After Treatment for Osteosarcoma

During treatment for osteosarcoma, most patients and families are focused on getting through treatment and beating the cancer. After treatment, the focus tends to shift toward the long-term effects of the cancer and its treatment, as well as worries about the cancer coming back.

It is normal to want to put osteosarcoma and its treatment behind you and to get back to a life that does not revolve around cancer. Getting the right follow-up care offers you or your child the best chance for recovery and long-term survival.

Follow-up exams and tests

For several years after treatment, regular follow-up exams will be very important.

The doctors will watch for possible signs of the cancer coming back, as well as for short-term and long-term side effects of treatment as part of these visits. Doctors may also include:

• Blood tests such as blood counts and kidney and liver function tests
• Imaging tests such as MRI scans, CT scans, or x-rays
• Hearing testing (audiogram)
• Ultrasound of the heart (echocardiogram)

Physical therapy and rehabilitation are a very important part of recovery after treatment for osteosarcoma, and your doctors and other health providers will continue to monitor your (child’s) progress as time goes on.

Visits with your treatment team will be frequent at first, but the time between visits may get longer as you get farther away from your treatment. The risk of recurrence goes down over time. However, routine doctor visits are still important because some of the side effects of treatment might not show up until years later. Follow-up care gives you a chance to discuss any questions or concerns that arise during and after recovery from cancer treatment.

Ask the cancer care team for a survivorship care plan

Talk with the treatment team about developing a survivorship care plan. This plan might include:

• A summary of the diagnosis, tests done, and treatment given
• A suggested schedule for follow-up exams and tests
• A schedule for other tests that might be needed in the future, such as early detection (screening) tests for other types of cancer, or tests to look for long-term health effects from the cancer or its treatment
• A list of possible late- or long-term side effects from treatment, including what to watch for and when to contact the doctor
• Diet and physical activity suggestions

Staying prepared and organized

Even if you’ve completed treatment, it’s still important to be organized and stay on top of your health. Keeping your records and health insurance coverage in order makes it easier to manage follow-up care, future checkups, and any new concerns that may come up.

Keep your health insurance

It’s very important to keep health insurance as an osteosarcoma survivor. It can help cover the cost of follow-up visits, tests, and any care you may need in the future. No one wants to think about cancer coming back, but it’s best to be prepared.

Save your medical records

At some point, you may see a new doctor who doesn’t know your cancer history. Keep copies of your medical records so you can easily share the details of your diagnosis and treatment when needed.

Late and long-term effects of treatment

Osteosarcoma treatment might affect a person’s health later in life. Most of the long-term side effects depend on what kind of treatment a person had, where the tumor was located, and how old the person was when treated. Young people in particular are at risk for possible late effects of their treatment as they have more expected years of life ahead of them.

Physical health after cancer treatment

The risk of long-term effects depends on many factors, such as the specific treatments received, doses of treatment, and age when treated.

For example, the late effects of surgery can range from small scars to the loss of a limb, which would require both physical rehabilitation and emotional adjustment.

Other late effects of treatment can include:

Other possible complications might come up as well. Your or your child’s doctor should carefully review any possible problems with you during follow-up appointments. For more information, see Late and Long-term Effects of Childhood Cancer Treatment.

Social and emotional health in children and families after cancer treatment

Most often, osteosarcoma develops during the childhood or teenage years, a very complex time in a person’s life. Osteosarcoma and its treatment can have a profound effect on how a person looks and how they view themselves and their body. It can also affect how they do some everyday tasks, including certain school, work, or recreational activities. Some people may also have a hard time coping with being away from school, friends, and activities they enjoyed before cancer. These impacts are often greatest during the first year of treatment, but they can be long-lasting in some people.

Once treatment is finished, a few emotional concerns can come up. Some of these might occur many years after treatment and can include:

• Dealing with physical changes that can result from the treatment
• Worries about the cancer returning or new health problems developing
• Feelings of resentment for having had cancer or having had to go through treatment or having health problems when others do not
• Feeling guilty for surviving cancer, when other friends with cancer did not
• Concerns about being treated differently or discriminated against (by friends, classmates, coworkers, employers, etc.)
• Concerns about dating, marrying, and having a family later in life

It is normal to have some anxiety or other emotional reactions after treatment, but feeling overly worried, depressed, or angry can affect many aspects of a young person’s growth. It can get in the way of relationships, school, work, and other aspects of life. With support from family, friends, other survivors, mental health professionals, and others, many people who have survived cancer can thrive despite the challenges they have had to face.

Parents and other family members, especially siblings, can also be affected, both emotionally and in other ways. Some common family concerns include financial stresses, job loss, relationship stress, and worry about cancer returning. Social workers and other professionals at cancer centers can help families access help for these issues. Reach out to your cancer center for help when needed.

To learn more about helping children with osteosarcoma and their loved ones cope during and after treatment, see Childhood Cancer.

Long-term follow-up guidelines

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 are used by your doctor to create a Survivorship Care Plan specific to your child’s treatment. They can help you know what to watch for, what screening tests should be done to look for problems, and how late effects can be treated.

To learn more, ask your child’s doctors about the COG survivor guidelines. You can also download them for free at the COG website: www.survivorshipguidelines.org. The guidelines are written for health care professionals, but patient education on some late effects of treatment is available (as “Health Links”) on the site as well.

For more on the possible long-term effects of treatment, see Late and Long-term Effects of Childhood Cancer Treatment.