Treatment delay and radiological errors in patients with bone metastases

Abstract

During routine investigations, we are surprised to find that therapy for bone metastases is sometimes delayed for a considerable period of time. To determine the extent of this delay and its causes, we reviewed the medical records of symptomatic patients seen at our hospital who had been recently diagnosed as having bone metastases for the last four years. The treatment delay was defined as the interval between presentation with symptoms and definitive treatment for bone metastases. The diagnostic delay was defined as the interval between presentation with symptoms and diagnosis of bone metastases. The results of diagnostic radiological examinations were also reviewed for errors. The study population included 76 males and 34 females with a median age of 66 years. Most bone metastases were diagnosed radiologically. Over 75% of patients were treated with radiotherapy. The treatment delay ranged from 2 to 307 days, with a mean of 53.3 days. In 490 radiological studies reviewed, we identified 166 (33.9%) errors concerning 62 (56.4%) patients. The diagnostic delay was significantly longer for patients with radiological errors than for patients without radiological errors (P < 0.001), and much of it was due to radiological errors. In conclusion, the treatment delay in patients with symptomatic bone metastases was much longer than expected, and much of it was caused by radiological errors. Considerable efforts should therefore be made to more carefully examine the radiological studies in order to ensure prompt treatment of bone metastases.

Challenges in the Diagnosis of bone Metastasis in Patients without a History of Malignancy at Their First Clinic Visit

“…PVD is significantly shorter for Group A and Group B compared with Group D (P =0.0059 and 0.019, respectively). POV, period from onset of symptoms to the first visit; PVD, period from the first visit to diagnosis; (n=X, Y), (n=POV, PVD).from unknown malignancy6 .We also found that FPC was associated with over half of the patients studied at the diagnosis of bone metasta-sis. Regarding skeletal-related events including spinal cord compression, pathological fractures, radiation to bone, and bone surgery, these have been reported to be present at the diagnosis of bone metastasis in 22.4, 22.4, and 10.0% of patients with breast cancer, lung cancer, and prostate cancer, respectively 7 , but these results were not limited only to bone metastasis in patients of unknown malignancy at their first visit.…”

MSH-5: índice para la detección oportuna de tumores malignos de rodilla

“…En algunas series se reportan hasta 17 semanas desde la primera consulta médica hasta el diagnóstico 12,13 . Ichinohe et al 14 encontraron un retraso en el diagnóstico de 3 a 307 días, con errores en el diagnóstico en el 56.4% de los pacientes. El retraso en el diagnóstico y en el tratamiento de las lesiones tumorales óseas también se asocia a radiografías simples inadecuadas, con mala técnica radiográfica, y a una historia clínica inicial incompleta 15 .…”