Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort study
AOSpine Knowledge Forum Tumor
(2020) Neurosurgery, volume 87, issue 2, pp. 303 - 311
(Article)
Abstract
BACKGROUND: Despite our inability to accurately predict survival in many cancer patients, a life expectancy of at least 3 mo is historically necessary to be considered for surgical treatment of spinal metastases. OBJECTIVE: To compare health-related quality of life (HRQOL) in patients surviving <3 mo after surgical treatment to patients
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surviving >3 mo to assess the validity of this inclusion criteria. METHODS: Patients who underwent surgery for spinal metastases between August 2013 and May 2017 were retrospectively identified from an international cohort study. HRQOL was evaluated using generic and disease-specific outcome tools at baseline and at 6 and 12 wk postsurgery. The primary outcome was the HRQOL at 6 wk post-treatment measured by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). RESULTS: A total of 253 patients were included: 40 patients died within the first 3 mo after surgery and 213 patients survived more than 3 mo. Patients surviving <3 mo after surgery presented with lower baseline performance status. Adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups at 6 wk post-treatment. No significant difference in patient satisfaction at 6 wk with regard to their treatment could be detected between both groups. CONCLUSION: When controlled for baseline performance status, quality of life 6 wk after surgery for spinal metastasis is independent of survival. To optimize improvement in HRQOL for this patient population, baseline performance status should take priority over expected survival in the surgical decision-making process.
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Keywords: Health-related quality of life, Life expectancy, Metastatic spine disease, Surgical care, Surgery, Clinical Neurology
ISSN: 0148-396X
Publisher: Lippincott Williams & Wilkins
Note: Funding Information: This study was organized and funded by AOSpine International through the AOSpine Knowledge Forum Tumor, a focused group of international spine oncology experts acting on behalf of AOSpine. Study support was provided directly through the AOSpine Research Department and the AO Clinical Investigation and Documentation Unit. A research grant for this study was received from the Orthopaedic Research and Education Foundation (OREF). The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Dr Dea has a consultancy agreement with Stryker and Baxter; he has received a speaker fee and holds stock ownership with Medtronic. Dr Versteeg has received consulting, travel, and accommodation fees from AOSpine International. Dr Sahgal has given educational seminars at Elekta AB, Accuray Inc, and Varian medical systems; has received a research grant from Elekta AB; has received travel accommodations and expenses from Elekta and Varian; and belongs to the Elekta MR Linac Research Consortium. Dr Rhines has educational commitments with Stryker. Dr Sciubba has received consulting fees and royalties from Medtronic, DePuy Synthes, Stryker, NuVasive, and K2M. Dr Arnold has received travel accommodations and expenses from AOSpine North America; holds intellectual property rights and interests, equity, and a position of responsibility from Evoke Medical; has received equity from Z-Plasty; has received consulting fees from Stryker Orthopaedics, Ulrich, Spineguard, In Vivo Therapeutics, and In Vivo; and has received consulting fees, travel accommodations, and expenses from Stryker Spine, Spinewave, and Medtronic. Dr Laufer has received consulting fees from Globus, DePuy Synthes, and SpineWave. Dr Gokaslan has received research support from AOSpine North America and holds stock ownership in Spinal Kinetics. Dr Fisher has received consulting fees and royalties from Medtronic, research grants from OREF, and fellowship support paid to institution from AOSpine and Medtronic. Publisher Copyright: © Congress of Neurological Surgeons 2019. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
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