Rehabilitation of Bone Sarcoma Patients Integrated During Treatments

Introduction: Bone sarcomas are the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves neoadjuvant chemotherapy with either limb salvage surgery or amputation. In critical care setting, rehabilitation is often overlooked. Along the years, these patients exhibit reduced physical activity compared with normal age-matched controls.
Approach to rehabilitation of these patients has evolved with the advances in medical treatment and surgical management. In addition, physical-therapy and occupational-therapy interventions are now tailored to address the multiple physical and psychosocial difficulties these patients face for the remainder of their lives.

We report outcomes of our cohort of 14 patients, all diagnosed with bone sarcomas of the lower limb. All treated surgically with limb salvage procedures and with chemotherapy, and referred to rehabilitation during adjuvant therapy.

Patients and Methods: Nine boys five girls, age range at diagnosis 3-19 years (avg. 12). Eleven diagnosed with osteosarcoma and three with Ewing sarcoma.

Results: All patients were integrated into intensive rehabilitation program including physiotherapy, hydrotherapy, nursing, psychology and others.
Rehabilitation was either as full hospitalization or in a day-care setting, range 1-12 months (avg. 7).

Two patients underwent AKA due to local recurrence, one survived and one died. Three other patients died due to metastases. Two patients had an infection necessitating removal of implants and shortening of the limb.
All ten surviving patients improved their ambulation. 8/10 subjectively needed less assistive devices, and eventually all walked independently – four with assistive devices (1 crutches, 2 foot brace, 1 shoe raise and crutches) and six independent (1 with AKA prosthesis). Objective parameters of gait showed improvement of all patients in average gait velocity of 1.08 meter/sec. (80% of average velocity in typically developed peers matched for age).

Conclusions: Management of patients with bone sarcomas should also include awareness of their rehabilitation after surgery, which enables achieving the highest functional status possible and permit them to enjoy dignity and an improved quality of life.