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BOA releases updated metastatic bone disease guidelines
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LIVERPOOL, United Kingdom — The new metastatic bone disease guideline released by the British Orthopaedic Association is more evidence-based than the 2001 version of the guidelines and helps orthopaedic surgeons better treat patients once a patient’s prognosis is known, according to a presenter at the British Orthopaedic Association Annual Meeting, here.
Robert U. Ashford, MD, FRCS (Tr & Orth), who was involved in the 2-year process to rewrite the guidelines, discussed the management of metastatic bone disease and the contents of the new guidelines. They represent a consensus statement from the British Orthopaedic Association (BOA) and the British Orthopaedic Oncology Society and are also endorsed by the British Association of Surgical Oncology, he said.
“The previous guidelines had several key messages, and they are fixation of lytic lesions around the hip had high failure rates, reconstruction should allow immediate weight bearing and last the lifetime of the patient, and solitary renal metastases should be radically excised,” Ashford told Orthopaedics Today Europe. “The new guideline is extensively rewritten. It is a very much more referenced, evidence-based document.”
Orthopaedic surgeons, spinal surgeons, anesthetists, oncologists and orthopaedic oncologists — a multidisciplinary team — worked on and approved the guidelines and introduced five key points within them. The points include an infrastructure at the hospitals designed for patients dealing with metastatic bone disease, the diagnosis of metastatic bone disease, the patient’s prognosis, treatment, “and for the first time we’ve put forth four minimum standards of care,” Ashford said.
The four minimum care standards are ready access to an orthopaedic surgeon and discussion with an oncologist for patients with a metastatic lesion being operated on.
Ashford said the third minimum care standard is that when ongoing symptoms arise from the metastatic lesion, “the patient should remain with the orthopaedic surgeon for follow-up to try to prevent implant failure, which is a big problem with these patients.”
The fourth added care standard is outcomes collection, which Ashford said is important, but challenging without any readily available funding. – by Susan M. Rapp
Reference:
Ashford RU. BOOS Revalidation: Management of metastatic bone disease. Presented at: British Orthopaedic Association Annual Congress; Sept. 15-18, 2015; Liverpool, United Kingdom.
Disclosure: Ashford reports no relevant financial disclosures.