Patient expectations for surgical outcome in extremity soft tissue sarcoma

BACKGROUND AND OBJECTIVES: Patients' expectations regarding their surgical recovery can significantly influence health outcomes. This study examines the relationship between pre-treatment outcome expectations and post-operative function and health-related quality of life (HRQoL) in patients with extremity soft tissue sarcoma (ESTS). Additionally, we evaluate predictors of patients' outcome expectations. METHODS: Data were prospectively collected on 157 ESTS patients (62% male, mean age 56 years) treated with limb-preservation surgery between January 2001 and February 2005. Associations between patients' outcome expectations and 1-year function and HRQoL outcomes were evaluated using multivariable regression analyses. Factors predicting patient expectations were investigated using multinomial logistic regression. RESULTS: Patients expecting a difficult recovery and patients with uncertain expectations had worse functional outcomes than patients anticipating an easy recovery. Education, dispositional optimism, tumor location, AJCC stage, and baseline function/HRQoL were significant predictors of patient expectations. For example, patients with primary school education more frequently reported uncertain expectations regarding length of recovery (OR = 20; 95% CI, 3.7-108.6) and complications (OR = 12; 95% CI, 2.7-58.0) than patients with post-secondary education. CONCLUSIONS: Patient expectations significantly influence functional outcome in ESTS. Patients at risk for uncertain expectations may benefit from additional, individualized education so as to optimize their treatment outcomes.