Pre-treatment expectations of patients with spinal metastases: what do we know and what can we learn from other disciplines? A systematic review of qualitative studies

R Gal,D Oostinga,C G Fisher,H Wessels,R Charest-Morin,J J Verlaan,A L Versteeg,H M Verkooijen

doi:10.1186/s12885-020-07683-7

Abstract

BackgroundLittle is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care.MethodsA comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients’ pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality.ResultsThe search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates.ConclusionsPatients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes.Trial registrationPROSPERO registration number: CRD42020145151.

Highlights

Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery
More patients will develop spinal metastases, which can lead to devastating consequences including progressive and unremitting pain, spinal instability and metastatic epidural spinal cord compression (MESCC) [1,2,3]
Radiotherapy has a central role in palliative treatment of uncomplicated painful spinal metastases, and aims to relieve pain and locally control the tumor

Summary

Introduction

Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care. More patients will develop spinal metastases, which can lead to devastating consequences including progressive and unremitting pain, spinal instability and metastatic epidural spinal cord compression (MESCC) [1,2,3]. The treatment goal for patients with spinal metastases is to enhance HRQOL by suppressing symptoms for their remaining time. Radiotherapy has a central role in palliative treatment of uncomplicated painful spinal metastases, and aims to relieve pain and locally control the tumor. Surgery may be required in case of mechanical pain, pathological fracture and/or neurological deficit caused by MESCC, with or without adjuvant radiotherapy [4]

Methods

Results

Discussion

Conclusion