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J Glob Oncol. 2018 Sep;4:1-11. doi: 10.1200/JGO.2016.005967. Epub 2017 Mar 24.

Health-Related Quality of Life and Survival Outcomes of Pediatric Patients With Nonmetastatic Osteosarcoma Treated in Countries With Different Resources.

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Michael W. Bishop, Catherine A. Billups, and Jami S. Gattuso, St Jude Children's Research Hospital; Michael W. Bishop, University of Tennessee Health Science Center, Memphis, TN; Shailesh M. Advani and Najat C. Daw, The University of Texas MD Anderson Cancer Center, Houston, TX; Milena Villarroel, Cecilia Rivera, and Juan A. Quintana, Luis Calvo McKenna Hospital, Santiago, Chile; Fariba Navid, Children's Hospital of Los Angeles, Los Angeles, CA; and Pamela S. Hinds, Children's National Health System and George Washington University, Washington, DC.



Health-related quality of life (HRQOL) improves throughout treatment of patients with nonmetastatic osteosarcoma. We compared HRQOL for patients in the United States and Chile treated on an international trial (OS99) with polychemotherapy and surgery, and we assessed the relationships among HRQOL measures, event-free survival (EFS), and overall survival (OS).


Patients with newly diagnosed, localized osteosarcoma and their parents completed three HRQOL instruments (PedsQL v.4, PedsQL Cancer v.3, and Symptom Distress Scale [SDS]). Data were collected at four time points throughout therapy. Repeated measures models were used to investigate the effect of treatment site on instrument scores. The log-rank test examined the impact of treatment site on survival outcomes, and Cox proportional hazards regression models evaluated baseline HRQOL measures as predictors of EFS and OS.


Of 71 eligible patients, 66 (93%) participated in the HRQOL studies in the United States (n = 44) and Chile (n = 22). The median age was 13.4 years (range, 5 to 23 years). Clinical characteristics were similar between treatment sites. US patients reported better scores for physical ( P = .030), emotional ( P = .027), and school functioning ( P < .001). Chilean patients reported poorer scores for worry ( P < .001) and nausea ( P = .007). Patient and parent nausea scores were similar between patients treated in the United States and Chile by the end of therapy. Differences in symptom distress were not observed between the countries. Neither HRQOL measures nor treatment site were associated with EFS or OS.


Although significant differences in HRQOL were observed between countries, outcomes were similar, and HRQOL measures were not associated with prognosis.

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