Quality of life following surgery for vertebral metastases from breast cancer

Okuyama, Tomoko; Korenaga, Daisuke; Tamura, Shuji; Maekawa, Soichiro; Kurose, S.; Ikeda, Toshihiko; Sugimachi, Keizō

doi:10.1002/(sici)1096-9098(199901)70:1<60::aid-jso11>3.0.co;2-u

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…Similar pain relief was achieved in our series, as evidenced by decreases in VAS and pain medication scale scores that lasted for at least 1 year. This reduction in pain and narcotics usage (with concomitant reduction in side effects) may significantly improve the patients' quality of life, regardless of whether the effect is secondary to pain-relieving vertebrectomy, decompression, and/or stabilization [36].…”

Section: Indications For Surgerymentioning

confidence: 99%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic disease who underwent spinal surgery. Pre-and postoperative pain levels (visual analog scale [VAS]), analgesic medication usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients (2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory.Of the 11 patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which (75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery), and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented. In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain relief and preservation or improvement of neurological function with an acceptably low rate of complications.

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Section: Indications For Surgerymentioning

confidence: 99%

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

et al. 2007

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“…For this reason, aggressive surgical intervention is often considered in patients with metastatic spine disease who can tolerate surgery [5,19,24,33,38,39,47,48,53,54]. Recently, Ogihara et al [36] reviewed patients with lung cancer metastatic to the spine in attempt to identify prognostic factors that may aid in stratifying patients towards medical or surgical treatment.…”

Section: Indications For Surgerymentioning

confidence: 99%

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

et al. 2007

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The histology of the primary tumor in metastatic spine disease plays an important role in its treatment and prognosis. However, there is paucity in the literature of histology-specific analysis of spinal metastases. In this study, prognostic variables were reviewed for patients who underwent surgery for breast metastases to the spinal column. Respective chart review was done to first identify all patients with breast cancer over an 8-year period at a major cancer center and then to select all those with symptomatic metastatic disease to the spine who underwent spinal surgery. Univariate and multivariate analyses were used to assess several prognostic variables. Presence of visceral metastases, multiplicity of bony lesions, presence of estrogen receptors (ER), and segment of spine (cervical, thoracic, lumbar, sacral) in which metastases arose were compared with patient survival. Eighty-seven patients underwent 125 spinal surgeries. Those with estrogen receptor (ER) positivity had a longer median survival after surgery compared to those with estrogen receptor negativity. Patients with cervical location of metastasis had a shorter median survival compared with those having metastases in other areas of the spine. The presence of visceral metastases or a multiplicity of bony lesions did not have prognostic value. In patients with spinal metastases from breast cancer, aggressive surgical management may be an option for providing significant pain relief and preservation/improvement of neurological function. Interestingly, in patients undergoing such surgery, cervical location of metastasis is a negative prognostic variable, and ER-positivity is associated with better survival, while presence of visceral or multiple bony lesions does not significantly alter survival.

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“…Most of the studies involving a surgical intervention have been retrospective and used historic methods for QoL assessment. 3,15,18,20,33 As such, the results of these studies must be interpreted knowing that Vitale the method for assessing QoL is suboptimal. The studies using statistically validated means for QoL assessment mainly have been nonsurgical treatment interventions such as strontium-89, 21 external beam radiation therapy, 12 bisphosphonates, 30 or chemotherapy.…”

Section: Prospective Studies Of Qol After Treatment For Bone Metastasesmentioning

confidence: 99%

“…Although prior studies have reported that surgery for bony metastases provides pain relief and improves mobility, no objective data on either benefit from patient reported tools have been presented. 2,3,18,20,33 These studies have used physician reported methods to show a reduction in pain and improved function. In addition, the rating instruments used to describe the outcomes of pain relief and function have varied in their reliability and utility.…”

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confidence: 99%

Prospective Quality of Life Research in Bony Metastatic Disease

Cheng

2003

Clinical Orthopaedics and Related Research

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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.

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Quality of life following surgery for vertebral metastases from breast cancer

Cited by 10 publications

References 10 publications

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients

Positive and negative prognostic variables for patients undergoing spine surgery for metastatic breast disease

Prospective Quality of Life Research in Bony Metastatic Disease

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