• Recommend this site In order to provide our website visitors and registered users with a service tailored to their individual preferences we use cookies to analyse visitor traffic and personalise content. Sometimes treatment being used to treat the main (primary) cancer will help shrink the metastases. It exhibits an upward trend over the study period. Sign up and get your guide! Bone metastases can greatly reduce your quality of life with cancer, yet newer treatments are making a difference for many people. The inpatients with bone metastases were aged ≥ 18 years and stratified by whether they underwent surgery. In addition to predisposing to fractures, bone metastases can make it difficult for fractured bones to heal. Cancer with BM was considered to be in the advanced stage; therefore, most patients were hospitalized for medical treatment. With osteolytic metastases, the tumor causes the breakdown (lysis) of bone. Clinical benefit in patients with metastatic bone disease: results of a Phase 3 study of denosumab versus zoledronic acid. NHIRD, National Health Insurance Research Database; BM, bone metastases; aHR, adjusted hazard ratios; QOL, quality of life; BRI, bone resorption inhibitor; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; HTN, hypertension; DM, diabetes mellitus; COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; IHD, ischemic heart disease; CHD, congestive heart disease. J Clin Oncol. If you agree to our use of cookies and the contents of our Privacy Policy please click 'accept'. No significant difference in the prevalence of COPD, CKD, stroke, hyperthyroidism, and sepsis was observed. Hence, there may have been a bias in selection. First, the severity of the patients’ disease could not be determined from the database. Cancer 1983; 52:610-614. It's thought that 10 to 15 percent of people with advanced cancer will suffer from this condition (which has other causes as well in addition to bone metastases). 2017;109(6). These treatments may include chemotherapy, targeted therapies, monoclonal antibodies, and immunotherapy drugs. Side effects of denosumab are similar to bisphosphonates but these drugs are more likely to result in a low calcium level with long-term use. In the past, 50% of patients with cancer would die within 6 months of surgery owing to a pathologic fracture or paraplegia due to spinal metastases.1 Most surgeons hesitate to perform surgical resection for cancer patients with BM despite the poor QOL, owing to comorbidities and limited life expectancy. • Web Design by Adhesion. Dr Scott Fraser, Jen-Ta Shih,1,2 Tsu-Te Yeh,1 Pei-Hung Shen,1 Chih-Chien Wang,1 Sheng-Hao Wang,1 Wu-Chien Chien,3– 6 Chi-Hsiang Chung,3– 5 Chia-Chun Wu1 1Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan; 3School of Public Health, National Defense Medical Center, Taipei, Taiwan; 4Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 5Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; 6Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, TaiwanCorrespondence: Chia-Chun WuDepartment of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. Better management of the primary cancer increases the survival rate of patients; hence, there is an increased demand for surgical intervention to treat metastatic bone lesions. When multiple myeloma invades bones the cancer cells both inhibit the bone making cells (osteoblasts) and stimulate the bone cells which break down bone (osteoclasts). N Engl J Med. We analyzed all the inpatient data included in Taiwan’s National Health Insurance Research Database (NHIRD), which was established in 1995. Spine (Phila Pa 1976). Overall survival improvement in patients with lung cancer and bone metastases treated with denosumab versus zoledronic acid: subgroup analysis from a randomized phase 3 study. We divided the patients into the following three age subgroups: 18–44 years, 45–64 years, and ≥ 65 years; the distribution of patients in each subgroup was similar in both groups. They work by suppressing the breakdown of bone to improve bone density. Other less common side effects of bisphosphonates given intravenously may include kidney damage, low calcium levels, muscle, joint, and/or bone pain (which can arise any time after treatment), unusual fractures of the femur, and atrial fibrillation. There are also treatments which address bone metastases specifically. Patients with BM before the index date, those who were lost to follow-up, those with unknown sex information, and pediatric patients (< 18 years old) were excluded from the study. Treatment of HER2-positive metastatic breast cancer. Create a personalised ads profile. How SIR-Spheres Work to Treat Liver Metastases From Prostate Cancer, Multiple Myeloma Overview: Symptoms, Causes, Diagnosis, and Treatment, Using Local Treatments for Breast Cancer Metastasis, Spinal Cancer: Diagnosis, Treatment, and Prognosis, How Non-Small Cell Lung Cancer Is Treated, A Closer Look at the Top 5 Deadliest Cancers, Reverse osteoporosis and prevent bone loss with effective medication, risk of blood clots in people with cancer, Interventions for Managing Medication-Related Osteonecrosis of the Jaw, Impact of Bone-Targeted Treatments on Skeletal Morbidity and Survival in Breast Cancer, Use of Adjuvant Bisphosphonates and Other Bone-Modifying Agents in Breast Cancer: A CancerCare Ontario and American Society of Clinical Oncology Clinical Practice Guideline, SEOM Clinical Guideline for Bone Metastases From