Prospective Quality of Life Research in Bony Metastatic Disease

Abstract

Metastatic bone disease is a major factor contributing to the deterioration in quality of life in patients with cancer. The decision to surgically stabilize an impending or existing pathologic fracture, or to excise a metastatic deposit is difficult because of the paucity of conclusive data regarding the efficacy of surgery in achieving pain relief, improved function, and quality of life. The psychometric properties of quality of life outcomes instruments and the differences between pain, function, and quality of life are explored in an attempt to define surgical goals. The results of different quality of life instruments in existing studies of internal fixation, chemotherapy, radiation therapy, and bisphophonate treatment suggest that although the majority of patients derive benefit from their treatment, the success of such treatment is heavily dependent the quality of life instrument. Existing instruments are deficient and obstacles to the design and implementation of quality of life assessment in patients with skeletal metastasis are reviewed. Recommendations for improving our ability to assess the risk to benefit ratio of surgery include moving away from physician reported results, devising more appropriate quality of life measurement techniques, analyzing the relationship between pain relief, physical function and quality of life, and focusing attention on prospectively evaluating optimal treatments for patients as they near the end of life.

The Scandinavian Sarcoma Group

“…The similarity of the medical care systems in the Scandinavian countries makes multicenter studies easier to perform. The activities reported at the annual Scandinavian meetings (SSG) (Rydholm and Alvegård 1994a, 1994b, 1998, 2000, 2001, 2003 stimulated Scandinavian sarcoma research, which is reflected in an increasing number of reports in the scientific literature.…”

“…Since start 1986 more than 1000 articles have been published by members of the Scandinavian Sarcoma Centers i.e., 1979(Solheim et al 1989(Alvegård and Rydholm 1994-1998(Rydholm and Alvegård 1998), 1998-2003 (Rydholm 1983). The SSG Register was designed to acquire data on referral, tumor characteristics, treatment and outcome with a minimum follow-up of 5 years.…”

“…294 GCT patients from 13 Scandinavian hospitals were prospectively collected in the SSG Registry 1986-2003. The overall local recurrence rate was 0.22.…”

Trends in the Surgical Treatment of Pathologic Proximal Femur Fractures Among Musculoskeletal Tumor Society Members

“…The barriers to performing research on patients with skeletal metastases are well characterized [3,17]. Many of these barriers are intrinsic to the patient population being studied.…”

Mixed Methods Research in the Development and Evaluation of Complex Interventions in Palliative and End-of-Life Care: Report on the MORECare Consensus Exercise

“…[12][13]26,36,[39][40][41][42] Outcomes often need to relate to families. 12 Difficulties in the administration and interpretation of outcome measures have been reported.…”