Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease

Nooh, Anas; Goulding, Krista; Isler, Marc; Mottard, Sophie; Arteau, Annie; Dion, Norbert; Turcotte, Robert

doi:10.1007/s11999.0000000000000065

Cited by 32 publications

(27 citation statements)

References 35 publications

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“…Recently, however, it has become necessary to initiate bone management programs concurrently with cancer treatment to effectively reduce pain and improve patients' QoL. Similar to previous studies, surgery, POP, or radiation in this study provided significant pain relief and improved QoL [6,8,[25][26][27][28]. We found that pain-related scores can be relieved quickly, but functional relief was slower than pain relief, especially in patients who underwent surgery and radiation.…”

Section: Discussionsupporting

confidence: 82%

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Wang

Sun

et al. 2021

Pain Ther

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Introduction: As life expectancy increases for lung cancer patients with bone metastases, the need for personalized local treatment to reduce pain is expanding. Methods: Patients were treated by a multidisciplinary team (MDT), and local treatment including surgery, percutaneous osteoplasty, or radiation. Visual analog scale (VAS) and quality of life (QoL) scores were analyzed. VAS at 12 weeks after treatment was the main outcome. We developed and tested machine learning models to predict which patients should receive local treatment. Model discrimination was evaluated by the area under curve (AUC), and the best model was used for prospective decision-making accuracy validation. Results: Under the direction of MDT, 161 patients in the training set, 32 patients in the test set, and 36 patients in the validation set underwent local treatment. VAS in surgery, percutaneous osteoplasty, and radiation groups decreased significantly to 4.78 ± 1.28, 4.37 ± 1.36, and 5.39 ± 1.31 at 12 weeks, respectively (p \ 0.05), with no significant differences among the three datasets, and improved QoL was also observed (p \ 0.05). A decision tree (DT) model that included VAS, bone metastases character, Frankel classification, Mirels score, age, driver gene, aldehyde dehydrogenase 2, and enolase 1 expression had a best AUC in predicting whether patients would receive local treatment of 0.92 (95% CI 0.89-0.94) in the training set, 0.85 (95% CI 0.77-0.94) in the test set, and 0.88 (95% CI 0.81-0.96) in the validation set. Conclusion: Local treatment provided significant pain relief and improved QoL. There were no significant differences in reducing pain and improving QoL among training, test, and validation sets. The DT model was best at

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Section: Discussionsupporting

confidence: 82%

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Wang

Sun

et al. 2021

Pain Ther

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“…Similar to previous studies, surgery, POP, or radiation provided signi cant pain relief and improved QoL [6,[26][27][28][29][30]. The MNOP algorithm suggests surgery or radiation as the main treatment for spinal metastases.…”

Section: Discussionsupporting

confidence: 69%

Machine Learning Algorithm Guiding Local Treatment Decisions For Lung Cancer Patients With Bone Metastases

Wang¹,

Sun

et al. 2020

Preprint

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Background: As life expectancy increases for lung cancer patients who develop bone metastases, the need for personalized local treatment for bone metastases is expanding.Methods: Lung cancer patients with bone metastases were treated by a multidisciplinary team via surgery, percutaneous osteoplasty, or radiation. The pre- and post-treatment visual analog scale (VAS) and Quality of Life (QoL) scores were analyzed. QoL at 12 weeks was the main outcome. Treatment-related costs and overall survival time (OS) were collected. We used machine learning to develop and test models to predict which patients should receive local treatment. Models discrimination were evaluated by the area under curve (AUC), and the best one was used for validation in clinical use. Results: Under the direction of a multidisciplinary team, 161 patients in the training set, and 32 patients in the test set underwent local treatment. A decision tree model included VAS scale, bone metastases character, Frankel classification, Mirels score, age, driver gene, aldehyde dehydrogenase 2, and enolase 1 expression had a best AUC of 0.92 (95%CI 0.89 to 0.94), and 36 patients in a validation set underwent local treatment guided by the model. Improved QoL and VAS scores were observed at 12 weeks after local treatment in training, test, and validation sets (p < 0.05), with no significant differences among the three datasets. There were no significant differences in mean costs among the three datasets in the four treatment groups. OS was 18.03±0.45 months and did not significantly differ among treatment groups or the three datasets. Conclusions: Local treatment not only had no negative influence on OS but also provided significant pain relief and improved QoL. QoL, OS or costs did not significantly differ between patients whose treatment was guided by a multidisciplinary team or machine learning model. Our machine learning model using clinical data can help guide clinicians to make local treatment decisions to improve patients’ QoL.Trial registration: No. ChiCRT-ROC-16009501

