Introduction:

As we discussed in our previous episode, July is sarcoma and bone tumor awareness month (if you haven’t listened to the previous episode, do that first!). In today’s episode we’re really going to dive into what are the rehab implications for people undergoing treatment for osteosarcoma so I can listen to the previous episode first and then come back for this one. 

Side Effects of Treatment for Osteosarcoma

As we discussed in the last episode osteosarcoma is typically treated with neoadjuvant chemotherapy followed by surgery and then sometimes followed with more chemotherapy.  Common chemotherapy regimens for osteosarcoma include methotrexate, doxorubicin, cisplatin, ifosfamide, and etoposide.  In rare circumstances osteosarcoma may be treated with radiation, but overall this is very rare and we’re going to focus our discussion today on the side effects of chemotherapy and surgery.

When you Google search side effects of osteosarcoma treatment, you’ll find much more general side effects especially when it comes to chemotherapy. For example: nausea, vomiting, hair loss, loss of appetite, the list goes on.

But what this very generalized list leaves out is the long-term side effects of osteosarcoma treatments. Now I think this is because most of these resources that I’m looking at for this particular purpose are more for the General Public. And as we know a lot of the general public doesn’t realize the widespread impact of cancer treatment both in the short-term and in the long-term.

So we’re going to do a deeper dive into what are some of these expected side effects of the different chemotherapy regimens.

Common side effects of chemotherapy for osteosarcoma:

• Cancer-related fatigue
• Gait & balance deficits
• CIPN (chemotherapy-induced peripheral neuropathy)
• Ototoxicity
• Anemia
• Skin rash
• Cardiotoxicity
• Pulmonary toxicity
• Fertility loss

Common side effects of surgery for osteosarcoma

The surgical side effects truly depend upon the surgical treatment approach. As we know, osteosarcomas were traditionally treated with an amputation: you cut off the part that has cancer and then you’re kind of done dealing with it, and then sometimes patients were fitted for a prosthesis, etc. However these days limb salvage surgery has kind of taken a more center stage position in the treatment of osteosarcoma. 

Now what I’m about to read you is actually a direct quote from the Moffitt Cancer Center website on osteosarcoma:

As with chemotherapy, osteosarcoma surgery is most frequently associated with short-term side effects. Infection, swelling and blood loss are most common, although minimally invasive surgical techniques can often help reduce the likelihood of these complications.

https://moffitt.org/cancers/osteosarcoma/faqs/what-are-the-long-term-effects-of-treatment-for-osteosarcoma/

In my opinion this couldn’t be further from the truth. And here’s why:

While hopefully many patients are not having long-term issues with infection, blood loss, and swelling, this statement tends to gloss over the fact that many patients are undergoing some kind of limb removal surgery or partial limb removal surgery as part of their osteosarcoma treatment. 

And depending on which bone was affected and which bone was removed, this absolutely has long-term side effects for our patients. For example, I’ll talk about a person I knew who had Ewing sarcoma.  

Part of his treatment was to actually remove the affected radius (where his Ewing sarcoma was located). And because of this, he no longer had the capacity to pronate and supinate that arm.

Perhaps this doesn’t seem like a big deal on paper, but to this individual, that drastically affected his ability to participate in his sports, & it was something he had to overcome as he underwent training for his future profession.

So the side effects of surgery for osteosarcoma can definitely affect a person for the long-term and I think we should embrace that and educate our patients in our communities on these long-term side effects.

If a person is now using a prosthesis, that absolutely changes their gait, balance, mobility, & independence. 

Sometimes it’s not just the bones that are impacted from the surgery. Sometimes these patients also have muscle and other soft tissue disruption, if not removal all together. Again, this absolutely changes a person’s functional mobility. 

How does this affect rehab?

One of the most important considerations when it comes to treating people with an osteosarcoma is their developmental status. Many patients who develop an osteosarcoma are either a child, an adolescent, sometimes even a young adult. As a result, some patients may still be experiencing periods of growth and development that could be affected by their cancer and or their cancer treatments. 

Conclusion:

While osteosarcomas are not a very common type of cancer, they can result in significant functional mobility impairments for patients. In a podcast later this month, we’re going to talk about rehab implications that we as PT’s must be aware of when we’re working with the patient with an osteosarcoma.

So now I want to hear from you: what did I miss? What else would you include in this episode about osteosarcomas? Message me on Instagram and let me know.

Until next time, this is Elise with TheOncoPT. And remember: you are exactly the physical therapist that your patients with cancer need. So let’s get to work.

References:

• Compston, Amy M. PT, DPT, CRT, CLT-LANA1; Zak, Jacqueline PT, DPT2; Alexander, John H. MD3; West, Julie M. MS, PA-C4; Scharschmidt, Thomas J. MD5; Valerio, Ian L. MD6; Mayerson, Joel L. MD7 Rotationplasty Rehabilitation Protocol: A Complex Case Report, Rehabilitation Oncology: April 2020 – Volume 38 – Issue 2 – p E32-E40 doi: 10.1097/01.REO.0000000000000182
• https://www.cancer.org/cancer/osteosarcoma.html
• Ambler, Steven B. PT, DPT, PhD, MPH1; Highsmith, M. Jason PT, DPT, PhD2; Alvero, Christine PT, DPT, MBA3; Binitie, Odion T. MD4 Functional Comparison of a Pediatric Patient With Osteosarcoma and Limb-Sparing Distal Femoral Endoprosthesis With an Identical Twin, Rehabilitation Oncology: October 2019 – Volume 37 – Issue 4 – p E1-E6 doi: 10.1097/01.REO.0000000000000148
• The Role of Physical Therapy in Pediatric Oncology SIG presentation
• Ospina PA, McNeely ML. A Scoping Review of Physical Therapy Interventions for Childhood Cancers. Physiother Can. 2019 Summer;71(3):287-296. doi: 10.3138/ptc.2018-13.pp. PMID: 31719724; PMCID: PMC6830414.
• https://www.cancer.net/cancer-types/osteosarcoma-childhood-and-adolescence/types-treatment#:~:text=With%20the%20therapy%20typically%20used,away%20after%20treatment%20is%20finished.