Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing's sarcoma: the Childhood Cancer Survivor Study

Abstract

Limb-sparing surgeries have been performed more frequently than amputation based on the belief that limb-sparing surgeries provide improved function and quality-of-life (QOL). However, this has not been extensively studied in the paediatric population, which has unique characteristics that have implications for function and QOL. Using the Childhood Cancer Survivor Study, 528 adult long-term survivors of pediatric lower extremity bone tumours, diagnosed between 1970 and 1986, were contacted and completed questionnaries assessing function and QOL. Survivors were an average of 21 years from diagnosis with an average age of 35 years. Overall they reported excellent function and QOL. Compared to those who had a limb-sparing procedure, amputees were not more likely to have lower function and QOL scores and self-perception of disability included general health status, lower educational attainment, older age and female gender. Findings from this study suggest that, over time, amputees do as well as those who underwent limb-sparing surgeries between 1970 and 1986. However, female gender, lower educational attainment and older current age appear to influence function, QOL and disability.

Does Limb-salvage Surgery Offer Patients Better Quality of Life and Functional Capacity than Amputation?

“…It is possible that differences were present between the two groups in terms of quality of life (SF-36) and TESS, but that the study was not adequately powered to detect these differences. Despite this, there is broad agreement among our data and those of other studies showing no major differences in terms of overall quality of life and TESS scores between the LSS and AKA groups [2,8,14,22,23,34]. Sixth, the ability to compare functional ability and quality of life in different age categories is unclear.…”

“…Third, the minimum followup of 12 months represents a shorter followup than for other studies evaluating functionality and quality of life [2,23]. Although this limits the long-term conclusions that can be drawn from this study, it provides additional insight into the midterm postoperative period after initial rehabilitation while possibly including a wider range of patient functionality.…”

“…The effects of surgical treatment of sarcomas on quality of life, however, remain controversial [22]. Studies attempting to compare overall quality of life between the two treatment modalities have tended to show no differences [2,23,25,30,34]. Psychological acceptance of LSS and amputation is reportedly similar [21,27,28,32].…”

Psychosocial Outcomes and Health-Related Quality of Life in Adult Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study

“…Childhood Cancer Survivor Study (CCSS) reports have examined psychosocial outcomes and HRQOL within specific diagnostic groups (7)(8)(9)(10)(11). However, it is necessary to examine the entire cohort of childhood cancer survivors, compare them with siblings, and identify demographic and treatment risk factors so that risk-based treatments to enhance HRQOL of life can be developed.…”

Quality of Life (QOL) in Long-Term Survivors of Osteosarcoma

“…On the other hand, orthopedic surgeons confront challenging problems related to limb-salvage surgery such as complications associated with the delayed chemotherapy (secondary malignancy or infertility) and postoperative complications such as infection and the mechanical failure or instability of the metal prosthesis [7][8][9]. Many studies have reported on the functional status of the extremities on the affected side in long-term survivors from osteosarcoma [10][11][12][13], however, there are insufficient about the quality of life [14][15][16][17][18][19][20]. So we conducted this study to evaluate the quality of life in longterm survivors from osteosarcoma.…”