Secondary amputation: a qualitative study of quality of life in patients after primary limb salvage surgery and after later ablative sarcoma treatment
DOI:
https://doi.org/10.2340/jrm.v57.34888Keywords:
qualitative, Quality of live, secondary amputation, patients viewAbstract
Objective: This study focuses on how patients experience the time following amputation after primary limb salvage surgery due to musculoskeletal malignancies. Limb salvage is state of the art in the treatment of musculoskeletal tumours. Nonetheless, in some cases, limb salvage can become problematic over time, resulting in poorer limb function and septic outcomes. This raises the question of whether amputation is indicated sooner rather than later. Patients who have undergone secondary amputation might retrospectively prefer a different approach.
Design: Interview study.
Subjects/patients: Patients who underwent primary limb salvage surgery followed by later ablative sarcoma treatment.
Methods: Semi-structured interviews and the standardized “Prosthetic Limb Users Survey of Mobility” questionnaire were conducted. Interviews were analysed according to Mayring content analysis method.
Results: Amputation is perceived as an improvement after a long course of illness with little quality of life. By enhancing the amputation environment and providing detailed information regarding quality of life afterwards, emotional pressure could be reduced and patient satisfaction improved.
Conclusion: Surgical options for ablation should be openly communicated earlier when consulting patients experiencing recurrent complications that might eventually lead to amputation. Supporting factors that subsequently may help to improve quality of life after amputation were further identified.
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References
Conference IH. Constitution of the World Health Organization. 1946. Bulletin of the World Health Organization 2002; 80: 983.
Gill TM, Feinstein AR. A critical appraisal of the quality of quality-of-life measurements. JAMA 1994; 272: 619-626. DOI: https://doi.org/10.1001/jama.272.8.619
https://doi.org/10.1001/jama.1994.03520080061045 DOI: https://doi.org/10.1001/jama.1994.03520080061045
Hui JY. Epidemiology and etiology of sarcomas. Surg Clin North Am 2016; 96: 901-914.
https://doi.org/10.1016/j.suc.2016.05.005 DOI: https://doi.org/10.1016/j.suc.2016.05.005
Bourcier K, Le Cesne A, Tselikas L, Adam J, Mir O, Honore C, de Baere T. Basic knowledge in soft tissue sarcoma. Cardiovasc Intervent Radiol 2019; 42: 1255-1261.
https://doi.org/10.1007/s00270-019-02259-w DOI: https://doi.org/10.1007/s00270-019-02259-w
Casali PG, Abecassis N, Aro HT, Bauer S, Biagini R, Bielack S, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2018; 29: iv51-iv67.
M'Bra KI, Kouassi AAN, Sery B, Yao LB, Kouassi KJE, Ochou PG, Jr., et al. [Secondary amputation of the limb after primary surgery of open fractures of the lower limb]. Pan Afr Med J 2018; 29: 172.
https://doi.org/10.11604/pamj.2018.29.172.13177 DOI: https://doi.org/10.11604/pamj.2018.29.172.13177
Greenberg DB, Goorin A, Gebhardt MC, Gupta L, Stier N, Harmon D, Mankin H. Quality of life in osteosarcoma survivors. Oncology (Williston Park) 1994; 8: 19-25; discussion 25-16, 32, 35.
Sugarbaker PH. Musculoskeletal cancer surgery: Treatment of sarcomas and allied diseases. Springer; 2004.
MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma 2002; 52: 641-649.
https://doi.org/10.1097/00005373-200204000-00005 DOI: https://doi.org/10.1097/00005373-200204000-00005
Baptista AM, Rebolledo DCS, Tavares MCM, Correia LFM, Caiero MT, Teixeira WJ, et al. Orthopedics: Musculoskeletal tumors. In: Zerati AE, Nishinari K, Wolosker N, editors. Vascular surgery in oncology. Cham: Springer International Publishing; 2022: 201-222.
https://doi.org/10.1007/978-3-030-97687-3_6 DOI: https://doi.org/10.1007/978-3-030-97687-3_6
Aravind M, Shauver MJ, Chung KC. A qualitative analysis of the decision-making process for patients with severe lower leg trauma. Plast Reconst Surg 2010; 126: 2019-2029.
https://doi.org/10.1097/PRS.0b013e3181f4449e DOI: https://doi.org/10.1097/PRS.0b013e3181f4449e
Eiser C, Darlington AS, Stride CB, Grimer R. Quality of life implications as a consequence of surgery: limb salvage, primary and secondary amputation. Sarcoma 2001; 5: 189-195.
https://doi.org/10.1080/13577140120099173 DOI: https://doi.org/10.1080/13577140120099173
Medical University of Vienna. RDA; Research, Documentation and Analysis. 2024 [cited 19.04.2024]; Available from: https://www.meduniwien.ac.at/web/mitarbeiterinnen/it-hilfe-support/it4science/plattformen/rda/.
Jamshed S. Qualitative research method-interviewing and observation. J Basic Clin Pharmacol 2014; 5: 87.
https://doi.org/10.4103/0976-0105.141942 DOI: https://doi.org/10.4103/0976-0105.141942
Mayring P. Qualitative content analysis [28 paragraphs]. Forum Qualitative Sozialforschung. Forum: Qualitative Social Research [On-line Journal]; 2000; 2000.
