Skip to main content

Advertisement

Log in

Young survivors of malignant bone tumours in the extremities: a comparative study of quality of life, fatigue and mental distress

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study was to compare the quality of life (QoL), fatigue and mental distress in survivors of malignant extremity bone tumours (EBT survivors) with age and gender-matched survivors of Hodgkin’s disease (HD survivors) and testicular cancer (TC survivors) as well as normative samples from the general population.

Patients and methods

Five years or more after end of treatment, 75 EBT survivors were mailed a questionnaire containing Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale, the Fatigue Questionnaire and questions about demography. Fifty-eight EBT survivors responded. TC survivors, HD survivors and normative samples (NORMs) had earlier on filled in the same questionnaire. For EBT survivors, gender and age-matched controls were randomly selected among TC survivors, HD survivors and NORMs.

Results

No significant differences in the fatigue or mental distress scores were observed between the survivor groups. The EBT survivors had significantly higher fatigue scores and lower depression scores than NORMs and significantly lower scores on all physical dimensions of QoL than TC survivors, HD survivors and NORMs. In multivariate analysis, a low level of education and lack of employment were significantly associated with caseness of mental distress. Older age at survey, female gender, being an EBT survivor and lack of employment were associated with caseness on the SF-36 Physical Component Summary Scale.

Conclusion

At long-term follow-up, EBT survivors did not show impaired mental health or fatigue at the group level, although their post-treatment status was characterised by reduced QoL dimensions on physical function compared to TC survivors, HD survivors and NORMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aksnes LH, Hall KS, Folleraas G, Stenwig AE, Bjerkehagen B, Taksdal I, Winderen M, Bruland OS, Saeter G (2006) Management of high-grade bone sarcomas over two decades: the Norwegian Radium Hospital experience. Acta Oncol 45:38–46

    Article  PubMed  Google Scholar 

  2. Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, Casadei R, Fabbri N, Forni C, Versari M, Campanacci M (2000) Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the Istituto Ortopedico Rizzoli according to the Istituto Ortopedico Rizzoli/Osteosarcoma-2 Protocol: an updated report. J Clin Oncol 18:4016–4027

    PubMed  CAS  Google Scholar 

  3. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 52:69–77

    Article  PubMed  Google Scholar 

  4. Chalder T, Berelowitz G, Pawlikowska T, Watts L, Wessely S, Wright D, Wallace EP (1993) Development of a fatigue scale. J Psychosom Res 37:147–153

    Article  PubMed  CAS  Google Scholar 

  5. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawerence Earlbaum, Hillsdale, NJ

    Google Scholar 

  6. Dahl AA, Haaland CF, Mykletun A, Bremnes R, Dahl O, Klepp O, Wist E, Fosså SD (2005) Study of anxiety disorder and depression in long-term survivors of testicular cancer. J Clin Oncol 23:2389–2395

    Article  PubMed  Google Scholar 

  7. Dahl AA, Mykletun A, Fosså SD (2005) Quality of life in survivors of testicular cancer. Semin Urol Oncol 23:193–200

    Google Scholar 

  8. Eiser C, Cool P, Grimer RJ, Carter SR, Cotter IM, Ellis AJ, Kopel S (1997) Quality of life in children following treatment for a malignant primary bone tumour around the knee. Sarcoma 1:39–45

    Article  Google Scholar 

  9. Eiser C, Darlington A-SE, Stride CB, Grimer RJ (2001) Quality of life implication as a consequence of surgery: limb salvage, primary and secondary amputation. Sarcoma 5:189–195

    Article  Google Scholar 

  10. Eiser C, Grimer RJ (1999) Quality of life in survivors of a primary bone tumour: a systematic review. Sarcoma 4:183–190

    Google Scholar 

  11. Elomaa I, Blomqvist CP, Saeter G, Akerman M, Stenwig E, Wiebe T, Bjork O, Alvegard TA (2000) Five-year results in Ewing’s sarcoma. The Scandinavian Sarcoma Group experience with the SSG IX protocol. Eur J Cancer 36:875–880

    Article  PubMed  CAS  Google Scholar 

  12. Felder-Puig R, Formann AK, Mildner A, Bretschneider W, Bucher B, Windhager R, Zoubek A, Puig S, Topf R (1998) Quality of life and psychosocial adjustment of young patients after treatment of bone cancer. Cancer 83:69–75

    Article  PubMed  CAS  Google Scholar 

  13. Ferrari S, Smeland S, Mercuri M, Bertoni F, Longhi A, Ruggieri P, Alvegaard TA, Picci P, Capanna R, Bernini G, Muller C, Tienghi A, Wiebe T, Comandone A, Bohling T, Del Prever A, Brosjo O, Bacci G, Saeter G (2005) Neoadjuvant chemotherapy with high-dose ifosfamide, high-dose methotrexate, cisplatin, and doxorubicin for patients with localized osteosarcoma of the extremity: a joint study by the Italian and Scandinavian Sarcoma Groups. J Clin Oncol 23:8845–8852

