CHALLENGES IN MANAGING NEGLECTED MALIGNANT BONE TUMORS, EXPLORING THE CAUSES AND THERAPEUTIC HURDLES AT A TERTIARY CARE INSTITUTE IN A LOW –MIDDLE INCOME COUNTRY
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Keywords
Orthopedic Oncology, Neglected Orthopedic Oncology Cases, Etiology, Treatment Challenges
Abstract
Background: Orthopedic oncology commonly affect bones, soft tissue, and musculoskeletal system are generally neglected and have devastating effects on physical and emotional health if not treated. It is needed to explore therapeutic challenges associated with neglected orthopedic oncology.
Material and Method: A descriptive cross-sectional study was conducted at Hayatabad Medical Complex and Rehman Medical Institute, Peshawar from May 2016 to June 2021. Tumors were categorized as neglected if there was a delay of over three months in seeking treatment. Tumor staging included X-rays, chest radiographs, full blood workups, MRI of the affected limb, and chest CT scans, using the Enneking staging approach. Data on age, gender, tumor site, histology, educational and socioeconomic status, prior treatments, and reasons for delay were collected and analyzed with SPSS- 22.
Results: Of 470 orthopedic oncology cases, 116 (24.6%) were neglected malignant bone and soft tissue tumors. These included osteosarcoma (62.5%), Ewing sarcoma (25%), and chondrosarcoma (12.9%). Delays in treatment averaged 9.4 months, mainly due to financial constraints (88%), lack of awareness (90%), and limited healthcare facilities (27%). Traditional bone setters were consulted in 68% of cases, with 10% misdiagnosed by surgeons. Most cases were advanced (stage III or II-B) and treated with amputation, chemotherapy, or radiation.
Conclusion: Study found a high proportion 24.6% cases as neglected malignant bone and soft tissue tumors. The majority were osteosarcomas 62.5%, followed by Ewing sarcomas 25% and chondrosarcomas 12.9%. Delays in seeking treatment averaged 9.4 months, primarily due to financial constraints, lack of awareness, and limited healthcare facilities.
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Farman Ullah
Registrar Orthopedic, HMC
Shafi Ul Haq
Consultant Orthopedic Surgeon
Sohail Rehman
Consultant Pediatric Orthopedic Surgeon
Fareeha Khalid
Medical Student
Waqas Ahmad
Consultant Orthopedic Surgeon
Muhammad ishfaq
Consultant Orthopedic Surgeon
Baqir Hussain
Assistant Professor, MTI LRH