The Aftercare after Cure: The Functional Impact of Cancer Treatment and Need for Creative Solutions to Complex Problems

Review Article

Austin J Med Oncol. 2014;1(1): 4.

The Aftercare after Cure: The Functional Impact of Cancer Treatment and Need for Creative Solutions to Complex Problems

Walczak BE*

Deparment of Musculoskeletal Oncology, McLaren Cancer Institute, USA

*Corresponding author: Brian E Walczak, Department of Musculoskeletal Oncology, McLaren Cancer Institute, 1080 Harrington Avenue, Mt Clemens, MI 48043, USA

Received: June 23, 2014; Accepted: July 25, 2014; Published: July 28, 2014


The American Cancer Society estimates that the overall five-year survival rate for all cancers diagnosed between 2003 and 2009 is 68% [1]. This is a significant improvement from a relative survival rate of 49% for cancers diagnosed between the years 1975-1977 [1]. Moreover, it is estimated that 1 out of 530 adults are now survivors of a childhood cancer [1]. Although surviving cancer is truly a success, some patients will feel the effects of treatment for the rest of their lives. This impact requires surgeons who will diligently strive to improve surgical techniques, develop novel uses of radiation and chemotherapy, and are willing to push the limits of complex orthopaedic reconstructions, all in an effort to provide the patient with the possibility of obtaining the highest level of function.

The Functional Impact of Cancer Treatments

The use of chemotherapy in the treatment of bone sarcomas evolved in the 1970s and 1980s. The use of cytotoxic medications was arguably the most important variable that resulted in a dramatic rise in the 5-year survival rate of osteosarcoma [2-4]. Recently, Bernthal et al. demonstrated that this effect continues even greater than 25 years later [5]. However, improved survival comes at a cost of late effects of limb salvage reconstructions. Certainly, the increased risk of secondary cancer after adjuvant treatments is well known [6]. However, the functional effects following treatment are much more difficult to define. Empirical evidence is validating that the late effects of orthopaedic reconstructive efforts following tumor resection are becoming increasingly prevalent. The difficulties that surgeons face with late reconstructive failures are unique and quite different from those seen during the initial treatment. Some of the challenges that surgeons face in this setting include substantial bone loss, soft tissue failure, and fracture all in the setting of the post-treatment effects of altered anatomy often due to previous tumor resection, significant cicatrix, and delayed wound healing especially if radiation was used.

The effects of significant bone loss after tumor resection and reconstructions are challenging problems. Patients may have to undergo several revision surgeries during their lives to continue to perform their daily functions. However, the impact of previous limb salvage efforts may lead to further bone loss that often necessitates novel uses of the current prosthetic designs (Figure 1).