Health resource utilisation associated with skeletal-related events in patients with bone metastases secondary to solid tumours: regional comparisons in an observational study

Durán, Ignacio; Fink, M.; Bahl, Amit; Hoefeler, H.; Mahmood, Aftab; Lüftner, Diana; Ghazal, Hassan; Wei, Rachel; Chung, Karen; Hechmati, Guy; Green, J.; Atchison, C.

doi:10.1111/ecc.12452

Cited by 22 publications

(17 citation statements)

References 24 publications

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“…In a recent multicenter, observational study designed to describe cross-regional differences in health resource utilization of SREs in Europe and US, Durah et al found that 25% of reported SREs required inpatient hospitalization for a mean of 18 days [20]. Furthermore, 96% of the SREs resulted in inpatient and/or outpatient procedures.…”

Section: Risk Of Hospitalizationmentioning

confidence: 99%

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

et al. 2020

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Background In patients with metastatic cancer, the bone is the third-most common site of involvement. Radiation to painful bone metastases results in high rates of pain control and is an integral part of bone metastases management. Up to one-third of inpatient consults are requested for painful bone metastases, and up to 60% of these patients had evidence of these lesions visible on prior imaging. Meanwhile recent advances have reduced potential side effects of radiation. Therefore, there is an opportunity to further improve outcomes for patients using prophylactic palliative radiation to manage asymptomatic bone metastases. Methods/study design In this trial, 74 patients with metastatic solid tumors and high-risk asymptomatic or minimally symptomatic bone metastases will be enrolled and randomized to early palliative radiation or standard of care. This will be the first trial to assess the efficacy of prophylactic palliative radiation in preventing skeletal related events (SREs), the primary endpoint. This endpoint was selected to encompass patient-centered outcomes that impact quality of life including pathologic fracture, spinal cord compression, and intervention with surgery or radiation. Secondary endpoints include hospitalizations, Bone Pain Index, pain-free survival, pain-related quality of life, and side effects of radiation therapy. Discussion In this study, we propose a novel definition of high-risk bone metastases most likely to benefit from preventive radiation and use validated questionnaires to assess pain and impact on quality of life and health resource utilization. Observations from early patient enrollment have demonstrated robustness of the primary endpoint and need for minor modifications to Bone Pain Index and data collection for opioid use and hospitalizations. With increasing indications for radiation in the oligometastatic setting, this trial aims to improve patient-centered outcomes in the polymetastatic setting. Trial registration ISRCTN Number/Clinical trials.gov, ID:NCT03523351. Registered on 14 May 2018.

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Section: Risk Of Hospitalizationmentioning

confidence: 99%

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

et al. 2020

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“…Patients with cancer that has metastasized to bone and individuals with osteoporosis are at risk of developing skeletal complications, including fractures, which can lead to pain, decreased quality of life (QoL) and lengthy stays in hospital [1][2][3][4][5]. High-dose regimens of bisphosphonates (such as zoledronic acid 4 mg every 3-4 weeks intravenously [5]) and the monoclonal antibody denosumab (an agent that targets receptor activator of nuclear factor kappa B ligand [RANKL]; 120 mg every 4 weeks subcutaneously [SC]) are approved for the prevention of skeletal-related events (SREs) in adults with advanced malignancies involving bone; low-dose regimens (such as zoledronic acid 5 mg yearly IV; denosumab 60 mg every 6 months SC) are approved for the treatment of osteoporosis [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases

Otto

Pautke

Wyngaert

et al. 2018

Cancer Treatment Reviews

229

226

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Medication-related osteonecrosis of the jaw (MRONJ) is primarily an adverse side effect of denosumab or bisphosphonates (particularly when used at high doses to prevent skeletal-related events [SREs] in patients with cancer and bone metastases) or possibly anti-angiogenic cancer treatment. While the implementation of preventive measures over recent years has reduced the risk of MRONJ in patients with bone metastases due to cancer, it is imperative to balance the risk of MRONJ against the beneficial effects of treatment with denosumab or bisphosphonates on the skeletal health of patients. Despite growing awareness of MRONJ within the medical community, there is a lack of large-scale, prospective clinical studies in this rapidly evolving field. Discussing preventive measures with patients and implementing them, both before and during treatment with bisphosphonates or denosumab, is the best option to reduce the risk of MRONJ. In particular, avoiding bone trauma and preventing and treating dental infections before and during denosumab or bisphosphonate therapy is crucial to minimize the risk of MRONJ. If MRONJ develops, conservative (non-surgical) treatment can provide symptom relief, but achieving mucosal closure remains challenging. When management of symptoms and mucosal healing are the ultimate goals of therapy, or after failure of conservative treatment, a surgical approach may be beneficial. This critical review, based on a best-evidence review of currently available literature, provides clear practical guidelines to help to prevent, manage and treat MRONJ. Overall, a multidisciplinary, pragmatic approach to MRONJ should be adopted, prioritizing patient's quality of life and management of their skeletal malignant disease.

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“…Bone pain is the most common symptom [8]. Patients with bone metastases develop their rst SRE shortly after diagnosis and most of them suffer from at least one SRE which results in increased cost and poor prognosis and quality of life [9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Prognosis of Bone Metastases in Common Solid Cancers at Initial Diagnosis: A Population-Based Study

Zhang

Hong

et al. 2020

Preprint

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Background Bone is one of the most common sites of advanced tumors. However, there is currently a lack of population-based surveys for the incidence and prognosis of bone metastases in common solid cancers.Methods Patients with 12 types of primary cancer and bone metastases at initial diagnosis between 2010 and 2015 were identified using the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier method and Cox logistic regression were conducted to analyze survival and the effect of bone metastases on different cancers.Results We included 89,782 patients with bone metastases at cancer diagnosis. Lung cancer had the highest incidence (17.61%) of bone metastases at diagnosis in any stage, followed by liver cancer (6.29%), nasopharyngeal carcinoma (6.22%) and renal cancer (5.19%). Among patients with breast and prostate cancer, only 3.4% and 4.39%, respectively, were identified as having bone metastases at diagnosis. Breast cancer (32.1%), prostate cancer (25.2%), thyroid cancer (46.8%) and nasopharyngeal carcinoma (24.8%) patients with only bone metastasis have an over 20% five-year survival rate. Compared with patients at a stage previous to metastasis, bone metastasis significantly increased the risk of mortality and reduced survival time, especially for patients with prostate cancer (HR: 19.64, 95% CI 18.36 to 21.02). Concomitant other organ metastases make patient survival worse. Regarding the metastases of prostate cancer, bone metastases are the main type, while for colorectal cancer, bone metastases and concomitant visceral metastases mainly occur.Conclusions The findings of this study provide estimates of the incidence and prognosis of patients with bone metastases during the initial diagnosis of common solid cancers. In addition, we also clarified the degree to which bone metastasis affects patient survival. Patient prognosis depends on the primary type of cancer. These results can be used as a reference for the screening of metastases, and the optimization of personalized treatment options to improve the quality of life and survival of patients.

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Health resource utilisation associated with skeletal-related events in patients with bone metastases secondary to solid tumours: regional comparisons in an observational study

Cited by 22 publications

References 24 publications

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

Early palliative radiation versus observation for high-risk asymptomatic or minimally symptomatic bone metastases: study protocol for a randomized controlled trial

Medication-related osteonecrosis of the jaw: Prevention, diagnosis and management in patients with cancer and bone metastases

Incidence and Prognosis of Bone Metastases in Common Solid Cancers at Initial Diagnosis: A Population-Based Study

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