Nyeko Richard, Geriga Fadhil, Angom Racheal, Balagadde Kambugu Joyce, van Heerden Jaques
Department of Paediatrics and Child Health, Lira University, Lira, Uganda.
Division of Paediatric Oncology, Uganda Cancer Institute, Kampala, Uganda.
PLoS One. 2025 Aug 4;20(8):e0329688. doi: 10.1371/journal.pone.0329688. eCollection 2025.
Pre-diagnosis manipulative therapies in patients diagnosed with osteosarcoma can compromise patients' outcomes. Limited literature exists on the pre-diagnosis non-oncological management of osteosarcoma, especially in resource-limited settings. We described and characterized the practice of pre-diagnosis manipulative therapy at the reference cancer treatment center in Uganda as a first step to improving the quality along the osteosarcoma treatment pathway.
We reviewed the demographic and clinical characteristics, pre-referral management, and outcome of children under 18 years treated for osteosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Data on pre-diagnosis management were extracted, as well as clinical and disease characteristics and outcome. Descriptive statistics and Kaplan-Meier survival analysis were used.
Nineteen (25.7%) of the 74 children with osteosarcoma in the current study had undergone prior manipulative therapy. The main forms of manipulative therapy were local therapeutic cuttings with the application of local herbs in 6 (31.5%) patients, massaging in 5 (26.3%), attempted incision and drainage in 4 (21.1%), and treatment as a local infection (osteomyelitis or arthritis) in 4 (21.2%). The majority, 15 (78.9%), of the patients who had manipulative therapy were males (X² = 5.73; p = 0.031). Children who underwent manipulative therapy were referred after a median of 45 days (range 11-139) compared to their counterparts, who were referred after a median of 28 days (range 1-147) (p = 0.012). Patients with manipulative therapy had a metastatic rate of 77.8%, while the rate was 60.4% for those who did not have manipulative therapy. The serum lactate dehydrogenase level was higher in patients who had manipulative therapy compared to those who did not have manipulative therapy (X2 = 3.98; p = 0.046). The median survival was 1.0 year (95% CI 0.8-1.3) for patients who underwent prior manipulative therapy and 1.8 years (95% CI 1.4-2.2) for those who did not report any form of manipulative therapy (p = 0.961).
Pre-diagnosis manipulative therapies lead to poorer outcomes in patients diagnosed with osteosarcoma, underscoring the need for bridging the quality gap in the osteosarcoma treatment pathway. This should include sensitization of the community and healthcare provider's, strengthening patient referral pathways, and improved accessibility to cancer treatment centers.
对诊断为骨肉瘤的患者进行诊断前的手法治疗可能会影响患者的治疗效果。关于骨肉瘤诊断前非肿瘤学管理的文献有限，尤其是在资源有限的环境中。我们描述并分析了乌干达参考癌症治疗中心的诊断前手法治疗情况，作为改善骨肉瘤治疗路径质量的第一步。
我们回顾了2016年1月至2020年12月期间在乌干达癌症研究所接受治疗的18岁以下骨肉瘤患儿的人口统计学和临床特征、转诊前管理及治疗结果。提取了诊断前管理、临床和疾病特征及治疗结果的数据。采用描述性统计和Kaplan-Meier生存分析。
本研究中74例骨肉瘤患儿中有19例（25.7%）曾接受过手法治疗。手法治疗的主要形式为局部治疗性切割并应用当地草药（6例，31.5%）、按摩（5例，26.3%）、尝试切开引流（4例，21.1%）以及按局部感染（骨髓炎或关节炎）治疗（4例，21.2%）。接受手法治疗的患者中，大多数（15例，78.9%）为男性（X² = 5.73；p = 0.031）。接受手法治疗的患儿转诊的中位时间为45天（范围11 - 139天），而未接受手法治疗的患儿转诊中位时间为28天（范围1 - 147天）（p = 0.012）。接受手法治疗的患者转移率为77.8%，未接受手法治疗的患者转移率为60.4%。接受手法治疗的患者血清乳酸脱氢酶水平高于未接受手法治疗的患者（X2 = 3.98；p = 0.046）。接受过手法治疗的患者中位生存期为1.0年（95%CI 0.8 - 1.3），未报告任何形式手法治疗的患者中位生存期为1.8年（95%CI 1.4 - 2.2）（p = 0.961）。
诊断前的手法治疗会导致骨肉瘤患者的治疗效果更差，这凸显了弥合骨肉瘤治疗路径质量差距的必要性。这应包括提高社区和医疗服务提供者的意识、加强患者转诊途径以及改善癌症治疗中心的可及性。
