Psychosocial and functional outcome in long-term survivors of osteosarcoma : a comparison between limb salvage and amputation

The purpose of this study was to compare the psychosocial and functional outcomes of osteosarcoma survivors who have limb salvage or amputation. Traditional opinion has been that limb-salvage surgery would provide functional and cosmetic advantage over amputation, yet the literature has been equivocal for long term survivors. We hoped to contribute to the literature by utilizing a comprehensive set of validated psychosocial and functional outcome tools. Methods: Participants were <25 years of age at the time of diagnosis and treated at the University of Texas M. D. Anderson Cancer Center between 1978 and 2005. The participants completed the function and quality of life questionnaire. Functional outcome was measured by the Toronto Extremity Salvage Score (TESS). Psychosocial outcomes were assessed by the Quality of Life – Cancer Specific Scale, Amputee Body Image Scale, Index of Self-esteem, and Sarason Social Support Scale. Results: 57 survivors participated, including 35 with limb salvage and 22 with amputation. Participants were 12 to 24 years post-diagnosis and 16 to 52 years of age at the time of this evaluation. Chi-square tests of independence revealed no comparative group differences in patient characteristics, including age at time of study participation, age at diagnosis, and time since diagnosis. Multiple linear regression models were used to examine differences in quality of life, body image, self-esteem, and social support between the two patient groups. No comparative group differences were found. Lower limb function was a significant predictor of quality of life (p < 0.001), and neither time since diagnosis nor surgery type impacted this relationship (p < 0.001). Upper limb function was not related to quality of life. Conclusion: Participants with more functional lower limbs reported better quality of life, regardless of whether the participant had an amputation or a limb salvage and regardless of time since diagnosis.