Physical functioning, pain and quality of life after amputation for musculoskeletal tumours

Abstract

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.

Patient experience after lower extremity amputation for sarcoma in England: a national survey

“…This may have an impact on disability, dependency and employment. In patients treated with amputation for sarcoma, physical functioning is associated with quality of life [8] and therefore poor quality rehabilitation services are likely to have significant impact on other aspects of life and the burden on society. We have therefore shown that there is an urgent need to improve service provision to patients diagnosed with sarcoma who have undergone or are facing amputation.…”

“…A patient completed survey instrument was developed. This included measures of pain, physical functioning and quality of life, the results of which are reported elsewhere [8]. Questions about service provision were derived from existing standards [5][6][7], from a Servqual questionnaire [9] for assessing the quality of prosthetic service provision and following discussions with a small sample of service users (n=3) and staff in a limb fitting service (n=2).…”

Malignant tumours of the foot and ankle

“…For them (and us), good functional and oncological results have been achieved with conservative treatment in malignant tumours of the foot. 9,31,34,35 …”

Ultrasound‐Guided Cryoablation of a Traumatic Hip Disarticulation Neuroma

“…During the Iran–Iraq war (1980–1988), there were 20,801 veterans with amputations; of those, 84 had either a hip disarticulation or transpelvic amputation . While there are limited studies highlighting the effect of these amputations on functional and social outcomes, there are scant data documenting complications including neuroma formation …”

“…5 While there are limited studies highlighting the effect of these amputations on functional and social outcomes, there are scant data documenting complications including neuroma formation. 4,6,7 Neuromas arise from nerves' ability to regenerate after an injury. Occurring after the transection of a nerve, neuromas are disorganized neuronal tissue that leads to a bulbous thickened end.…”