Osteosarcoma Rehabilitation: Key Guidelines for Recovery After Treatment

Osteosarcoma, commonly known as "bone cancer," is a highly malignant tumor originating in bone-forming tissue. Affecting primarily individuals aged 10-25 and those over 60, osteosarcoma is more common in men than women. The main treatment options include surgery, chemotherapy, radiotherapy, targeted therapy, and immunotherapy. Beyond the physical toll, osteosarcoma brings significant psychological stress to patients. Early recognition of warning signs and proper rehabilitation post-treatment are essential for recovery and quality of life. Here’s a comprehensive guide to osteosarcoma recovery and management.

Q1: How to Manage Periosteal Reactions (Pain, Localized Swelling, and Tenderness)?

Periosteal reactions occur when tumor cells rapidly grow, causing new bone formation that presses against the periosteum, resulting in pain and localized swelling. Avoid acupuncture, cupping, or any pressure on the affected area; instead, seek prompt medical treatment.

Primary treatment involves chemotherapy or surgery. For pain management, medications like acetaminophen, NSAIDs, tramadol, oxycodone, morphine, and fentanyl can be used, depending on pain severity. These medications can also be combined with therapies like radiotherapy and targeted treatments for improved relief.

Q2: What to Do if Postoperative Knee Joint Effusion Occurs?

Joint effusion after knee replacement is common and usually subsides within 1-3 months. Effusion results from surgical trauma and tissue response, but should absorb within 2-3 weeks post-surgery. If effusion persists, options like physical therapy, aspiration, and joint washing are effective. Extended effusion beyond three months, or signs like redness, fever, and pain, may indicate infection and require immediate medical attention.

Q3: How to Manage Lung Metastasis or Pneumonia in Osteosarcoma Patients?

If lung metastasis is detected, a multidisciplinary approach is crucial. Surgical removal may be possible for isolated or limited lung metastases, while chemotherapy or targeted therapy is recommended for multiple metastases. If it’s merely a lung infection, anti-infective treatments can be administered, but CT scans should be done regularly to differentiate between infection and metastasis.

Q4: Managing Pain in Osteosarcoma Patients

Pain management follows the World Health Organization’s (WHO) three-step ladder:

Mild Pain: Acetaminophen or NSAIDs, though long-term use can have adverse effects.
Mild to Moderate Pain: Combine acetaminophen/NSAIDs with mild opioids like codeine or tramadol.
Moderate to Severe Pain: Use strong opioids like morphine or fentanyl, monitoring for side effects like constipation and nausea.

Q5: How to Address Postoperative Fever?

Persistent fever post-surgery can be a side effect of chemotherapy, especially if white blood cells or neutrophils are low. A temperature above 38.0°C indicates febrile neutropenia, which requires broad-spectrum antibiotics and medications to stimulate white blood cells. Signs like redness, swelling, or pain at the surgery site could suggest infection, needing a bacterial culture and possibly debridement.

Q6: Is Postoperative Chemotherapy Necessary for Osteosarcoma Patients?

The need for chemotherapy post-surgery depends on pathology results. Well-differentiated parosteal osteosarcoma may only need surgery, while typical osteosarcoma requires postoperative chemotherapy to target potential micro-metastases and reduce recurrence. The standard approach—chemotherapy + surgery + chemotherapy—has been shown to extend survival.

Q7: Common Side Effects of Chemotherapy in Osteosarcoma Patients

Chemotherapy side effects vary by drug:

Common Drugs: Adriamycin, ifosfamide, cisplatin, and high-dose methotrexate.
Side Effects: Gastrointestinal issues, bone marrow suppression, hair loss, and specific toxicities:
- Adriamycin: Cardiovascular issues.
- Ifosfamide: Bladder toxicity (e.g., blood in urine).
- Cisplatin: Kidney and ear toxicity, requiring hydration.
- High-dose Methotrexate: Oral ulcers, liver toxicity; use leucovorin for protection.

Regular monitoring and early intervention can reduce chemotherapy delays and ensure effective treatment.

Rehabilitation Best Practices

Adopting a structured rehabilitation and pain management plan helps in recovery and improves quality of life for osteosarcoma patients. Ensuring a multidisciplinary approach, prompt infection control, and adherence to prescribed rehabilitation exercises can lead to a smoother recovery journey.