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“…The EORTC QLQ-C30 and adjunct BM22 20 questionnaires were chosen for the primary outcome measure as they are bone-metastasis-specific PROM tools with the most comprehensive research evidence 19 , 20 The bone tumour-specific Musculoskeletal Tumor Society Score (MSTS) was chosen to measure function due to its validation in the MBD population, significant evidence base, and comparable validity and utility to the alternative TESS and PROMIS scores. 6 , 11 , 21 The pain assessment questionnaires used in the study include the visual analogue scale 10 (VAS) and the Functional Assessment of Cancer Therapy in Bone Pain 22 (FACT-BP) scores. The VAS score was chosen for its ubiquity of use in the MBD literature and the FACT-BP for its validation in the MBD patient population.…”

Section: Methodsmentioning

confidence: 99%

“…Two studies from the USA and Canada published in 2018 recorded patient-reported outcomes after surgery for MBD with limited follow-up (maximum six months and mean five months, respectively). 5 , 6 Both demonstrated an early reduction in pain and improvement in function as early as two weeks from surgery but ‘failed’ to demonstrate any improvement in quality of life up to one-year post-surgery. This is not surprising in view of the progressive nature of systemic cancer, and is perhaps not the most appropriate focus for studies investigating post-surgical outcomes in MBD.…”

Section: Introductionmentioning

confidence: 99%

A prospective longitudinal study investigating outcomes including patient-reported outcome measures after surgery for metastatic bone disease

et al. 2021

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Aims Surgery is often indicated in patients with metastatic bone disease (MBD) to improve pain and maximize function. Few studies are available which report on clinically meaningful outcomes such as quality of life, function, and pain relief after surgery for MBD. This is the published protocol for the Bone Metastasis Audit — Patient Reported Outcomes (BoMA-PRO) multicentre MBD study. The primary objective is to ascertain patient-reported quality of life at three to 24 months post-surgery for MBD. Methods This will be a prospective, longitudinal study across six UK orthopaedic centres powered to identify the influence of ten patient variables on quality of life at three months after surgery for MBD. Adult patients managed for bone metastases will be screened by their treating consultant and posted out participant materials. If they opt in to participate, they will receive questionnaire packs at regular intervals from three to 24 months post-surgery and their electronic records will be screened until death or five years from recruitment. The primary outcome is quality of life as measured by the European Organisation for Research and the Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ) C30 questionnaire. The protocol has been approved by the Newcastle & North Tyneside 2 Research Ethics Committee (REC ref 19/NE/0303) and the study is funded by the Royal College of Physicians and Surgeons of Glasgow (RCPSG) and the Association for Cancer Surgery (BASO-ACS). Discussion This will be the first powered study internationally to investigate patient-reported outcomes after orthopaedic treatment for bone metastases. We will assess quality of life, function, and pain relief at three to 24 months post-surgery and identify which patient variables are significantly associated with a good outcome after MBD treatment. Cite this article: Bone Jt Open 2021;2(2):79–85.

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Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease

Abstract: Level II, therapeutic study.

Cited by 32 publications

References 35 publications

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Machine Learning Algorithm Guiding Local Treatment Decisions For Lung Cancer Patients With Bone Metastases

A prospective longitudinal study investigating outcomes including patient-reported outcome measures after surgery for metastatic bone disease

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Early Improvement in Pain and Functional Outcome but Not Quality of Life After Surgery for Metastatic Long Bone Disease

Abstract: Level II, therapeutic study.

Cited by 32 publications

References 35 publications

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Machine Learning Algorithm Guiding Local Treatment Decisions to Reduce Pain for Lung Cancer Patients with Bone Metastases, a Prospective Cohort Study

Machine Learning Algorithm Guiding Local&nbsp;Treatment Decisions For Lung Cancer Patients With Bone Metastases

A prospective longitudinal study investigating outcomes including patient-reported outcome measures after surgery for metastatic bone disease

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Machine Learning Algorithm Guiding Local Treatment Decisions For Lung Cancer Patients With Bone Metastases