Survival in patients operated on for pathologic fracture: Implications for end-of-life orthopedic care Journal Article
| Authors: | Nathan, S. S.; Healey, J. H.; Mellano, D.; Hoang, B.; Lewis, I.; Morris, C. D.; Athanasian, E. A.; Boland, P. J. |
| Article Title: | Survival in patients operated on for pathologic fracture: Implications for end-of-life orthopedic care |
| Abstract: | Purpose: Life expectancy is routinely used as part of the decision-making process in deciding the value of surgery for the treatment of bone metastases. We sought to investigate the validity of frequently used indices in the prognostication of survival in patients with metastatic bone disease. Methods: The study prospectively assessed 191 patients who underwent surgery for metastatic bone disease. Diagnostic, staging, nutritional, and hematologic parameters cited to be related to life expectancy were evaluated. Preoperatively, the surgeon recorded an estimate of projected life expectancy for each patient. The time until death was recorded. Results: Kaplan-Meier survival analyses indicated that the survival estimate, primary diagnosis, use of systemic therapy, Eastern Cooperative Oncology Group (ECOG) performance status, number of bone metastases, presence of visceral metastases, and serum hemoglobin, albumin, and lymphocyte counts were significant for predicting survival (P < .004). Cox regression analysis indicated that the independently significant predictors of survival were diagnosis (P < .006), ECOG performance status (P < .04), number of bone metastases (P < .008), presence of visceral metastases (P < .03), hemoglobin count (P < .009), and survival estimate (P < .00005). Diagnosis, ECOG performance status, and visceral metastases covaried with surgeon survival estimate. Linear regression and receiver-operator characteristic assessment confirmed that clinician estimation was the most accurate predictor of survival, followed by hemoglobin count, number of visceral metastases, ECOG performance status, primary diagnosis, and number of bone metastases. Nevertheless, survival estimate was accurate in predicting actual survival in only 33 (18%) of 181 patients. Conclusion: A better means of prognostication is needed. In this article, we present a sliding scale for this purpose. © 2005 by American Society of Clinical Oncology. |
| Keywords: | survival; adult; cancer survival; aged; bone neoplasms; middle aged; survival analysis; bone tumor; fracture; major clinical study; bone metastasis; cancer staging; cancer diagnosis; neoplasm staging; prospective study; prospective studies; nutritional status; accuracy; metastasis; breast cancer; lung cancer; hemoglobin; hemoglobin blood level; prostate cancer; albumin; proportional hazards model; preoperative period; physician; liver cancer; visceral metastasis; validity; terminal care; kaplan meier method; kidney cancer; decision making; fractures, bone; life expectancy; orthopedics; lymphocyte count; hematologic disease; receiver operating characteristic; orthopedic procedures; orthopedic surgery; linear regression analysis; pathologic fracture |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 23 |
| Issue: | 25 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2005-09-01 |
| Start Page: | 6072 |
| End Page: | 6082 |
| Language: | English |
| DOI: | 10.1200/jco.2005.08.104 |
| PUBMED: | 16135474 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 23" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus" |
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