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Project

ASSESSMENT OF THE FUNCTIONAL OUTCOME AND QUALITY OF LIFE IN SARCOMA PATIENTS

Primary bone and soft tissue sarcomas are an exceptionally rare form of cancer, collectively accounting for only 1% of all malignancies diagnosed. There have been dramatic improvements in the survival rate of sarcoma patients in the past 40 years owing to increasing effectiveness of chemo-therapy. This, along with developments in imaging techniques have led to earlier diagnosis and more accurate preoperative staging. It is estimated that there are nearly 50,000 survivors of pediat-ric bone and soft tissue sarcomas in the United States, 70% of those are younger than the age of 50(18,25). Whilst traditional treatment for bone tumours used to be amputation, advances in surgical techniques have made limb-salvage procedures a valid alternative method of treatment in 80-85% of patients with primary bone sarcomas. Sarcomas often occur in the patients’ extremities and treatment typically involve limb salvage surgery with bone and/or muscle resection. These surgeries often leave the patients with disfig-urements, psychological trauma, and functional disabilities(48). Perhaps the most difficult and life-altering decision that patients (and their parents) with prima-ry bone sarcomas about the knee joint have to make involves choosing the type of surgical proce-dure that will provide them with the outcome that meets their functional as well as aesthetic ex-pectations. Akahane et al(2) evaluated the quality of life for patients with osteosarcoma around the knee joint after three different surgical procedures, that is, amputation, endoprosthetic recon-struction and rotationplasty. They found that patients treated with rotationplasty showed signifi-cantly higher functional scores compared to the two other groups of patients. Bekkering et al(6) investigated the long-term quality of life after bone sarcoma surgery around the knee joint and found that despite the functional disability, survivors were busy with work, study, relationships, and sometimes they have founded a family. There are few reports available in the literature on the quality of life in sarcoma survivors(3,5,7,11-15,19-24,26-33,37-43,45,47,49-54). In a study by Sachsenmaier and colleagues(42), it was found that elderly patients, retired patients, and those who live alone need more intensive psychological care. Female patients were found to cope poorly with their disease compared to male gender. It was also found that the physical status greatly influences the overall outcome and quality of life in this group of patients. This stresses the importance of enrolment in tailored rehabilitation programs. Most published reports in the literature on assessment of gait in the lower-extremity sarcoma survivors were focused on bone sarcoma patients after wide resection and endoprosthetic recon-struction(8,9,34-36,44). Singh et al(44) studied the gait pattern after endoprosthetic replacement around the knee joint and found that despite decreased walking velocity, stride length, and stance phase of the operated limb, these patients still have a symmetrical gait. An electromyographic assessment of gait after bone sarcoma surgery about the knee by Carty and colleagues(10) showed prolonged activation of rectus femoris and hamstring muscles in the affected limb compared to a control group(10). Other researchers found that limb-salvage patients often adopt a “stiff-legged” gait pat-tern. These findings are of utmost importance for the development of efficient rehabilitation pro-grams for these patients. To our knowledge, there has been no published studies on gait analysis after resection of soft tissue sarcomas (STS) of the lower extremity. The rare and heterogeneous aspects of STS and the paucity of knowledge of movement strategies in these patients hinder the development of effec-tive rehabilitation protocols for recovering movement after resection of STS in the lower limb. Tanaka et al(46) investigated the knee extension strength and postoperative functional outcome after quadriceps resection for soft tissue sarcoma of the thigh. They found that knee extension strength decreased when the number of resected quadriceps increased and this was associated with lower functional scores. They concluded that good functional results can be expected if at least two quadriceps muscles are preserved. However, no detailed assessment of gait in this group of patients has been published. This project aims at analysing the functional outcome and health related quality of life (HRQoL) in both skeletally immature and adult survivors of bone and soft tissue sarcomas of the lower ex-tremities. The increasing number of long-term sarcoma survivors and prolonged life expectancy makes studying these outcomes of utmost importance. There is definitive need to gain more knowledge into the functional and psychosocial outcomes of the current treatment options of this group of patients. This should help in evolving towards better informed, and on the longer term evidence-based decision-making, rehabilitation programs, and follow-up services.

Date:4 Oct 2019 →  4 Oct 2023
Keywords:Sarcoma, Quality of life, Functional Outcome, Gait analysis
Disciplines:Cancer therapy, Oncology not elsewhere classified, Rehabilitation sciences, Orthopaedics not elsewhere classified
Project type:PhD project