Early Clinical and Economic Outcomes of Prophylactic and Acute Pathologic Fracture Treatment

Mosher, Zachary A.; Patel, Harshadkumar; Ewing, Michael A; Niemeier, Thomas E; Hess, Matthew; Wilkinson, Eric B; McGwin, Gerald; Ponce, Brent A.; Patt, Joshua C.

doi:10.1200/jop.18.00431

Cited by 10 publications

(12 citation statements)

References 50 publications

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“…Mosher et al used The Nationwide Inpatient Sample database from 2002-2014 and found that prophylactic fixation was associated with decreased in-hospital mortality, acute renal failure, anemia, and peri- and postoperative blood transfusions. Similarly, prophylactic fixation had a decreased length of stay and total charges (−3,405 USD, p =0.001) compared to acute fracture treatment [ 17 ]. A 2019 article by El Abiad et al used the American College of Surgeons National Surgical Quality Improvement Program database to compare 30-day postoperative outcomes in prophylactic versus postfracture stabilization for metastatic lesions of the long bones and found lower risk of discharge to a facility other than home (OR 0.48, p =0.02), shorter length of hospital stay (IRR = 0.86, p =0.01), and lower risk of major medical complications (OR = 0.64, p < 0.01) compared with postfracture stabilization [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Mosher et al used e Nationwide Inpatient Sample database from Sarcoma 52002-2014 and found that prophylactic fixation was associated with decreased in-hospital mortality, acute renal failure, anemia, and peri-and postoperative blood transfusions. Similarly, prophylactic fixation had a decreased length of stay and total charges (−3,405 USD, p � 0.001) compared to acute fracture treatment[17]. A 2019 article by (a) (b) Imaging of a patient with an unobserved pathologic lesion who went on to complete fracture.…”

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confidence: 99%

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Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging

Colello

Pichiotino

Tanner

et al. 2020

Sarcoma

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The purpose of this study is to evaluate the benefit of reviewing scout CT images, obtained for routine oncologic surveillance, for the early identification of pathologic bony lesions. A retrospective review was conducted on patients who previously underwent surgical treatment by two orthopedic oncology surgeons at a tertiary care institution from 2009–2019 for pathologic lesions or fractures of the humerus or femur. Radiographic records were reviewed to identify patients in this cohort who had available scout views from CT imaging prior to official diagnosis of the bony lesion or fracture. CT scout images were assessed by two independent reviewers to identify any pathologic lesions, and radiographic reports were reviewed to identify if the lesions were noted by radiology at the time of the initial scan interpretation. One hundred and forty-four patients were identified, and thirty-nine had an available scout CT image prior to official diagnosis of the lesion. Twenty-five patients (64.1%) had lesions identified by authors on scout CT versus only 9 (23.1%) who had lesions that were documented in the initial CT radiologic report. There was a total of 29 lesions identified by the study authors on scout CT, and 19 (65.5%) were not reported in the initial radiographic interpretation with an average interval between observation by authors and official diagnosis of 202 days. Of the impending fractures, three patients (16.7%) went on to complete fracture prior to referral to orthopedics with an average interval between these missed lesions on scout CT and their presentation with fracture of 68 days. This study advocates for the careful review of all scout CT imaging as an essential part of the work up for metastatic disease and encourages all practitioners to utilize this screening tool for the identification of pathologic bony lesions which may help expedite early treatment to reduce patient morbidity.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging

Colello

Pichiotino

Tanner

et al. 2020

Sarcoma

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“…Early intervention for patients with metastatic bone disease has been shown to reduce patient morbidity as well as overall cost. 20 A prompt, proactive response has been shown to reduce complication rates, length of stay, need for community care, and overall treatment costs, and this is specifically true of pathologic fracture. 20 A prophylactic approach has shown to be safer and much more cost-effective compared with traditional management, or acute fixation, after a completed fracture.…”

