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. 2019 Mar;27(3):965-980.
doi: 10.1007/s00520-018-4386-8. Epub 2018 Aug 28.

Desmoid fibromatosis through the patients' eyes: time to change the focus and organisation of care?

Olga Husson  1   2 , Eugenie Younger  3 , Alison Dunlop  3 , Lucy Dean  3 , Dirk C Strauss  3 , Charlotte Benson  3 , Andy J Hayes  3 , Aisha Miah  3 , Winan van Houdt  3 , Shane Zaidi  3 , Myles Smith  3 , John Williams  4 , Robin L Jones  3   5 , Winette T A van der Graaf  3   5
Affiliations

Desmoid fibromatosis through the patients' eyes: time to change the focus and organisation of care?

Olga Husson et al. Support Care Cancer. 2019 Mar.

Abstract

Purpose: Desmoid fibromatosis (DF) is a rare, unpredictable disease with no established, evidence-based treatments. Individual management is based on consensus algorithms. This study aimed to examine the specific health-related quality of life challenges faced by DF patients, current experiences and expectations of care.

Methods: Twenty-seven DF patients were purposively sampled from The Royal Marsden Hospital. Two focus groups and 13 interviews (males 12, females 15; mean age at study 39.5 years) explored health-related quality of life issues and experiences of healthcare. Thematic content was analysed.

Results: Discussions revealed four key themes (diagnostic pathway; treatment pathway; living with DF; supportive care). Diagnostic delay resulted from lack of recognition by patients and healthcare professionals. Some patients received an initial diagnosis of cancer, causing significant distress. Treatment decisions were challenging, and patients experienced uncertainty among clinicians about optimal therapies. Side-effects of treatment were severe, including fatigue, nausea, anorexia, low libido and depression. Pain was the most debilitating symptom and dependency on painkillers was a significant concern. Functional limitation and restricted mobility frequently affected daily activities. Patients experienced difficulty accomplishing their role in society; relationship problems, caring for children, employment and financial difficulties. Social isolation and lack of understanding were common. The psychological impact of this "life-changing and life-long" condition was profound. All patients requested knowledgeable healthcare professionals, more information, continuity of care and peer support.

Conclusions: DF patients face complex physical, psychological and practical challenges. Comprehensive care services are needed. Increasing awareness may help to improve diagnostic pathways and overall patient experience.

Keywords: Desmoid-type fibromatosis; Functional limitation; Health-related quality of life; Pain; Supportive care.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Schematic representation of main findings
See this image and copyright information in PMC

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