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

Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
British Journal of Cancer (Impact Factor: 4.84). 12/2004; 91(11):1858-65. DOI: 10.1038/sj.bjc.6602220
Source: PubMed


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.

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Available from: Mark L Greenberg, Aug 08, 2014
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    • "The findings from this study suggest employment, fertility and functional status was adversely affected in survivors. Finally, the Childhood Cancer Survivor Study (Nagarajan et al., 2004) examined the function and quality of life of survivors of pelvic and lower extremity osteosar-coma and Ewing's sarcoma. While amputees were likely to do as well as those who underwent limbsparing surgeries, the findings suggest female gender, lower educational attainment and older current age appear to influence function, quality of life, and disability. "
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    • "In one study of 528 former participants in the Childhood Cancer Survivor Study (Nagarajan et al., 2004), no significant differences were found between 192 survivors who had undergone limb-sparing surgery and the 336 who had received amputations. In fact, the authors felt there was clear evidence that amputees do well in the long run, contrary to some earlier hypotheses. "
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    ABSTRACT: Purpose: To evaluate the current evidence on quality-of-life (QOL) outcomes for survivors of pediatric bone cancer in the lower extremities and to ascertain whether limb-sparing surgery does indeed bestow an advantage to these survivors. Methods: A thorough search of the literature was conducted. Inclusion criteria were as follows: (a) published in the last 10 years in English, (b) focused upon patients diagnosed when they were < 25 years of age, and (c) focused on QOL and functional outcomes in pediatric bone cancer patients who underwent either limb-sparing surgery or amputation in their course of treatment. Results: Sixteen articles were found that fulfilled all inclusion criteria. No significant differences in QOL outcomes were found. However some differences were found in functional outcomes when pediatric bone cancer survivors were compared by tumor site. Survivors with more proximal tumors had better functional outcomes with limb-sparing sparing surgery than their counterparts with amputation. Conclusions: Future nursing research should focus on interventions to improve short and long term QOL in these patients, as no studies were found that addressed potential interventions.
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