The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective

Giammalva, Giuseppe Roberto; Ferini, Gianluca; Torregrossa, Fabio; Brunasso, Lara; Musso, Sofia; Benigno, Umberto Emanuele; Gerardi, Rosa Maria; Bonosi, Lapo; Costanzo, Roberta; Paolini, Federica; Palmisciano, Paolo; Umana, Giuseppe Emmanuele; Bonaventura, Rina Di; Sturiale, Carmelo Lucio; Iacopino, Domenico Gerardo; Maugeri, Rosario

doi:10.3390/life12040571

Cited by 9 publications

(8 citation statements)

References 99 publications

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“…Metastatic spine disease management remains a palliative approach. Nonetheless, medical and surgical care are cardinal in ameliorating pain and improving quality of life in such patients [ 104 ].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

Esperança-Martins

Roque

Barroso

et al. 2023

Cancers

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Metastatic spine disease (MSD) and metastatic spinal cord compression (MSCC) are major causes of permanent neurological damage and long-term disability for cancer patients. The development of MSD is pathophysiologically framed by a cooperative interaction between general mechanisms of bone growth and specific mechanisms of spinal metastases (SM) expansion. SM most commonly affects the thoracic spine, even though multiple segments may be affected concomitantly. The great majority of SM are extradural, while intradural-extramedullary and intramedullary metastases are less frequently seen. The management of patients with SM is particularly complex and challenging, with multiple factors—such as the spinal stability status, primary tumor radio and chemosensitivity, cancer biological burden, patient performance status and comorbidities, and patient’s oncological prognosis—influencing the clinical decision-making process. Different frameworks were developed in order to systematize and support this process. A multidisciplinary, personalized approach, enriched by the expertise of each involved specialty, is crucial. We reviewed the most recent evidence and proposed an updated algorithmic approach to patients with MSD according to the clinical scenario of each patient. A flowchart-based approach offers an evidence-based management of MSD, providing a valuable clinical decision tool in a context of high uncertainty and quick-acting need.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

Esperança-Martins

Roque

Barroso

et al. 2023

Cancers

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“…Spine is one of the most common sites for the involvement of metastatic disease (8,9). As an advanced stage of cancer, metastatic spinal disease is often characterized by severe back pain, infection, neurological sequelae, and ambulatory disability (8), which are particularly challenging for surgeons. Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications.…”

Section: Introductionmentioning

confidence: 99%

“…As an advanced stage of cancer, metastatic spinal disease is often characterized by severe back pain, infection, neurological sequelae, and ambulatory disability (8), which are particularly challenging for surgeons. Of note, patients with spine metastasis have been proved to be relevant to declined life expectancy (8) and poor quality of life (10)(11)(12) because of above complications. Studies have demonstrated that surgical interventions could be capable of improving the quality of patient's remaining life due to immediate pain relief and functional recovery among patients with spine metastasis (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life and Mental Health Status Among Cancer Patients With Metastatic Spinal Disease

Liu

Cao

Shi

et al. 2022

Front. Public Health

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This study aimed to investigate the quality of life and mental health status and further to identify relevant risk factors among advanced cancer patients with spine metastases. This study prospectively included and analyzed 103 advanced cancer patients with spine metastases. Patient's basic information, lifestyles, comorbidities, tumor characteristics, therapeutic strategies, economic conditions, quality of life, anxiety, and depression were collected. Patient's quality of life was assessed using the Functional Assessment of Cancer Therapy-General Scale (FACT-G), and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale (HADS). Subgroup analysis was performed based on different age groups, and a multivariate analysis was performed to test the ability of 20 potential risk factors to predict quality of life, anxiety, and depression. The mean total FACT-G score was only 61.38 ± 21.26. Of all included patients, 52.43% had skeptical or identified anxiety and 53.40% suffered from skeptical or identified depression. Patients had an age of 60 or more and <70 years had the lowest FACT-G score (54.91 ± 19.22), highest HADS anxiety score (10.25 ± 4.22), and highest HADS depression score (10.13 ± 4.94). After adjusting all other potential risk factors, age was still significantly associated with quality of life (OR = 0.57, 95%CI: 0.38–0.86, p < 0.01) and depression (OR = 1.55, 95%CI: 1.00–2.42, p = 0.05) and almost significantly associated with anxiety (OR = 1.52, 95%CI: 0.94–2.43, p = 0.08). Besides, preference to eating vegetables, time since knowing cancer diagnosis, surgical treatment at primary cancer, hormone endocrine therapy, and economic burden due to cancer treatments were found to be significantly associated with the quality of life. A number of comorbidities and economic burden due to cancer treatments were significantly associated with anxiety. Advanced cancer patients with spine metastases suffer from poor quality of life and severe anxiety and depression, especially among patients with an age of 60 or more and <70 years. Early mental health care and effective measures should be conducted to advanced cancer patients with spine metastases, and more attention should be paid to take care of patients with an age of 60 or more and <70 years in terms of their quality of life and mental health status.

