Survivorship in young patients with bone cancer Michelle Greene, PhD, Magdalena Kobierska, MD, Paul M. Kent, MD, FAAP, Patricia Piasecki, RN, MS, CNP Introduction With advancements in treatment, there is currently an estimated 80% survival rate for all cancers in children, translating into 1 in 570 young adults, or approximately 250,000 survivors in the United States. 1,3 Given such high survival rates, there is growing interest regarding the long- term health consequences of treatment in such patients. Along with the rising cure rates for malignant musculoskeletal tumors in children and adolescents comes the reality of substantial disability related to cancer treatment. Approximately 75% of survivors of primary malignant bone tumors suffer long-term consequences of chemo- therapy, radiotherapy, and surgery, including musculoskeletal problems, cardiovascular disease, renal dysfunction, endocrinopathies, psychological disability, and secondary malignancies (Fig). 3 Psychosocial aspects of survivorship—Michelle Greene, PhD In some studies, more than 75% of the survivors have symptoms of posttraumatic stress disorder such as bad dreams, anxiety, and fear of secondary malignancy. 3 The psychological and physical challenges faced by children and AYA with bone tumors are clearly distinct from their healthy peers and youths with other childhood cancers such as a brain tumor, acute lymphoblastic leukemia, or acute myeloid leukemia. 4-6 Although both psychological and physical problems improve over time for these patients, recovery and functioning are different across domains. Health-Related Quality of life (HRQoL) has been broadly considered “the balance between what an individual can and would like to be able to do” and as “subjective and objective impact of dysfunction linked with an illness, injury of medical treatment.” 5 Physical functioning and HRQoL are more significantly affected than psychological HRQoL, and although the physical domain improves, overall, it remains significantly different from healthy peers. 6,8-12 Differences between psychological and physical HRQoL can be seen as early as diagnosis and acute treatment. At diagnosis, adolescents with OS and their parents have reported worry, pain, and physical functioning as the most affected or lowest domains of HRQoL and cognitive functioning, emotional, and school functioning as highest domains of HRQoL. 6 From diagnosis to 12 weeks after diagnosis, pain, procedural anxiety, treatment anxiety, and emotional functioning Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/cpcancer Curr Probl Cancer 0147-0272/$ - see front matter & 2013 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.currproblcancer.2013.07.011 Curr Probl Cancer 37 (2013) 236–243