Osteosarcoma - Childhood and Adolescence: Follow-Up Care

Approved by the Cancer.Net Editorial Board, 06/2023

ON THIS PAGE: You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. Use the menu to see other pages.

Care for children diagnosed with cancer does not end when active treatment has finished. Your child’s health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children and teens treated for cancer, including osteosarcoma, should have life-long follow-up care.

Your child’s follow-up care may include regular physical examinations and medical tests. Doctors want to keep track of your child’s recovery in the months and years ahead. The main considerations for the long-term health of children and teens who have had osteosarcoma are recurrence of osteosarcoma, appearance of a new type of cancer (called a secondary cancer), orthopedic complications, and other late effects of the cancer treatment.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, occupational therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care.

Watching for recurrence or secondary cancer

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your child's doctor will ask specific questions about your child’s health. Some children may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress.

Recurrence of osteosarcoma more than 5 years later is rare. The drugs used to treat osteosarcoma have a small chance, about 1.5%, of causing a blood cancer called leukemia. This is called secondary leukemia.

Managing long-term and late side effects of childhood cancer

Sometimes, side effects may linger beyond the active treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years after treatment has ended. Late effects can occur almost anywhere in the body. They include physical problems, such as heart, kidney, and lung problems and second cancers, which is a new cancer that happens in someone who has had cancer before. They also include emotional problems, such as anxiety and depression, and problems with memory, thinking, attention, and learning.

For osteosarcoma, there may be orthopedic complications following treatment. During follow-up care, doctors will evaluate whether the surgery resulted in a well-functioning limb or whether there were complications. Common orthopedic complications include:

  • Fractures, also called broken bones. Fractures may occur if treatment included bone grafting.

  • Problems with an internal prosthesis, which is an artificial body part, such as an artificial knee

  • Infection

Doctors typically treat fractures and internal prosthesis complications with another surgery. They treat infections with long-term antibiotic therapy. However, in rare cases, an amputation may be needed. Rehabilitative care will be offered for both the patient's physical and emotional needs.

Other possible late effects for children treated for osteosarcoma are related to the type of chemotherapy received. The most common drugs and related long-term effects include:

Chemotherapy used

Potential long-term effect

Monitoring and management


Hearing loss and neuropathy, which is pain or numbness in the fingers and toes

Hearing tests or, in some cases, hearing aids


Heart problems

Periodic echocardiograms


Secondary leukemia (see above)

Treatment, often similar to the treatment for newly diagnosed leukemia


Infertility and kidney damage

Freezing of sperm may be recommended after puberty before beginning chemotherapy.

Ovarian cryopreservation, which is freezing a portion of the ovary, might be recommended when it becomes a standard technique.

Learn more about preserving fertility in children with cancer.

Meanwhile, kidney damage, especially loss of salts in the urine, may require taking supplements. This is unlikely if kidney damage was not already a problem during treatment.

Generally, most children and teens recovering from osteosarcoma do well. Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects, such as heart problems, hearing loss, kidney damage, and secondary cancers. Follow-up care should also address your child’s quality of life, including any developmental or emotional concerns. Learn more about childhood cancer survivorship.

The Children's Oncology Group (COG) has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate, independent website: www.survivorshipguidelines.org

Keeping a child’s personal health records

You are encouraged to organize and keep a personal record of your child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, they have a clear, written history of the diagnosis, the treatments, and the doctor’s recommendations about the schedule for follow-up care. The American Society of Clinical Oncology (ASCO) offers forms to help create a treatment summary to keep track of the cancer treatment your child received and develop a survivorship care plan when treatment is completed.

Some children continue to see their oncologist, while others transition back to the care of their pediatrician, primary care doctor, or another health care professional. This decision depends on several factors, including:

  • The type and stage of cancer

  • Treatments received

  • Side effects

  • Health insurance rules

  • Your family’s personal preferences

Talk with the health care team about your child’s ongoing medical care and any concerns you have about their future health.

If a doctor who was not directly involved in your child’s cancer care will lead the follow-up care, share the cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about the specific cancer treatment given are very valuable to the health care professionals who will care for your child throughout their lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.