ABSTRACT
Sarcomas often occur in patients' extremities and treatment typically involves bone resection/limb salvage surgery. Such treatments leave survivors with physical disfigurements, functional disabilities, and/or emotional traumas. Our post-surgery psychological intervention investigated how these experiences impinge on sarcoma survivors' lives. Twenty-three survivors aged 19-60 years (M = 36 years) participated in a tri-disciplinary (rehabilitative exercise, plastic surgery and psychological) intervention. Of these, 17 participated in psychodynamic counselling, 10 completed a mental-health questionnaire and seven kept a reflective journal. An exemplar case study research design was employed and data were subjected to interpretative phenomenological analysis. The findings reveal that survivors typically experience a number of body image issues and mobility difficulties, which they are reluctant to share with their oncologist in case they are viewed as being ungrateful or vain. In instances where such issues remain unaddressed, then sarcoma survivors have a tendency to adopt avoidant coping strategies and social isolation practices. These practices negatively impact on their mental health and functional quality of life. Hence, it is suggested that a short three part (body image, mobility, and coping strategy) screen be devised and used at all sarcoma 2-year follow-up assessment consults to identify which survivors are in need of psychological assistance.
Subject(s)
Activities of Daily Living , Body Image/psychology , Bone Neoplasms/surgery , Cancer Survivors/psychology , Giant Cell Tumor of Bone/surgery , Mobility Limitation , Quality of Life , Sarcoma/surgery , Adaptation, Psychological , Adult , Bone Neoplasms/physiopathology , Bone Neoplasms/psychology , Chondrosarcoma/physiopathology , Chondrosarcoma/psychology , Chondrosarcoma/surgery , Extremities/surgery , Female , Giant Cell Tumor of Bone/physiopathology , Giant Cell Tumor of Bone/psychology , Humans , Limb Salvage , Male , Mental Health , Middle Aged , Qualitative Research , Sarcoma/physiopathology , Sarcoma/psychology , Sarcoma, Ewing/physiopathology , Sarcoma, Ewing/psychology , Sarcoma, Ewing/surgery , Social Isolation/psychology , Western Australia , Young AdultABSTRACT
INTRODUCTION. Previously, amputation was the only treatment option for patients with malignant bone tumors. Due to technological, medical and surgical advances, the number of survivors and years of survival has been increasing, and thus, the interest in evaluating the impact of this disease on quality of life. OBJECTIVE. To evaluate the health related quality of life reported by patients with bone tumors undergoing different treatments (no surgery/amputation/salvage). MATERIAL AND METHODS. Patients (n = 85) with bone tumors over the age of 18, both sexes, from the Instituto Nacional de Rehabilitación of Mexico City were included, divided into three groups according to type of treatment. The study design was cross-sectional, descriptive of a nonrandom sample. Quality of life was assessed with the Inventory of Quality of Life and Health (InCaViSa). Data were analyzed using descriptive statistics, comparisons between patients with different treatments were evaluated with multivariate analysis of covariance and Sidak post hoc tests. RESULTS. Statistically significant differences were detected in six of the twelve areas of quality of life that are assessed by the scale: physical functioning, isolation, body perception, treatment attitude leisure time and daily life. Health related quality of life in the study group is best for those patients who received amputation compared with the other treatments, while patients limb salvage procedures are those with greater impairment.
Subject(s)
Bone Neoplasms/therapy , Quality of Life , Adolescent , Adult , Aged , Amputation, Surgical , Bone Neoplasms/psychology , Cross-Sectional Studies , Female , Giant Cell Tumor of Bone/psychology , Giant Cell Tumor of Bone/therapy , Humans , Male , Middle Aged , Osteosarcoma/psychology , Osteosarcoma/therapy , Salvage Therapy , Sarcoma/psychology , Sarcoma/therapy , Young AdultABSTRACT
In 1999, we began a study to assess the long-term effect of connective tissue cancer treatment on clinical, social, and psychologic aspects of the lives of surviving patients. A specially designed computer program generated an 85-item questionnaire, which was sent to more than 2000 patients with malignant bone and soft tissue neoplasms. Twelve hundred forty-four patients responded. The data were entered into a computer system and were correlated with the clinical information already contained in the system for the individual patients. Although there are many possible uses for these data, we chose to do a study comparing the lifestyle and physical and sociologic problems for 144 patients treated with chemotherapy and surgery for high-grade osteosarcoma against a control population consisting of 61 patients treated surgically for benign giant cell tumors of bone. The data show a remarkable degree of compensation on the part of the patients with the malignant tumors in terms of some problems but some significant differences particularly in physical status and functional limitations.
