Psychosocial and functional outcomes in long-term survivors of osteosarcoma: a comparison of limb-salvage surgery and amputation.
BACKGROUND
Traditionally, physicians have believed that limb-salvage surgery has functional and cosmetic advantages over amputation, yet the literature is equivocal. Therefore, we sought to compare the psychosocial and functional outcomes in osteosarcoma survivors after limb-salvage surgery and amputation. We hypothesized there to be neither psychosocial nor functional outcome differences between groups.


METHODS
Participants received treatment of extremity osteosarcoma, had received their cancer diagnosis at least 2 years prior, and were at least 16 years old. A comprehensive set of validated psychosocial and functional measures was used to assess outcome.


RESULTS
Fifty-seven patients participated in this study (33 who underwent limb-salvage surgery and 24 who underwent amputation). Participants had gone 12-24 years since diagnosis and were 16-52 years old at study participation. We used multiple linear regression models to examine differences in quality of life, body image, self-esteem, and social support between the two groups and found no differences. Lower limb function was a significant predictor of quality of life (P < 0.001), whereas surgery type did not impact this relationship. Body image was rated significantly worse by those who underwent late amputation, amputation after failed limb salvage, than by those who did not.


CONCLUSIONS
Participants with more functional lower limbs had better quality of life than did those with less functional lower limbs regardless of whether they underwent amputation or limb-salvage surgery.
Division of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. rrobert@mdanderson.org
Rhonda S
RS
Robert
Giulia
G
Ottaviani
Winston W
WW
Huh
Shana
S
Palla
Norman
N
Jaffe
D000293:Adolescent; D000328:Adult; D000671:Amputation, Surgical / Q000523:psychology*; D001828:Body Image; D001859:Bone Neoplasms / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000523:psychology / Q000601:surgery*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D020127:Recovery of Function; D012649:Self Concept; D012944:Social Support; D011795:Surveys and Questionnaires; D017741:Survivors / Q000706:statistics & numerical data*; D055815:Young Adult