Following treatment for osteosarcoma, the main concerns for most people are the immediate and long-term effects of the tumor and its treatment, and concerns about possible recurrence of the tumor.

Follow-up care

After treatment is over, it is very important to go to all follow-up appointments. During these visits, doctors will ask about symptoms, do physical exams, and may order blood tests or imaging tests such as CT scans or x-rays. Follow-up is needed to check for cancer recurrence or spread, as well as possible side effects of certain treatments. This is the time for you to ask the health care team any questions you need answered and to discuss any concerns you might have.

You or your child will probably see the oncologist and the orthopedic surgeon every few months during the first year after treatment, and less often thereafter. Physical exams, x-rays or CT scans of the chest, and x-rays of the affected bone are typically recommended about every 3 to 4 months for 3 years, every 6 months in years 4 and 5, and once a year after that.

Some chemotherapy drugs can cause problems with hearing or heart damage. People who get these drugs may also have audiograms to check hearing or tests to check heart function.

Almost any cancer treatment can have side effects. Some may last for a few weeks to several months, but others can be permanent. Tell the cancer care team about any symptoms or side effects so they can help manage them.

It is certainly understandable to want to put the tumor and its treatment behind you and to get back to a 'normal' life. But it's important to realize that follow-up care is a central part of this process that offers you (or your child) the best chance for recovery and long-term survival.

It is also important to keep medical insurance. Even though no one wants to think of the cancer coming back, it is always a possibility. If it happens, the last thing you want is to have to worry about paying for treatment.

Keeping good medical records

As much as you may want to put the experience behind you once treatment is completed, it is also very important to keep good records of your (child's) medical care during this time. This can be very helpful later on if you (or your child) change doctors. Be sure the doctors have the following information:

• A copy of the pathology report from any biopsies or surgeries
• If there was surgery, a copy of the operative report(s)
• If there were hospitalizations, copies of the discharge summaries that doctors prepare when patients are sent home
• If there was chemotherapy treatment for the cancer, a list of the drugs, drug doses, and when they were given
• If there was radiation, a summary of the type and dose of radiation and when and where it was given

Social, emotional, and other issues in people with osteosarcoma

Most cases of osteosarcoma develop during the teenage years, a very sensitive time in a child's life. An osteosarcoma diagnosis can have a profound effect on a person's outward appearance and how they view themselves and their body. It can also affect the ability to do some everyday tasks. This can have an impact on their ability to continue certain school, work, or recreational activities. The effect will probably be greatest during the first year of treatment. The treating center should evaluate the family situation as soon as possible, so that any areas of concern can be addressed.

Some common family concerns include financial stresses, transportation to the cancer center, the possible loss of a job, and the need for home schooling. Cancer care teams usually recommend that school-age children attend school as much as possible. This helps patients maintain important social connections and gives them a chance to tell their friends what is happening to them.

Friends may become a great source of support, but you should be aware that some people have a lot of misunderstanding and fears about cancer. Some cancer centers have a school re-entry program that can help in situations like this. With this program, health educators visit the school and tell students about the diagnosis, treatment, and changes the person will go through. They will also answer any questions from teachers and classmates.

Centers that treat many patients with osteosarcoma might have programs to introduce new patients to other patients who have already completed their therapy. Seeing another person with osteosarcoma doing well is often the best inspiration for a patient. There are also support groups that encourage athletics and full use of the child's limbs. Many amputees or people with prostheses are able to take part in athletics and often do.

Although the psychological impact of this disease in children and teenagers is most obvious, the challenges faced by adults with this disease must not be ignored. Adult patients should also be encouraged to take advantage of the cancer centers' physical therapy, occupational therapy, and counseling services.

Long-term effects of cancer treatment

Because of significant advances in treatment, more young people treated for cancer are now living longer lives. With survivors living longer, their health as adults has come more into focus in recent years. Researchers have learned that the effects of cancer treatment may affect that person's health later in life. This result becomes known as a late effect.

Just as the treatment of cancer in young people requires a very specialized approach, so does aftercare and monitoring for late effects. Careful follow-up after cancer treatment allows for early recognition of and attention to the after-effects of treatment.

Young people with cancer are at risk, to some degree, for several possible late effects of their cancer treatment. This risk depends on a number of factors, such as their particular type of cancer, the specific cancer treatments they received, dosages of cancer treatment, and their age when receiving the cancer treatment.

Infertility

Infertility is not a common side effect of the treatment for osteosarcoma, but it can occur. Women may have changes in menstrual periods, but normal monthly cycles usually return after chemotherapy ends. Boys and men may lose the ability to make sperm. This usually returns, but the sperm count may remain low.

Talk to your (child's) cancer care team about the risks of infertility with treatment, and ask if there are options for preserving fertility, such as sperm banking. For more information, see our document, Fertility and Cancer: What Are My Options?

Development of a second cancer

Rarely, some types of chemotherapy may cause a second type of cancer (such as leukemia), years after the osteosarcoma is cured. Radiation therapy can also raise the risk of a new cancer developing at the site of the treatment. However, the importance of treating the osteosarcoma effectively generally far outweighs this risk.

Other late effects

The late effects of osteosarcoma treatment can also include heart damage or hearing problems after receiving certain chemotherapy drugs.

Long-term follow-up care for children

To help increase awareness of late effects and improve follow-up care of childhood cancer survivors throughout their lives, the Children's Oncology Group (COG) has developed long-term follow-up guidelines for survivors of childhood cancers. These guidelines, written for doctors and other health care professionals, describe in detail the suggested long-term follow-up care based on the treatments the child has received. It is very important to discuss possible long-term complications with your child's health care team, and to make sure there is a plan in place to watch for these problems and treat them, if needed. To learn more, ask your child's doctors about the COG survivor guidelines, and see the document, Childhood Cancer: Late Effects of Cancer Treatment.

Last Medical Review: 01/14/2009
Last Revised: 01/14/2009