Study finds cancer patients under-referred for orthopedic oncology surgery

Issue: June 25, 2012

There is a disconnect between the number of cancer patients estimated to have bone metastases and the number of patients sent for orthopedic care each year, according to an article published in the Canadian Journal of Surgery.

According to the study abstract, researchers with the Division of Orthopaedic Trauma at Vancouver General Hospital performed a retrospective review of patients who underwent treatment for pathologic lesions or fracture secondary to metastatic disease from July 1987 to March 2007.

Upon review, the researchers found the mean number of cases treated annually to be 13 of an estimated 14,000 patients per year. The 13 patients, the authors wrote in the abstract, demonstrated an 11-day median length of stay and in-hospital mortality rate of 14%.

The caseload, according to the abstract, was “much lower than anticipated,” which the authors attributed to under-referral from oncology services.

In a Canadian Journal of Surgery press release, the authors stated 14% of patients included in the study died in hospital care. Although they noted that the mortality rate appears high, they explained many procedures were undertaken as palliative interventions as part of the patients’ final care. Further, they added that the results of the study suggest failure to seek a timely surgical opinion may have contributed to some of the poor outcomes.

“It seems there is reluctance to consider surgery or ignorance of what additional benefit orthopedics can offer,” the authors wrote. “Engaging with oncologists to consider available orthopedic interventions might provide more effective overall care in patients with [cancer that has spread to the bones].”

Reference:

Kelly M, Lee M, Clarkson P, O’Brien PJ. Metastatic disease of the long bones: A review of the health care burden in a major trauma centre. Can J Surg. 2012. doi: 10.1503/cjs.049009