TY - JOUR
T1 - Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma
AU - Gil, Sebastian
AU - Fernandez-Pineda, Israel
AU - Rao, Bhaskar
AU - Neel, Michael D.
AU - Baker, Justin N.
AU - Wu, Huiyun
AU - Wu, Jianrong
AU - Anghelescu, Doralina L.
N1 - Publisher Copyright:
© The Author(s) 2018.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Background: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. Objective: We studied outcomes of limb amputations in children with metastatic osteosarcoma. Design: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. Setting/Participants: We studied 12 patients with osteosarcoma at a single institution. Measurements: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. Results: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P =.03) and 3 months (median 0 [range, 0-8]; P =.02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P =.6) and 3 months (median 0.2 [range, 0-0.5]; P =.3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). Conclusions: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.
AB - Background: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. Objective: We studied outcomes of limb amputations in children with metastatic osteosarcoma. Design: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. Setting/Participants: We studied 12 patients with osteosarcoma at a single institution. Measurements: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. Results: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P =.03) and 3 months (median 0 [range, 0-8]; P =.02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P =.6) and 3 months (median 0.2 [range, 0-0.5]; P =.3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). Conclusions: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.
KW - emotional and psychological well-being
KW - end of life
KW - limb amputation
KW - metastatic osteosarcoma
KW - mobility
KW - pain
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U2 - 10.1177/1049909118791119
DO - 10.1177/1049909118791119
M3 - Article
C2 - 30058346
AN - SCOPUS:85052533473
SN - 1049-9091
VL - 36
SP - 105
EP - 110
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
IS - 2
ER -