Self-reported global function among adult survivors of childhood lower-extremity bone tumors: A report from the Childhood Cancer Survivor Study (CCSS)

Rajaram Nagarajan, Rona Mogil, Joesph P. Neglia, Leslie L. Robison, Kirsten K. Ness

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28 Scopus citations


Introduction: Adult survivors of childhood lower-extremity bone tumors may experience physical and psychosocial late effects that impact physical performance, global function and quality of life. The identification of survivors at greatest risk for poor outcomes will inform potential intervention targets. Methods: Study participants were selected from the Childhood Cancer Survivor Study (CCSS), a multi-institutional study of childhood cancer survivors. Adult survivors (n = 629) of either childhood onset osteosarcoma or Ewing's sarcoma, with a primary tumor location in the lower-extremity were identified and contacted via mail to complete an additional questionnaire. Participants completed the Reintegration into Normal Living Index (RNL) to evaluate global function (maximum score of 22), daily function (maximum score of 16) and self perception (maximum score of 6). Results: Survivors reported high levels of global function with an adjusted mean overall RNL index score of 20.6 (SE 0.14), mean daily function score of 15.0 (SD 0.10) and mean self perception score of 5.6 (SE 0.05). While female gender and increasing age were associated with lower RNL scores, the magnitude of difference is of questionable clinical significance. Global function was only moderately correlated with physical performance (r = 0.56) and QOL (r = 0.59). Discussion: Based upon the RNL index, the vast majority of long-term survivors of childhood lower extremity bone tumors adapt well to their environment. Implications for cancer survivors: While some long-term survivors of lower-extremity bone tumors may report measurable limitations in physical performance and quality of life, the majority do not report moderate or severe difficulties with social integration.

Original languageEnglish (US)
Pages (from-to)59-65
Number of pages7
JournalJournal of Cancer Survivorship
Issue number1
StatePublished - Mar 2009

Bibliographical note

Funding Information:
This work was supported by grant CA 55727 (LL Robison, Principal Investigator), National Cancer Institute, Bethesda, MD, with additional support provided to St. Jude Children’s Research Hospital by the American Lebanese Syrian Associated Charities (ALSAC), to the University of Minnesota by the Children’s Cancer Research Fund and to R Nagarajan by the National Childhood Cancer Foundation, Arcadia, CA (Research Fellowship) and the American Society of Clinical Oncology, Alexandria, VA (Young Investigator Award)


  • Bone sarcoma
  • Childhood cancer survivor
  • Global function
  • Physical performance
  • Quality of life


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