Section: Healthcare Costsmentioning

confidence: 99%

“…20 A prompt, proactive response has been shown to reduce complication rates, length of stay, need for community care, and overall treatment costs, and this is specifically true of pathologic fracture. 20 A prophylactic approach has shown to be safer and much more cost-effective compared with traditional management, or acute fixation, after a completed fracture. 21 Patients are living longer with advances in systemic therapy, targeted therapy, and radiotherapy treatments, thus making durable reconstruction of a metastatic skeletal location more important.…”

Section: Healthcare Costsmentioning

confidence: 99%

Metastatic bone disease: Early referral for multidisciplinary care

Ardakani

Faimali

Nystrom

et al. 2022

CCJM

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It is estimated that more than half of all cancers develop bony metastases, exacting a substantial cost in terms of patient quality of life and healthcare expenses. Prompt diagnosis and management have been shown to reduce morbidity and costs. When a patient with a history of cancer presents with musculoskeletal pain, heightened awareness of the risk of bone metastasis should prompt immediate referral to an orthopedic specialist. A multidisciplinary approach is needed to identify an appropriate treatment plan for the patient based on the prognosis, fracture status, and extent of skeletal disease. KEY POINTSMore than 50% of patients with cancer survive their disease for at least 10 years, making durable reconstruction in metastatic skeletal disease more important.Most patients with metastatic bone disease present to an orthopedic team after a pathologic fracture has already occurred, increasing the likelihood of discomfort and morbidity.Awareness of the diagnostic and therapeutic challenges associated with metastatic bone disease is essential for timely referral to an orthopedic specialist.

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“…Large database studies found prophylactic stabilization to be associated with lower odds of adverse events, death, blood transfusion, increased length of hospital stay, and decreased mortality and treatment cost compared to fracture fixation [133,134]. An institutional study found prophylaxis to be associated with less average blood loss, shorter hospital stays, higher likelihood of discharge to home vs. extended care facility, and greater likelihood of support-free ambulation [135].…”

Section: Therapeutic Approaches To Managing Metastatic Bone Diseasementioning

confidence: 99%

Bone Metastatic Breast Cancer: Advances in Cell Signaling and Autophagy Related Mechanisms

Othman

Winogradzki

Lee

et al. 2021

Cancers

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Bone metastasis is a frequent complication of breast cancer with nearly 70% of metastatic breast cancer patients developing bone metastasis during the course of their disease. The bone represents a dynamic microenvironment which provides a fertile soil for disseminated tumor cells, however, the mechanisms which regulate the interactions between a metastatic tumor and the bone microenvironment remain poorly understood. Recent studies indicate that during the metastatic process a bidirectional relationship between metastatic tumor cells and the bone microenvironment begins to develop. Metastatic cells display aberrant expression of genes typically reserved for skeletal development and alter the activity of resident cells within the bone microenvironment to promote tumor development, resulting in the severe bone loss. While transcriptional regulation of the metastatic process has been well established, recent findings from our and other research groups highlight the role of the autophagy and secretory pathways in interactions between resident and tumor cells during bone metastatic tumor growth. These reports show high levels of autophagy-related markers, regulatory factors of the autophagy pathway, and autophagy-mediated secretion of matrix metalloproteinases (MMP’s), receptor activator of nuclear factor kappa B ligand (RANKL), parathyroid hormone related protein (PTHrP), as well as WNT5A in bone metastatic breast cancer cells. In this review, we discuss the recently elucidated mechanisms and their crosstalk with signaling pathways, and potential therapeutic targets for bone metastatic disease.

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Early Clinical and Economic Outcomes of Prophylactic and Acute Pathologic Fracture Treatment

Cited by 10 publications

References 50 publications

Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging

Predicting Pathologic Bone Lesions Using Scout Computed Tomography (CT) Imaging

Metastatic bone disease: Early referral for multidisciplinary care

Bone Metastatic Breast Cancer: Advances in Cell Signaling and Autophagy Related Mechanisms

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