Barriers to rehabilitation of patients with extremity sarcomas

Abstract

The treatment of most extremity bone or soft tissue sarcomas involves either limb salvage surgery with adjuvant chemoradiation therapy or amputation. The rehabilitation of patients with extremity sarcomas is challenging, and the approach differs depending on the choice of surgical procedure as well as potential-associated medical complications. Early, interdisciplinary rehabilitation involvement is helpful in lessening the impact of expected impairments and disability. There is a lack of evidence examining specific rehabilitation interventions in this patient population. Functional outcomes and quality of life studies suggest overall similar findings between limb salvage patients and amputees, but with differences in various subscales. Rehabilitation interventions are therefore individualized; based on the assessment of medical limitations, functional goals and expectations, and modification of environmental factors. Overcoming medical and oncologic barriers to rehabilitation; as well as psychological, structural, cultural, political, and economic barriers; can serve to lessen the degree of disability.

Amputations for extremity soft tissue sarcoma in an era of limb salvage treatment: Local control and survival

“…However, patients who underwent a primary or a non‐primary amputation for ESTS seem to have comparable oncological outcomes. Given this comparable oncological outcome, the need is urgent on behalf of the patient for amputation levels to be chosen adequately and for optimal rehabilitation to be provided by surgeons and rehabilitation specialists …”

Identifying the Prevalence, Trajectory, and Determinants of Psychological Distress in Extremity Sarcoma

“…Performance status and physical impairment have been consistently found to be significantly associated with distress in cancer patients and survivors [2, 26, 30–32]. Psychological distress may impair the rehabilitation process that is critical postoperatively to train compensatory muscles to achieve effective gait restoration [68]. From the general orthopaedic literature, it is recognized that depression and anxiety during rehabilitation for orthopaedic conditions have a negative impact on recovery [69] and are associated with poor function and pain outcomes following joint arthroplasty in particular [70, 71].…”

Prescriptions for Optimal Healing

“…This is an excellent resource for those interested in oncology rehabilitation and includes chapters by nearly 150 contributors. Another example is the physiatrists who are writing about the barriers to oncology rehabilitation and how to overcome them [14‐21]. A third example is the recent announcement by the American Academy of Physical Medicine and Rehabilitation that it will focus on oncology rehabilitation at the 2011 Annual Assembly [22].…”