Quality of life. Lancet 1991; 338: 350-351.
https://doi.org/10.1016/0140-6736(91)90485-8 DOI: https://doi.org/10.1016/0140-6736(91)90485-8
Stokke J, Sung L, Gupta A, Lindberg A, Rosenberg AR. Systematic review and meta-analysis of objective and subjective quality of life among pediatric, adolescent, and young adult bone tumor survivors. Pediatr Blood Cancer 2015; 62: 1616-1629.
https://doi.org/10.1002/pbc.25514 DOI: https://doi.org/10.1002/pbc.25514
Simon MA, Aschliman MA, Thomas N, Mankin HJ. Limb-salvage treatment versus amputation for osteosarcoma of the distal end of the femur. J Bone Joint Surg Am 1986; 68: 1331-1337.
https://doi.org/10.2106/00004623-198668090-00005 DOI: https://doi.org/10.2106/00004623-198668090-00005
Silva RS, Guilhem DB, Batista KT, Tabet LP. Quality of life of sarcoma patients after conservative surgery or limb amputation. Acta Ortopédica Brasileira 2019; 27: 276-280.
https://doi.org/10.1590/1413-785220192705219143 DOI: https://doi.org/10.1590/1413-785220192705219143
Doukas WC, Hayda RA, Frisch HM, Andersen RC, Mazurek MT, Ficke JR, et al. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma. J Bone Joint Surg Am 2013; 95: 138-145.
https://doi.org/10.2106/JBJS.K.00734 DOI: https://doi.org/10.2106/JBJS.K.00734
Solooki S, Mostafavizadeh Ardestani SM, Mahdaviazad H, Kardeh B. Function and quality of life among primary osteosarcoma survivors in Iran: amputation versus limb salvage. Musculoskelet Surg 2018; 102: 147-151.
https://doi.org/10.1007/s12306-017-0511-y DOI: https://doi.org/10.1007/s12306-017-0511-y
Fauske L, Bondevik H, Ahlberg K, Bjørndal A. Identifying bone sarcoma survivors facing psychosocial challenges. A study of trajectories following treatment. Eur J Cancer Care (Engl) 2019; 28: e13119.
https://doi.org/10.1111/ecc.13119 DOI: https://doi.org/10.1111/ecc.13119
Fauske L, Bruland OS, Grov EK, Bondevik H. Cured of primary bone cancer, but at what cost: a qualitative study of functional impairment and lost opportunities. Sarcoma 2015; 2015: 484196.
https://doi.org/10.1155/2015/484196 DOI: https://doi.org/10.1155/2015/484196
Ali S, Fatima Haider SK. Psychological adjustment to amputation: Variations on the bases of sex, age and cause of limb loss. J Ayub Med Coll Abbottabad 2017; 29: 303-307.
Gallagher P, Allen D, Maclachlan M. Phantom limb pain and residual limb pain following lower limb amputation: a descriptive analysis. Disabil Rehabil 2001; 23: 522-530.
https://doi.org/10.1080/09638280010029859 DOI: https://doi.org/10.1080/09638280010029859
Cimino SR, Hitzig SL, Fung V, Dainty KN, MacKay C, Sale JEM, et al. Quality of life following non-dysvascular lower limb amputation is contextualized through occupations: a qualitative study. Disabil Rehabil 2024; 46: 3887–3894.
https://doi.org/10.1080/09638288.2023.2258340 DOI: https://doi.org/10.1080/09638288.2023.2258340
Bragaru M, Dekker R, Geertzen JH, Dijkstra PU. Amputees and sports: a systematic review. Sports Med 2011; 41: 721-740.
https://doi.org/10.2165/11590420-000000000-00000 DOI: https://doi.org/10.2165/11590420-000000000-00000
Webster JB, Levy CE, Bryant PR, Prusakowski PE. Sports and recreation for persons with limb deficiency. Arch Phys Med Rehabil 2001; 82: S38-S44.
https://doi.org/10.1016/S0003-9993(01)70045-7 DOI: https://doi.org/10.1016/S0003-9993(01)70045-7
Valliant PM, Bezzubyk I, Daley L, Asu ME. Psychological impact of sport on disabled athletes. Psychol Rep 1985; 56: 923-929.
https://doi.org/10.2466/pr0.1985.56.3.923 DOI: https://doi.org/10.2466/pr0.1985.56.3.923
Couture M, Caron CD, Desrosiers J. Leisure activities following a lower limb amputation. Disabil Rehabil 2010; 32: 57-64.
https://doi.org/10.3109/09638280902998797 DOI: https://doi.org/10.3109/09638280902998797
Burger H, Marincek C, Isakov E. Mobility of persons after traumatic lower limb amputation. Disabil Rehabil 1997; 19: 272-277.
https://doi.org/10.3109/09638289709166538 DOI: https://doi.org/10.3109/09638289709166538
Medhat A, Huber PM, Medhat MA. Factors that influence the level of activities in persons with lower extremity amputation. Rehabil Nurs 1990; 15: 13-18.
https://doi.org/10.1002/j.2048-7940.1990.tb01147.x DOI: https://doi.org/10.1002/j.2048-7940.1990.tb01147.x
Waters RL, Perry J, Antonelli D, Hislop H. Energy cost of walking of amputees: the influence of level of amputation. J Bone Joint Surg Am 1976; 58: 42-46.
https://doi.org/10.2106/00004623-197658010-00007 DOI: https://doi.org/10.2106/00004623-197658010-00007
McQuerry J, Gammon L, Carpiaux A, Talwalkar V, Iwinski H, Walker J, et al. Effect of amputation level on quality of life and subjective function in children. J Pediatr Orthop 2019; 39: e524-e530.
https://doi.org/10.1097/BPO.0000000000001321 DOI: https://doi.org/10.1097/BPO.0000000000001321
Matthews D, Sukeik M, Haddad F. Return to sport following amputation. J Sports Med Phys Fitness 2014; 54: 481-486.
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