Bone cancer in children
Bone cancer, such as osteosarcoma and Ewing sarcoma, mainly occurs in children and teenagers between 10 and 20 years old. In the Netherlands, around 30 children are diagnosed each year. Tumors usually grow in the long bones, such as the thigh, shin and arm, or in the pelvis. Treatment typically includes chemotherapy and surgery to remove the tumor. These are major surgeries that can affect appearance. Depending on the size and place of the tumor, different surgeries are available, such as an amputation, a rotationplasty, or limb-sparing surgery where the removed bone is replaced with a prosthesis or donor bone.
Insecure
The study involved 132 young people who were on average 20 years old and eight years after surgery. They completed questionnaires about how they saw their bodies and whether they experience emotional problems, such as stress, anxiety, or depression.
The results show that these young people can struggle with their body image after treatment. Hinke van der Hoek: ‘About one-third of participants said they often felt insecure or dissatisfied with their appearance. These feelings were linked to emotional problems, like depression, anxiety, and stress.’ Leonie Tigelaar adds: ‘Interestingly, young people who had an amputation generally reported a more positive body image than those who had limb-sparing surgery. Scores for those with rotationplasty were in between. This is striking, because it is often assumed that amputations or rotationplasties cause more problems with body image.’
Psychosocial support
Hinke van der Hoek: ‘We mainly looked at medical factors. But these surprising results show that body image after bone cancer is likely influenced more by other things, such as personality, coping style, or support from family and friends. When new patients face a choice between different surgeries, it is important that doctors talk with them about their expectations, worries, and preferences. This is called ‘shared decision-making’. Also for follow-up care, it is important to keep paying attention to how young people feel about their bodies, so they can receive the right support if needed.’