Aftermath of Cancer Surgery: Quality of Life

Patients diagnosed with benign bone or soft tissue masses usually have surgery and resume their previous lifestyle. Those with aggressive benign tumors may be challenged with altered mobility or limited extremity function due to the nature of their tumor and/or its location in the body.

Malignant bone and soft tissue tumors are considered rare diseases. Patients diagnosed with one of these rare tumors require rare treatment involving either chemotherapy, radiation or both therapies, and rare surgery to remove the tumors and reconstruct the defect, which cause rare side effects. Only those who have been diagnosed with cancer and undergone its treatments can truly understand the physical and emotional impact cancer has on every aspect of a person's life. Resuming daily activities including hygiene (bowel/bladder function), work responsibilities, school studies, as well as social and sexual relations may be difficult. Most complex cancer surgeries cause life-altering changes. Patients require adequate time to adjust and cope with a new lifestyle and adapt to some physical limitations.

Late effects of cancer treatments or treatment-induced second malignancies, while rare, can occur. That is why medical follow-up is necessary for 10 years. Physical effects of cancer treatment can range from minor problems such as daily fatigue, skin and appetite changes to more severe problems causing altered mobility, chronic nerve pain, bowel/bladder difficulties and infertility. Thorough physical exams and follow-up x-rays and scans are important for cancer survivors. Refer to our Oncologic Surveillance table for more information.

Whether benign or malignant, a tumor diagnosis is anxiety-provoking. All patients react differently to their diagnosis, treatments and surgery due to tumor type and location in the body. Our team is committed to provide patients and their families an individualized care plan with the intent to cure.

Psychosocial

The psychosocial aspects of oncology care did not receive much attention until 2008 with the publication of the Institute of Medicine (IOM) report entitled "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs." Over the past decade, there has been slow but steady progress to encourage national and international oncology associations to focus on the quality of psychosocial care of cancer patients. Based on research done by Anne Fiore, DNP, our service integrates all psychosocial aspects of care throughout a patient’s cancer care continuum (diagnosis, treatment, survivorship). Research shows that no matter what type of cancer a patient has (i.e. bone, soft tissue, breast, colon, kidney, lung, prostate, etc.), the challenges encountered are quite similar, such as:

• Physical/body image changes
• Fears of recurrence and/or death
• Lack of ability to resume daily, work and recreational activities
• Changes in interpersonal relationships and social functioning
• Stress, anxiety or depression associated with the phases of diagnosis, treatment and survivorship

The experience of cancer and/or cancer-specific surgery has been described as “a life changing experience with a duality of positive and negative aspects, which is unique to the individual but has some universality.” Doyle (2008)

These challenges fall under the psychosocial domain of health care. Your team not only provides you with the best individualized physical medicine (i.e. chemotherapy, radiation, surgery), but also cares for your entire well-being. To support patients through treatment and survivorship, Mass General offers a variety of integrative therapies (acupuncture, art & music therapy, massage, story-telling, etc).

Symptoms of stress and anxiety are a normal occurrence during the diagnosis and treatment phases of cancer. However, if these symptoms heighten to a level of depression and interfere with daily self-care, family interactions, ability to concentrate, sleep, and eat, cause excessive fatigue, and overall poor quality of life. Some patients find it beneficial to seek care from our mental health providers (psychologist, psychiatrist, social worker). During the diagnosis and treatment phases of care, especially if prolonged rehabilitation is required after surgery, levels of stress and anxiety increase about finances due to the inability, or potential inability, to resume work. Our team can discuss disability options with you.

Our multidisciplinary team provides compassionate patient-family centered care. We are committed to investigate your reported outcomes of treatment and surgery, both physical and mental health. At each visit, you will be asked to complete an electronic survey. We will discuss these survey scores with you and compare them to previous ones.

Based on the research by Anne Fiore, CNP, DNP, describing living with the aftermath of spine and pelvic surgery for malignant bone tumors, patients requested providers to "please listen" and recommended:

• Practical support and resources to manage life at home (returning home after hospital/rehab stay was identified as the most vulnerable time of their treatment/surgical experience)
• Recovery timelines
• Honest communication about length of recovery and bad disease news
• Positive feedback relative to recovery progress & continuity of providers
• Ongoing patient education throughout every phase of cancer care
• We are always open to suggestions on how to improve our care.

Adolescent and Young Adult (AYA) Cancer Program

The Adolescent and Young Adult (AYA) Cancer Program was created to optimize the care, outcomes, and experiences of adolescent and young adult patients (ages 15-39) with cancer through integrated care delivery, research, and education. Learn more.

Benson-Henry Institute for Mind Body Medicine

The Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital teaches patients ways to counteract stress and build resiliency by eliciting the relaxation response. Learn more.

Physical

The physical side effects following musculoskeletal cancer surgery can be life-altering. In particular, bone tumors (especially in the spine and pelvis) can cause alterations in mobility. These patients require highly individualized, tailored symptom management in order to establish a new normal.

The physical challenges following musculoskeletal cancer treatment (chemotherapy and radiation) and surgery include:

• Altered mobility
• Chronic pain (neuropathy)
• Altered body function (bowel, bladder, sexual)

Cancer Rehab

Cancer patients are experiencing improving survival as the result of better treatment, including surgery, targeted therapies, and radiation. With improving survivorship, patients often experience musculoskeletal and neurologic impairments from either their cancer or treatments. These impairments can result in reduced function, activities of daily living, quality of life and loss of independence. Common impairments experienced by cancer patients include deconditioning, fatigue, joint pain, bowel or bladder incontinence and neuropathy.

Cancer rehabilitation aims to address these impairments and improve patient function and quality of life. Each patient is evaluated on a holistic and individual basis to determine what functional needs they have. Whether a patient has back pain from tumor or surgery, poor posture and head drop from late effects of radiation, or impaired balance from chemotherapy-induced peripheral neuropathy, the goal of the cancer physiatrist is to help improve these impairments.

In the chordoma and sarcoma populations, patients often experience unique daily difficulties with pain and function depending on the location of their tumor and treatment endeavors. Cancer rehabilitation aims to help improve pain and quality of life in order to maintain independence.

Learn more about the Cancer Rehabilitation Program at Mass General.

Lifestyle Medicine

After 10 years, patients are considered cured but should continue to be followed for survivorship management. Typical survivorship issues discussed at surveillance visits include (but are not limited to):

• Genetic counseling
• Smoking
• Exercise
• Nutrition
• Sun safety
• Body weight
• Dental Care
• Care of radiated skin
• Blood work after chemotherapy
• Routine health maintenance (mammogram, Pap smear, prostate exams, colonoscopy)

Learn more about Lifestyle Medicine at Mass General.