The impact of cancer and treatment-related effects on the physical and psychosocial well-being and quality of life among Hong Kong Chinese survivors of childhood osteosarcoma: An exploratory study

Dr Li, William Ho Cheung   (Principal Investigator (PI))

Professor Chan Godfrey Chi Fung   (Co-Investigator)

12

2018-05-01

2019-04-30

63460

The impact of cancer and treatment-related effects on the physical and psychosocial well-being and quality of life among Hong Kong Chinese survivors of childhood osteosarcoma: An exploratory study

childhood cancer, children and adolescent, osteosarcoma, quality of life, survivor

Nursing,Psychology

201711159215

Seed Fund for PI Research – Basic Research

2017

Completed

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents [1,2]. In Hong Kong, an average of 10 new cases of osteosarcoma are being diagnosed among children and adolescents aged 0-19 years each year and it accounts for 5% of all childhood malignancies [3]. The primary treatments of osteosarcoma consist of chemotherapy and surgical interventions that include amputation or limb-sparing surgery. The introduction of neoadjuvant and post-operation adjuvant chemotherapy greatly increase the survival success of osteosarcoma patients [4,5]. The 5-year overall survival rates of childhood osteosarcoma survivors have been increasing substantially with a percentage approaching to 70% [5-7]. Regrettably, the improved survival rates may lead to long-term sequelae related to disease and treatments that can negatively affect survivors’ physical and psychological well-being [4,5]. Treatments of osteosarcoma not only result in massive musculoskeletal loss that can cause structural and functional impairment of childhood osteosarcoma survivors, but also pose negative impact on their psychological and social well-being, and quality of life (QoL). It is obvious that the limitation in physical performance affects the survivors’ abilities to participate in daily activities, take part in social life and pursue their academic achievements or career [8,9]. Moreover, the presence of scars, limb deformities or skin discoloration resulting from the surgical procedures caused a disfigured body image in osteosarcoma survivors [6]. The altered body appearance not only lowers survivors’ self-esteem but also decreases their self-perceived attractiveness. Some of the osteosarcoma survivors become reluctant to expose their affected limb and consider their body disfigurement to be a sign of deviation [6,9]. Some survivors also reported a degree of discrimination from society due to their disturbed body appearance or use of mobility aid such as wheelchair [9]. In addition, the limitation in physical ability and energy impede the survivors to attend school or work [8,10]. Consequentially, limited job opportunities and poor academic performance bring about low self-esteem and poor QoL of the survivors. Although childhood leukemia is the majority cancer group which affects a large childhood population, the survivors of childhood leukemia have better prognosis and lesser physical impairments when compared with the childhood osteosarcoma survivors. In fact, osteosarcoma survivors suffer the most severe restriction in participating daily activities and social life [10]. Moreover, osteosarcoma survivors are at high risk in suffering adverse psychological problems such as depression [11]. As a consequence, osteosarcoma survivors are more vulnerable to the adverse effects of cancer treatment, severely affected their physical and psychological well-being, and QoL. Yet, the healthcare system in Hong Kong is mainly focused on providing medical treatment and physiological care to childhood cancer survivors or their family members, with very little consideration has been given to the psychological needs of survivors of childhood osteosarcoma [12,13]. There is an imperative need to investigate the impact of cancer and treatment-related effects on the physical and psychosocial well-being, and quality of life among Hong Kong Chinese survivors of childhood osteosarcoma. Despite numerous studies have examined the impact of cancer and treatment-related late effects on the physical and psychological aspects of osteosarcoma survivors in the Western countries, it has not been studied specifically in Hong Kong Chinese population. Problems arise when there is a difference in perception and recognition of psychological problems and emotional well-being between Western and Chinese culture. Moreover, the difference in coping strategies between Chinese and Western children also affects how they react and cope with the devastating effect from cancer and its treatments. Previous studies showed that Chinese children prefer to use emotion-focused coping strategies while Western children prefer to adopt problem-focused coping strategies [14]. Furthermore, the philosophical doctrine of Chinese culture, Taoism and Fatalism, emphasize the belief of fate and destiny which influence how Chinese interpret their diseases. In other words, Chinese tend to believe that there is a force beyond their control to dominate the fate [15]. Therefore, Chinese believe there is nothing they can do to change their fate including their cancer prognosis. This may cause Hong Kong Chinese survivors of childhood osteosarcoma have higher risk to develop depressive symptoms or tend not to seek any help from others. Due to the cultural and belief differences, the findings from those studies in the foreign counties may not be applicable and transferable in Hong Kong context. The aim of the study is to examine the impact of cancer and treatment-related effects on the physical and psychosocial well-being and quality of life among Hong Kong Chinese survivors of childhood osteosarcoma.