A new scoping review of supportive care interventions has uncovered significant gaps in care and substantial economic burdens faced by patients with metastatic bone disease (MBD), highlighting the urgent need for improved research and standardized treatment protocols.
The comprehensive analysis, led by R. Lor Randall, MD, FACS, from the University of California Davis Comprehensive Cancer Center, reveals that MBD patients face disproportionate healthcare costs and challenges compared to other cancer patients. The economic impact is particularly striking, with MBD patients incurring mean costs of $75,325, significantly higher than the $31,382 for other stage IV cancer patients without musculoskeletal involvement.
Economic and Clinical Impact
"There's a dearth in this area of MBD. [This disease is] limited and quite heterogeneous. There's no routine standardized collection that can enhance treatment evaluation in this cohort of patients," explains Dr. Randall. The research indicates that musculoskeletal-related events account for nearly 20% of the cancer care economy, highlighting the substantial financial burden of this condition.
Research Findings and Care Gaps
The investigation reviewed 572 publications, with only 13 meeting relevance criteria. Of these, seven were clinical trials, two were trial protocols, and four were interviews focusing on enhanced palliative care, palliative radiotherapy, and alternative therapies. Notably, the research revealed a concerning lack of endpoints assessing fractures or musculoskeletal system complications.
Disparities in Care Access
Analysis of the American College of Surgeons database revealed significant disparities in care access and outcomes:
- Lung cancer patients with MBD showed adverse effects based on race and socioeconomic status
- Breast cancer patients with MBD experienced negative impacts related to race and insurance status
- Colon cancer patients in lower socioeconomic groups reported worse outcomes
Quality of Life Impact
The 2019 Bone Metastases Quality of Life (BOMET-QOL) 10 questionnaire study, involving 172 breast cancer patients, demonstrated significant quality of life differences between patients with and without MBD. The study highlighted how MBD significantly affects patients' daily activities and family interactions.
Treatment Outcomes and Pain Management
Recent research published in the Journal of Surgical Oncology offers some hope, showing that patients receiving appropriate interventions for MBD can return to baseline function within six weeks of treatment. However, pain management remains a complex challenge, requiring sophisticated patient-reported outcome measures to standardize assessment across large populations.
Future Directions
Dr. Randall emphasizes the need for orthopedic oncologists to take ownership of MBD management. The research underscores the importance of developing more comprehensive care protocols and standardized data collection methods to better serve this vulnerable patient population.
