Function and Health Status in Surgically Treated Bone Metastases

Abstract

In a prospective study, we evaluated if surgery substantially improved functional and quality of life outcomes in patients with nonspinal bone metastases. Sixty-seven patients were followed up prospectively. The Short Form-36, the Musculoskeletal Tumor Society 1987 form, the Musculoskeletal Tumor Society 1993 form, and the Toronto Extremity Salvage Score were administered preoperatively and 6 weeks and 3 months postoperatively. Fifty percent of the patients had pathologic fractures. Intramedullary nailing was done in 36 patients, prosthetic replacement was done in 24 patients, and plating was done in five patients. The average postoperative survival was 8 months. At 6 weeks, 13 patients had died and seven were lost to followup. Twenty-one percent of patients had complications, although only 4.5% needed additional surgery. The patients' Musculoskeletal Tumor Society 1987 form, Musculoskeletal Tumor Society 1993 form, and Toronto Extremity Salvage Score scores improved at 6 weeks and 3 months postoperatively. There were no improvements in the Short Form-36 mental and physical summary scales of the patients. The number of patients using pain medication did not decrease. Patients had functional improvements after surgical treatment of bone metastases, even patients with a limited life expectancy. Future prospective studies should anticipate a high rate of attrition with this population from death and loss to followup. Prognostic study, Level I (high quality prospective study-all patients were enrolled at the same point in their disease with > or = 80% followup of enrolled patients). See the Guidelines for Authors for a complete description of levels of evidence.