PSYCHOSOCIAL ADAPTATION OF LONG-TERM SURVIVORS OF BONE SARCOMA

Previous studies comparing amputation and a limb-salvage procedure as treatments for bone tumors described no differences between the two tr eatments regarding the incidence of psychopathology or quality-of-life outcomes. These studies were limited by the absence of standardized m easures of psychopathology, by samples that included an overly broad a ge range, or by including patients who had either upper- or lower-limb bone cancers. A sample of 45 patients (43 with lower-limb osteosarcom a and 2 with Ewing's sarcoma) who were aged 11-24 years at diagnosis a nd had survived an average of seven years at the time of the study wer e evaluated using both standardized measures of psychological symptoms and a semistructured clinical interview. No differences were found in the mean psychopathology scores of the two treatment groups (32 treat ed with a limb salvage procedure and 13 with initial amputation). Sign ificant differences in psychosocial adaptation were found between the two groups. The amputees felt they were not employed at a level approp riate to their skills and training, and they were less likely than the limb salvage group to have married since the diagnosis. They also fel t they had been subjected to greater job and social discrimination. Fu rthermore, good coping skills protected the limb-spared group, but not the amputees, from having higher scores on the measures of psychopath ology, depression, and anxiety. The greater distress and the more comp romised social and work satisfaction among the amputees warrants furth er study. The authors suggest different directions for psychosocial in terventions for the two groups.