Gil S, Fernandez-Pineda I, Rao B, Neel MD, Baker JN, Wu H, Wu J, Anghelescu DL. Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma.
Am J Hosp Palliat Care 2018;
36:105-110. [PMID:
30058346 DOI:
10.1177/1049909118791119]
[Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
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.
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