQl-cancer-specific questionnaires and BIS (> 16 years) are suggested. The use of Patient-Reported Outcome Measurement Information Systems (PROMIS) can provide a comprehensive assessment of symptoms such as anxiety, pain, and fatigue. The development of new bone sarcoma-specific, pediatric and adult self-reported questionnaires, or the validation and translation of existing bone sarcoma-specific questionnaires, along with the utilization of new digital possibilities, holds great value for upcoming trials.