Limb versus life—the outcomes of osteosarcoma in Cambodia

Abstract

Osteosarcoma (OS) is a serious disease affecting mainly children and young adults. In a resource poor setting the treatment options are limited and further obstacles can be found with respect to late presenting pathology, access to modern treatment modalities such as effective chemotherapy, and cultural reluctance to undergo certain treatments. Clinical outcome studies and epidemiology for this disease in developing countries are scarce. We report on the outcomes of 30 patients treated by the CSC, a rehabilitative surgery centre in Cambodia, from 2002 to present. Enneking staging, location, and treatment protocols were evaluated. Outcome measures were months of survival, EDQ5S life quality scores and clinically relevant inquiries. Kaplan-Meier analysis estimates and the Wilcoxon chi-square test were used for statistical inferences. We find a grim prognosis for patients diagnosed with OS in Cambodia, 53% survive the first year after presentation and the five-year survival stands at 8%. There is a higher mean age for presentation of OS compared to Western norms, namely, 18.8 years and 21.7 years for females and males, respectively. Most patients opted for surgical treatment without adjuvant chemotherapy, which is not within the means of many Cambodian patients. Acceptance of amputation, earlier diagnosis, patient education, and access to standardized chemotherapy needs to be enhanced if Cambodian patients are to have a fighting chance.