Better Communication in Osteosarcoma Care Can Help Reduce Hospitalization and Improve Quality of Life in Adolescents and Young Adults


Clinical Oncology in Adolescents and Young Adults, published by Dove Medical Press, has published an article entitled "Outpatient chemotherapy, family centered care, and electronic information for adolescents and young adults with osteosarcoma."

Osteosarcoma is a bone cancer that most commonly affects adolescents and young adults. Treatment is difficult and often involves many hospitalizations. "This age group would like to spend less time in the hospital during therapy. This article shows that “old drugs can do new tricks," explains author Dr. Pete Anderson, professor at MD Anderson Children's Cancer Hospital in Houston.

Although current osteosarcoma chemotherapy regimens are "standard" (doxorubicin, cisplatin, high-dose methotrexate ± Ifosfamide/mesna and etoposide ± mifamurtide), they cause many short-term, intermediate, and long-term side effects. Generally 12-15 cycles of chemotherapy are given in the hospital over 7-10 months. Even in the absence of new research protocols, improvement in quality of life is now possible: All osteosarcoma chemotherapy agents can be administered in the outpatient setting.

Outpatient Care

The need to adapt optimal therapy to the needs of this population are critical for long-term success. Adolescents and young adults need options that take into account the expense of therapy, education regarding their disease and treatment as well as a focus on their quality of life. A major aspect of their care includes reduced clinic visits and hospitalization.

In this study, a number of tested approaches to address these issues in the AYA populations are described and may be of considerable help in other programs dealing with this patient population. For example, research studying the use of portable pumps and backpacks with iv fluid concluded that current inpatient chemotherapy cycles for osteosarcoma can safely be given in the Outpatient Clinic.

According to Dr. Mark W. Kieran, Editor-in-Chief, "A major issue in the field of oncology care, and in particular for adolescent and young adult patients, has been the need to reduce time in hospital. The ability to maintain effective therapy but shifted to the outpatient setting is therefore of considerable importance."

Outpatient chemotherapy is not only less expensive, but in the adolescent and young adult population can result in better quality of life for some. This paper shares information to help reduce frequency of hospitalization and review some tools and strategies to facilitate communication when providing outpatient chemotherapy, family centered care, and information/education. These include a) anti-emetics with both longer acting 5HT antagonists and aprepitant, b) outpatient chemotherapy guidelines, and c) a 5-week editable calendar that is part of our EMR. Sharing absolute lymphocyte count (ALC) recovery information provides another means to increase hope and/or understanding of osteosarcoma prognosis.

Finally, this article shares an advanced directive/palliative care "checklist" of issues for patients and caregivers to consider at end of life when "cure is not the answer to the cancer". In summary, better communication at all stages of osteosarcoma care can help reduce hospitalization and improve quality of life and hope in the osteosarcoma AYA population.

The authors of the article are as follows: Dr. Pete Anderson, Patricia Wells, Theresa Lazarte, Laura Gore, Laura Salvador, and Maritza Salazar-Abshire, MD Anderson Children’s Cancer Hospital, Houston, TX, USA.

Clinical Oncology in Adolescents and Young Adults is an international, peer-reviewed, open access journal publishing original research, reports, editorials, reviews and commentaries on all aspects of epidemiology, diagnosis and treatment of cancers in adolescents and young adults.

Dove Medical Press Ltd is a privately held company specializing in the publication of Open Access peer-reviewed journals across the broad spectrum of science, technology and especially medicine.

Updated 23 July 2014