    Article  PubMed  Google Scholar 

  14. Fosså SD, Dahl AA, Loge JH (2003) Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 21:1249–1254

    Article  PubMed  Google Scholar 

  15. Gil-Fernandez J, Ramos C, Tamayo T, Tomas F, Figuera A, Arranz R, Martinez-Chamorro C, Fernandez-Ranada M (2003) Quality of life and psychological well-being in Spanish long-term survivors of Hodgkin’s disease: results of a controlled pilot study. Ann Hematol 82:14–18

    PubMed  CAS  Google Scholar 

  16. Greenberg DB, Goorin A, Gebhardt MC, Gupta L, Stier N, Harmon D, Mankin H (1994) Quality of life in osteosarcoma survivors. Oncology (Huntingt) 8:19–25

    CAS  Google Scholar 

  17. Hillmann A, Hoffmann C, Gosheger G, Krakau H, Winkelmann W (1999) Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements. J Bone Jt Surg Am Vol 81:462–468

    Article  CAS  Google Scholar 

  18. Holmen J, Midthjell K, Kruger O, Langhammer A, Holmen TL, Bratberg GH, Vatten L, Lund-Larsen PG (2003) The Nord–Trondelag Health Study 1995–97(HUNT2): objectives, contents, methods and participation. Nor Epidemiol 13:19–32

    Google Scholar 

  19. Hudson MM, Mertens AC, Yasui Y, Hobbie W, Chen H, Gurney JG, Yeazel M, Recklitis CJ, Marina N, Robison LR, Oeffinger KC (2003) Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA 290:1583–1592

    Article  PubMed  CAS  Google Scholar 

  20. Joly F, Henry-Amar M, Arveux P, Reman O, Tanguy A, Peny AM, Lebailly P, Mace-Lesec’h J, Vie B, Genot JY, Busson A, Troussard X, Leporrier M (1996) Late psychosocial sequelae in Hodgkin’s disease survivors: a French population-based case-control study. J Clin Oncol 14:2444–2453

    PubMed  CAS  Google Scholar 

  21. Knobel H, Havard-Loge J, Brit-Lund M, Forfang K, Nome O, Kaasa S (2001) Late medical complications and fatigue in Hodgkin’s disease survivors. J Clin Oncol 19:3226–3233

    PubMed  CAS  Google Scholar 

  22. Lindner NJ, Ramm O, Hillmann A, Roedl R, Gosheger G, Brinkschmidt C, Juergens H, Winkelmann W (1999) Limb salvage and outcome of osteosarcoma. The University of Muenster experience. Baillière’s Clin Orthop 358:83–89

    Article  Google Scholar 

  23. Loge JH, Abrahamsen AF, Ekeberg, Kaasa S (2000) Fatigue and psychiatric morbidity among Hodgkin’s disease survivors. J Pain Symptom Manage 19:91–99

    Article  PubMed  CAS  Google Scholar 

  24. Loge JH, Abrahamsen AF, Ekeberg O, Kaasa S (1999) Hodgkin’s disease survivors more fatigued than the general population. J Clin Oncol 17:253–261

    PubMed  CAS  Google Scholar 

  25. Loge JH, Abrahamsen AF, Ekeberg O, Kaasa S (1999) Reduced health-related quality of life among Hodgkin’s disease survivors: a comparative study with general population norms. Ann Oncol 10:71–77

    Article  PubMed  CAS  Google Scholar 

  26. Loge JH, Kaasa S, Hjermstad MJ, Kvien TK (1998) Translation and performance of the Norwegian SF-36 Health Survey in patients with rheumatoid arthritis. I. Data quality, scaling assumptions, reliability, and construct validity. J Clin Epidemiol 51:1069–1076

    Article  PubMed  CAS  Google Scholar 

  27. Mykletun A, Dahl AA, Haaland CF, Bremnes R, Dahl O, Klepp O, Wist E, Fosså SD (2005) Side effects and cancer-related stress determine quality of life in long-term survivors of testicular cancer. J Clin Oncol 23:3061–3068

    Article  PubMed  Google Scholar 

  28. Nagarajan R, Clohisy DR, Neglia JP, Yasui Y, Mitby PA, Sklar C, Finklestein JZ, Greenberg M, Reaman GH, Zeltzer L, Robison LL (2004) Function and quality-of-life of survivors of pelvic and lower extremity osteosarcoma and Ewing’s sarcoma: the Childhood Cancer Survivor Study. Br J Cancer 91:1858–1865

