Physical functioning, pain and quality of life after amputation for musculoskeletal tumours: a national survey.
Patients who have limb amputation for musculoskeletal tumours are a rare group of cancer survivors. This was a prospective cross-sectional survey of patients from five specialist centres for sarcoma surgery in England. Physical function, pain and quality of life (QOL) outcomes were collected after lower extremity amputation for bone or soft-tissue tumours to evaluate the survivorship experience and inform service provision. Of 250 patients, 105 (42%) responded between September 2012 and June 2013. From these, completed questionnaires were received from 100 patients with a mean age of 53.6 years (19 to 91). In total 60 (62%) were male and 37 (38%) were female (three not specified). The diagnosis was primary bone sarcoma in 63 and soft-tissue tumour in 37. A total of 20 tumours were located in the hip or pelvis, 31 above the knee, 32 between the knee and ankle and 17 in the ankle or foot. In total 22 had hemipelvectomy, nine hip disarticulation, 35 transfemoral amputation, one knee disarticulation, 30 transtibial amputation, two toe amputations and one rotationplasty. The Toronto Extremity Salvage Score (TESS) differed by amputation level, with poorer scores at higher levels (p < 0.001). Many reported significant pain. In addition, TESS was negatively associated with increasing age, and pain interference scores. QOL for Cancer Survivors was significantly correlated with TESS (p < 0.001). This relationship appeared driven by pain interference scores. This unprecedented national survey confirms amputation level is linked to physical function, but not QOL or pain measures. Pain and physical function significantly impact on QOL. These results are helpful in managing the expectations of patients about treatment and addressing their complex needs.
Freeman Hospital, Newcastle Upon Tyne, United Kingdom, NE7 7DN, UK.
S
S
Furtado
Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, B31 2AP, UK.
R J
RJ
Grimer
Robert Jones and Agnes Hunt NHS Foundation Trust, Oswestry, SY10 7AG, UK.
P
P
Cool
Freeman Hospital, Newcastle Upon Tyne, United Kingdom, NE7 7DN, UK.
S A
SA
Murray
Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
T
T
Briggs
Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, HA7 4LP, UK.
J
J
Fulton
Robert Jones and Agnes Hunt NHS Foundation Trust, Oswestry, SY10 7AG, UK.
K
K
Grant
The Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
C H
CH
Gerrand
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000009:adverse effects / Q000534:rehabilitation*; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation; D001186:Artificial Limbs; D001859:Bone Neoplasms / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology; D011594:Psychometrics; D011788:Quality of Life; D020127:Recovery of Function; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D055815:Young Adult
Sarcoma; amputation; quality of life