Identification of adult knee primary bone tumour symptom presentation: A qualitative study

• Delays in diagnosis of primary bone tumours are common and can affect outcomes.
• Patient and Healthcare Professional perspectives of tumour symptoms were explored.
• Early symptoms are similar to routine musculoskeletal conditions.
• Later symptoms showed greater similarities among participants compared to early.
• Findings may offer an opportunity to improve earlier diagnosis.

ObjectivesThe aim of this study was to identify the symptom presentation of adult knee primary bone tumours from onset to Consultant diagnosis, from combined patient and healthcare professional perspectives.Materials and methodsA qualitative study using in-depth semi-structured interviews recruited a purposive sample of adult patients with a knee primary bone tumour (n = 8) and healthcare professionals with expertise in orthopaedic oncology (n = 6). Following informed consent, recorded interviews explored participants' experiences of symptom presentation. A grounded theory approach was utilised to analyse transcribed data, producing themes. Methods to increase rigour and trustworthiness were employed. Recruitment continued until data saturation was achieved.ResultsFour key themes were established: 1] Symptoms started with intermittent pain which became more severe and more constant, 2] Pain was mechanical in nature but became more difficult to ease; 3] The pain story was unusual with a protracted symptom duration and failure to improve with conservative treatment; 4] Non-painful symptoms included swelling, and systemic signs were uncommon. More similarities between healthcare professionals' and patients' perceptions were found at Consultant diagnosis compared to onset.ConclusionNew insights of symptom presentation, particularly in the early stages have been provided which are not reflected in current guidelines. Although starting similarly to routine musculoskeletal presentations, a number of distinctive features may enable earlier diagnosis.