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“…Spine metastases are a severe consequence of cancer patients, and the incidence of spine metastases has significantly increased due to growing cancer patients and prolonged life expectancy among those patients [2]. This disease is featured by intractable severe back pain, neurological sequelae, and even incontinence and disability, all of which could have a significant impact on the quality of life among patients with a limited life expectancy [3]. Thus, maintaining or promoting the patient's quality of life to the greatest extent possible is the primary objective of contemporary treatment for spinal metastases.…”

Section: Introductionmentioning

confidence: 99%

A novel nomogram to stratify quality of life among advanced cancer patients with spinal metastatic disease after examining demographics, dietary habits, therapeutic interventions, and mental health status

Long

Wang

et al. 2022

BMC Cancer

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Background It would be very helpful to stratify patients and direct patient selection if risk factors for quality of life were identified in a particular population. Nonetheless, it is still challenging to forecast the health-related quality of life among individuals with spinal metastases. The goal of this study was to stratify patient’s populations for whom the assessment of quality of life should be encouraged by developing and validating a nomogram to predict the quality of life among advanced cancer patients with spine metastases. Methods This study prospectively analyzed 208 advanced cancer patients with spine metastases, and collected their general characteristics, food preferences, addictions, comorbidities, therapeutic strategies, and mental health status. The functional assessment of cancer therapy-general (FACT-G) and hospital anxiety and depression scale (HADS) were used to assess quality of life and mental health, respectively. The complete cohort of patients was randomly divided into two groups: a training set and a validation set. Patients from the training set were conducted to train and develop a nomogram, while patients in the validation set were performed to internally validate the nomogram. The nomogram contained significant variables discovered using the least absolute shrinkage and selection operator (LASSO) approach in conjunction with 10-fold cross-validation. The nomogram’s predictive ability was assessed utilizing discrimination, calibration, and clinical usefulness. Internal validation was also completed using the bootstrap method after applying 500 iterations of procedures. A web calculator was also developed to promote clinical practice. Results Advance cancer patients with spinal metastases had an extremely low quality of life, as indicated by the average FACT-G score of just 60.32 ± 20.41. According to the LASSO and 10-fold cross-validation, Eastern Cooperative Oncology Group (ECOG) score, having an uncompleted life goal, preference for eating vegetables, chemotherapy, anxiety status, and depression status were selected as nomogram predictors. In the training set, the area under the receiver operating characteristic curve (AUROC) was 0.90 (95% CI: 0.84–0.96), while in the validation set, it was 0.85 (95% CI: 0.78–0.93). They were 0.50 (95% CI: 0.41–0.58) and 0.44 (95% CI: 0.33–0.56), respectively, for the discrimination slopes. The nomogram had favorable capacity to calibrate and was clinically useful, according to the calibration curve and decision curve analysis. When compared to patients in the low-risk group, patients in the high-risk group were above four times more likely to experience a poor quality of life (82.18% vs. 21.50%, P < 0.001). In comparison to patients in the low-risk group, patients in the high-risk group also exhibited significant higher levels of anxiety and depression. The webpage for the web calculator was https://starshiny.shinyapps.io/DynNomapp-lys/. Conclusions This study suggests a nomogram that can be applied as a practical clinical tool to forecast and categorize the quality of life among patients with spine metastases. Additionally, patients with poor quality of life experience more severe anxiety and depression. Effective interventions should be carried out as soon as possible, especially for patients in the high-risk group, to improve their quality of life and mental health condition.

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The Palliative Care in the Metastatic Spinal Tumors. A Systematic Review on the Radiotherapy and Surgical Perspective

Cited by 9 publications

References 99 publications

Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

Multidisciplinary Approach to Spinal Metastases and Metastatic Spinal Cord Compression—A New Integrative Flowchart for Patient Management

Quality of Life and Mental Health Status Among Cancer Patients With Metastatic Spinal Disease

A novel nomogram to stratify quality of life among advanced cancer patients with spinal metastatic disease after examining demographics, dietary habits, therapeutic interventions, and mental health status

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