Long-term functional outcomes and quality of life in adult survivors of childhood extremity sarcomas: a report from the St. Jude Lifetime Cohort Study.
This study compared measured physical performance, health-related quality of life (HRQOL), and social role attainment between extremity sarcoma survivors and controls, and evaluated associations between disease and treatment exposures, health conditions, and performance measures.



Survivors of extremity sarcoma from the St. Jude Lifetime cohort and controls frequency matched by age-, sex-, and race completed physical performance testing and questionnaires. Survivors with Z-scores on outcome measures ≤ -2.0 SD (compared to controls) were categorized with severe impairment/limitation.



Among 206 survivors (52.4 % male median age 36 years (range 19-65)), 37 % had low relative lean mass, 9.7 % had an ejection fraction <50 %, 51.5 % had diffusion capacity for carbon monoxide <75 %, 27.7 % had sensory and 25.2 % motor neuropathy, and 78.2 % had musculoskeletal complications. Severe impairments/limitations were present among ≥25 % of survivors on fitness, balance, and physical HRQOL measures, and among ≥15 % on strength and activity of daily living measures. Lower extremity tumor location (OR 8.23, 95 % CI 2.54-26.67, P value 0.0004) and amputation (OR 8.07, 95 % CI 3.06-21.27, P value <0.0001) were associated with poor fitness. Poor fitness was associated with increased odds of scoring <40 on the SF-36 physical component summary (OR 4.83, 95 % CI 1.95-11.99, P value 0.001) and role-physical subscale (OR 3.34, 95 % CI 1.33-8.43, P value 0.01). Survivors and controls had similar rates of marriage, independent living, employment, and college attendance.



Extremity sarcoma survivors experience high rates of physical impairment and report lower than expected physical HRQOL. However, they are as likely as peers to be married, live independently, be employed, and attend college.



Follow-up for extremity sarcoma survivors should include assessment of need for further orthopedic care and rehabilitation to address cardiopulmonary and musculoskeletal health.
Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA. israel.fernandez-pineda@stjude.org.
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Fernandez-Pineda
Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Hudson
Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Pappo
Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Bishop
Department of Psychology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Klosky
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Brinkman
Department of Biostatistics, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Srivastava
Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Neel
Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Rao
Department of Surgery, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Davidoff
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Krull
Department of Oncology, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Mulrooney
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Robison
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 226 Danny Thomas Place, MS133, Memphis, TN, 38105, USA.
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Ness
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012509:Sarcoma / Q000401:mortality / Q000473:pathology; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
Function; Musculoskeletal sarcoma; Physical performance; Quality of life; Social role attainment; Survivor