Cancer patients under-referred for orthopedic oncology services

There is a disconnect between the number of cancer patients estimated to have bone metastases and the number of patients who are sent for orthopedic care each year, states an article in the Canadian Journal of Surgery (CJS).

Almost half of the 140 000 new cases of cancer diagnosed in Canada each year can spread to the bones, but very few of these patients are referred to orthopedic services even though they could benefit in terms of quality of life, less pain and better outcomes if their bones could be prevented from breaking.

Researchers in the Division of Orthopaedic Trauma at the Vancouver General Hospital (VGH) reviewed the cases of all cancer patients treated for bone lesions or fractures caused by bone lesions at their hospital over a 20-year period and found that an average of only 13 out of a possible 14 000 patients per year received orthopedic care.

"It seems there is reluctance to consider surgery or ignorance of what additional benefit orthopedics can offer," the authors state. Surgical procedures aren't without risk, which may explain the reluctance.

Among the patients included in the study, survival ranged from less than one year to more than 18 years, and 14% died in hospital care. "The mortality rate does seem high, but many procedures were undertaken as palliative interventions as part of the patients' final care," the authors explain. They go on to state that their results suggest that failure to seek a timely surgical opinion may contribute to some of the poor outcomes reported.

"Engaging with oncologists to consider available orthopedic interventions might provide more effective overall care in patients with [cancer that has spread to the bones]," the authors state.