New tool helps physicians estimate survival for patients with cancers that have spread to bone

February 8, 2018, Wolters Kluwer Health

A simple three-factor tool can help doctors estimate survival time in patients with long bone metastases (LBMs)—advanced cancer that has spread to the bones of the limbs, reports a study in the February 7, 2018, issue of The Journal of Bone & Joint Surgery. The journal is published in partnership with Wolters Kluwer. Reliable survival estimates in these cases can help prevent overtreatment and undertreatment.

"This study presents a model to easily stratify patients with symptomatic LBM according to their expected survival," write J.J. Willeumier, MD, of Leiden University Medical Center, the Netherlands, and colleagues from several European institutions. The researchers believe their model can help to select the most appropriate for patients with symptomatic bone metastases.

Model Helps Match Treatment to Expected Survival

Physicians and surgeons are often called upon to estimate survival for patients with advanced cancer to help them maximize the remaining quality of life. Accurate survival estimates are important to avoid overtreatment (putting the patient through treatments that would ultimately not provide much benefit) and undertreatment (not offering treatments that would be beneficial). But data on which to base survival estimates are often sparse, especially for patients with LBMs.

To assess their "easy-to-use prognostic model," Dr. Willeumier and colleagues analyzed 1,520 patients treated for symptomatic LBMs at six Dutch hospitals between 2000 and 2013. The patients' average age was 65; the most common initial (primary) cancer sites were the breast and lung. The main symptoms requiring treatment were painful bone lesions and impending or actual pathologic fractures.

The authors previously identified three independent predictors of survival in patients with spinal metastases and applied them to these patients with LBM:

  • Clinical profile of the primary tumor. Among the patients with LBM, the profile was "favorable" (longer survival) in those with primary breast cancer but "unfavorable" (shorter survival) in those with primary lung cancer.
  • Performance status. A standard score (Karnofsky Performance Scale) to assess the patient's ability to perform everyday tasks.
  • Presence of organ/brain metastases, in addition to LBMs.

Depending on their individual combination of these factors, patients could be classified into groups with median survival times of 29.1 months, 10.5 months, 4.6 months, and 2.2 months. The authors created a simple-to-use flowchart for use in estimating survival. The model performed well in predicting the survival category for individual patients based on their actual survival. The model's performance was also validated when applied to a separate group of patients with symptomatic LBMs.

The new model can help physicians and patients with LBMs make decisions about the most appropriate treatment, the authors believe. For example, in patients with longer expected survival, more extensive surgery might avoid failure of the implant over time and preserve function. In contrast, for those expected to live only a few months, palliative therapy might be a more appropriate choice.

The authors have developed an online and mobile app that further facilitates use of the model. The English-language version of the "OPTIModel" app can be accessed at http://optimal-study.nl/nl_NL/tooleng/.

"The simplicity and clarity of the facilitate and encourage its use in the routine care of with LBM, to provide the most appropriate treatment for each individual patient," Dr. Willeumier and coauthors add. They believe their survival estimation tool might become even more useful in the future, with continued advances in tumor classification and individualized cancer therapies.

Explore further: Decreased survival when surgery refused for esophageal cancer

More information: J.J. Willeumier et al. An Easy-to-Use Prognostic Model for Survival Estimation for Patients with Symptomatic Long Bone Metastases, The Journal of Bone and Joint Surgery (2018). DOI: 10.2106/JBJS.16.01514

Related Stories

Decreased survival when surgery refused for esophageal cancer

January 30, 2018
(HealthDay)—Refusing surgery for esophageal cancer (EC) is associated with worse survival, according to a study presented at the annual meeting of The Society of Thoracic Surgeons, held from Jan. 27 to 31 in Fort Lauderdale, ...

Estimating survival in patients with lung cancer, brain metastases

November 17, 2016
A new article published online by JAMA Oncology updates a tool to estimate survival in patients with lung cancer and brain metastases.

Study shows bone metastases treatment can improve overall survival

November 15, 2012
It is common for patients initially diagnosed with lung cancer to have the cancer spread to sites like the liver, brain and bone. One of the most frequent sites of metastases is the bone, with an estimated 30 to 40 percent ...

Surgery tied to longer survival for lung cancer patients

June 22, 2016
(HealthDay)—Many patients with advanced stage non-small-cell lung cancer (NSCLC) might live longer if treated surgically, but few patients are actually undergoing surgery, according to a study published online June 9 in ...

Where prostate cancer spreads in the body affects survival time

March 7, 2016
In the largest analysis of its kind, researchers at the Duke Cancer Institute and other top cancer centers have found that the organ site where prostate cancer spreads has a direct impact on survival.

MSK surgeons present strategies for increasing survival in soft tissue sarcoma patients

May 16, 2016
Up to 50% of patients with soft tissue sarcoma (STS) develop lung metastases. Effective systemic therapies for metastatic STS are currently limited; when possible, surgical removal of the lung metastases (known as pulmonary ...

Recommended for you

Scientists discover new method of diagnosing cancer with malaria protein

August 17, 2018
In a spectacular new study, researchers from the University of Copenhagen have discovered a method of diagnosing a broad range of cancers at their early stages by utilising a particular malaria protein that sticks to cancer ...

Researchers find pathways that uncover insight into development of lung cancer

August 17, 2018
Lung cancer is the leading cause of preventable cancer death. A disease of complex origin, lung cancer is usually considered to result from effects of smoking and from multiple genetic variants. One of these genetic components, ...

Developing an on-off switch for breast cancer treatment

August 17, 2018
T-cells play an important role in the body's immune system, and one of their tasks is to find and destroy infection. However, T-cells struggle to identify solid, cancerous tumors in the body. A current cancer therapy is using ...

Pregnant? Eating broccoli sprouts may reduce child's chances of breast cancer later in life

August 16, 2018
Researchers at the University of Alabama at Birmingham have found that a plant-based diet is more effective in preventing breast cancer later in life for the child if the mother consumed broccoli while pregnant. The 2018 ...

Scientists discover chemical which can kill glioblastoma cells

August 15, 2018
Aggressive brain tumour cells taken from patients self-destructed after being exposed to a chemical in laboratory tests, researchers have shown.

Three scientists share $500,000 prize for work on cancer therapy

August 15, 2018
Tumors once considered untreatable have disappeared and people previously given months to live are surviving for decades thanks to new therapies emerging from the work of three scientists chosen to receive a $500,000 medical ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.