    Article  PubMed  CAS  Google Scholar 

  29. Ness KK, Mertens AC, Hudson MM, Wall MM, Leisenring WM, Oeffinger KC, Sklar CA, Robison LL, Gurney JG (2005) Limitations on physical performance and daily activities among long-term survivors of childhood cancer. Ann Intern Med 143:639–647

    PubMed  Google Scholar 

  30. Nicholson HS, Mulvihill JJ, Byrne J (1992) Late effects of therapy in adult survivors of osteosarcoma and Ewing’s sarcoma. Med Pediatr Oncol 20:6–12

    Article  PubMed  CAS  Google Scholar 

  31. Nilbert M, Saeter G, Elomaa I, Monge OR, Wiebe T, Alvegard TA (1998) Ewing’s sarcoma treatment in Scandinavia 1984–1990—ten-year results of the Scandinavian Sarcoma Group Protocol SSGIV. Acta Oncol 37:375–378

    Article  PubMed  CAS  Google Scholar 

  32. Pawlikowska T, Chalder T, Hirsch SR, Wallace P, Wright DJ, Wessely SC (1994) Population based study of fatigue and psychological distress. BMJ 308:763–766

    PubMed  CAS  Google Scholar 

  33. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ (1994) Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Jt Surg Am Vol 76:649–656

    CAS  Google Scholar 

  34. Ruffer JU, Flechtner H, Tralls P, Josting A, Sieber M, Lathan B, Diehl V (2003) Fatigue in long-term survivors of Hodgkin’s lymphoma; a report from the German Hodgkin Lymphoma Study Group (GHSG). Eur J Cancer 39:2179–2186

    Article  PubMed  CAS  Google Scholar 

  35. Saeter G, Alvegard TA, Elomaa I, Stenwig AE, Holmstrom T, Solheim OP (1991) Treatment of osteosarcoma of the extremities with the T-10 protocol, with emphasis on the effects of preoperative chemotherapy with single-agent high-dose methotrexate: a Scandinavian Sarcoma Group study. J Clin Oncol 9:1766–1775

    PubMed  CAS  Google Scholar 

  36. Smeland S, Muller C, Alvegard TA, Wiklund T, Wiebe T, Bjork O, Stenwig AE, Willen H, Holmstrom T, Folleras G, Brosjo O, Kivioja A, Jonsson K, Monge O, Saeter G (2003) Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders. Eur J Cancer 39:488–494

    Article  PubMed  CAS  Google Scholar 

  37. Sprangers MA (2002) Quality-of-life assessment in oncology. Achievements and challenges. Acta Oncol 41:229–237

    Article  PubMed  Google Scholar 

  38. Sprangers MA, Van Dam FS, Broersen J, Lodder L, Wever L, Visser MR, Oosterveld P, Smets EM (1999) Revealing response shift in longitudinal research on fatigue—the use of the thentest approach. Acta Oncol 38:709–718

    Article  PubMed  CAS  Google Scholar 

  39. Strand BH, Dalgard OS, Tambs K, Rognerud M (2003) Measuring the mental health status of the Norwegian population: a comparison of the instruments SCL-25, SCL-10,SCL-5 and MHI-5 (SF-36). Nord J Psychiatry 57:113–118

    Article  PubMed  Google Scholar 

  40. Veenstra KM, Sprangers MA, van der Eyken JW, Taminiau AH (2000) Quality of life in survivors with a Van Ness–Borggreve rotationplasty after bone tumour resection. J Surg Oncol 73:192–197

    Article  PubMed  CAS  Google Scholar 

  41. Ware JE, Snow KK, Kosinski M (2000) SF-36 Health Survey: manual and interpretation guide. QualityMetric, Lincoln, RI

    Google Scholar 

  42. Ware JE Jr, Gandek B, Kosinski M, Aaronson NK, Apolone G, Brazier J, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M, Thunedborg K (1998) The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51:1167–1170

    Article  PubMed  Google Scholar 

  43. Weddington W-WJ, Segraves KB, Simon MA (1985) Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 3:1393–1399

    PubMed  Google Scholar 

  44. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Cooperation with the Norwegian Urologic Cancer Group (project 3) and the Scandinavian Sarcoma Group is acknowledged.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liv Hege Aksnes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aksnes, L.H., Hall, K.S., Jebsen, N. et al. Young survivors of malignant bone tumours in the extremities: a comparative study of quality of life, fatigue and mental distress. Support Care Cancer 15, 1087–1096 (2007). https://doi.org/10.1007/s00520-007-0227-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0227-x

Keywords

Navigation