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Cindy Oertel
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Lisa Doty
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Cancer patients with bone pain benefit from evaluation and treatment by orthopaedic surgeons
ROSEMONT, Ill.-- According to a research study of 963 breast cancer patients reported in The Journal of Bone and Joint Surgery, patients who have spinal instability and pain due to the spread of the cancer to the spine can obtain pain relief by undergoing surgery to decompress and stabilize the spine. But these patients are not always referred to an orthopaedic surgeon who can evaluate them and perform surgery if indicated.
"Breast cancer is the most common type of cancer that metastases, or spreads, to the spine," said senior study author C. S. B. Galasko, MSc, ChM, FRCS, FRCSE, of the University of Manchester, Manchester, United Kingdom. "However, any tumor can metastasize to the spine and cause enough damage to produce excruciating pain."
To determine if breast cancer patients who had metastactic lesions were appropriately diagnosed and referred for treatment, Dr. Galasko's study reviewed the records of 963 patients who had been treated for breast cancer in 31 hospitals in a single region of the United Kingdom. Because it may take years for skeletal metastases to appear, the researchers evaluated patients seven years after their diagnosis of breast cancer was confirmed.
A total of 1412 women were diagnosed with and treated for breast cancer in 31 hospitals in the area. Of these, 963 had complete records which were analyzed. Overall, 420 (44 percent) of the 963 patients had complained of bone pain and of these, 207 (21 percent of 963) had proven skeletal metastases, while 213 (22 percent) had other causes for the bone pain, such as arthritis. Only 45 of those with metastases were referred to an orthopaedic surgeon for evaluation and treatment.
"Because neither radiation therapy nor chemotherapy will alleviate the pain associated with spinal instability, it's important that these patients be referred to an orthopaedic surgeon for evaluation and treatment," Dr. Galasko said. "Orthopaedic surgeons and cancer specialists need to work together to help these patients."
He has treated 80 patients with spinal instability secondary to metastatic disease. Thirty four of the 80 patients had spinal cord compression and weakness of the lower extremities severe enough to affect their ability to walk or stand. Some also had a loss of bladder function.
Seventy one (89 percent) had complete relief from pain and four (5 percent) had partial relief. The operative treatment involved both spinal decompression and the insertion of a rod to stabilize the spine.
"The symptoms of spinal instability--pain and immobility--can be relieved for several years in these patients, thus improving their quality of life," Dr. Galasko said.
An orthopaedic surgeon is a medical doctor with extensive training in the diagnosis and treatment of injuries and diseases of the musculoskeletal system-the bones, joints and muscles of the body.
The Journal of Bone and Joint Surgery (JBJS) is the official scientific publication of the 24,500 member American Academy of Orthopaedic Surgeons, a not-for-profit organization which provides educational programs for orthopaedic surgeons, allied health professionals and the public. The peer-reviewed JBJS, located in Needham Mass., is published monthly. Abstracts are available online at http://www.jbjs.org.
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