Solid Tumours (2016), A Comprehensive Review of Denosumab for Bone Metastasis in Patients With Solid Tumors, They can strengthen bones affected by metastases to reduce both pain and the risk of fractures. Osteonecrosis may occur with any drugs in the category of bisphosphonates but 94 percent of cases are found with intravenous bisphosphonate drugs and it is very uncommon with oral drugs. Results were comparable between all age subgroups, sexes, and when the analysis was restricted to certain comorbidities and cancers. Even so, with the advancement of medical instruments and surgical techniques, the location of lesions may not be a limiting factor. Patients aged ≥ 18 years, who had been recently diagnosed with bone metastases (BM), were enrolled and assigned to either the surgery or non-surgery groups. • Testimonials • Privacy Policy While these people may use the term "bone cancer," cancers which spread to bones are not considered bone cancer. 2017;9(1):116–125. Scagliotti GV, Hirsh V, Siena S, et al. Javascript is currently disabled in your browser. The chi-square and Fisher’s exact tests were used to compare categorical variables and the t-test was used to compare continuous variables between the surgery and non-surgery groups. 2005;366(9486):643–648. It is the Official Journal of the American Academy of Hospice and Palliative Medicine and the National Hospice and Palliative Care Organization. The aHR of mortality was significantly lower in the surgery group than in the non-surgery group (aHR = 0.7, p < 0.001). The treatment will depend on the type of cancer as well as the number and location of bone metastases. Bone metastases occur in roughly 70 percent of women with metastatic breast cancer (bones are the most common site of metastases), and bone metastases from breast cancer are a significant cause of pain and disability for these women (and men). Orthop Nurs. There has also been considerable progress in the non-surgical treatment of cancers, specifically in improving the survival rate of patients with advanced cancer. Lee CK, Davies L, Wu YL, et al. In fact, in addition to people with metastatic breast cancer, Zometa is now recommended for early stage breast cancer as an adjuvant therapy to reduce the chance that breast cancer will spread to bones in the first place. The location of BM also played a significant role. doi:10.4055/cios.2017.9.1.116, 14. Use precise geolocation data. Xgeva or Prolia 120 mg subcutaneously every 4 weeks, Zometa 4 mg IV every 12 weeks or every 3 to 4 weeks, Xgeva/Prolia (denosumab) 120 mg subcutaneously every 4 weeks, Denosumab 120 mg subcutaneously every 4 weeks. Thank you, {{form.email}}, for signing up. As expected, old age and comorbidities were associated with a higher aHR or mortality. He is an associate professor of clinical medicine at Weill Cornell Medical College and attending physician in the Department of Hematology Oncology at the New York Presbyterian Weill Cornell Medical Center. Copyright 2017 Informa PLC. Gul, G., Sendur, M., Aksoy, S., Sever, A., and K. Altundaq. 2008;27(3):160–171. There were more male patients than female patients enrolled in this study (52.4% versus 47.6%) and in the non-surgery group (53.2% versus 46.8%); however, the number of male patients was lower than that of female patients in the surgery group (46% versus 54%). The trend of surgery for BM has increased steadily in the present study (Figure 3). Some of the general treatments used for metastatic cancer may also reduce bone metastases. doi:10.1080/00016470410001708270, 5. Management of skeletal metastatic disease has attracted increasing attention in the last few years. In November 2014, the Society for Integrative Oncology (SIO) published clinical practice guidelines to inform both clinicians and patients on the use of integrative therapies during breast cancer treatment and to treat breast cancer treatment‐related symptoms. Bisphosphonates are also approved for postmenopausal women with early-stage breast cancer. The following comorbidities and associated complications were assessed using the corresponding ICD-9-CM codes: hypertension (HTN, ICD-9-CM: 401–405), diabetes mellitus (DM, ICD-9-CM: 250), chronic obstructive pulmonary disease (COPD, ICD-9-CM: 490–496), chronic kidney disease (CKD, ICD-9-CM: 585), ischemic heart disease (IHD, ICD-9-CM: 410–414), congestive heart disease (CHD, ICD-9-CM: 428–429), stroke (ICD-9-CM: 430–438), pneumonia (ICD-9-CM: 480–486), injury (ICD-9-CM: 800–999), hyperthyroidism (ICD-9-CM: 242), liver disease (ICD-9-CM: 571), depression (ICD-9-CM: 296.2–296.3, 300.4, 311), and sepsis (ICD-9-CM: 003.1, 036.1, 038). For metastatic breast cancer, with bone metastases, the American Society of Clinical Oncology guidelines from 2017 recommend women be treated with one of the following drugs as soon as bone metastases are detected: For prostate cancer, 2017 clinical practice guidelines also recommended that bone-modifying agents be started at the time of diagnosis of bone metastases. Chemotherapy, radiation therapy, and/or targeted therapy may also be used. 2001;26(3):298–306. Several features of • software development by maffey.com These focused issues require further investigation in the future studies. Acta Orthop Scand. doi:10.1007/s00402-007-0464-y, 6. Denosumab works by binding with and inactivating a receptor on a protein (RANKL) that regulates bone remodeling. Osteonecrosis of the jaw in cancer after treatment with bisphosphonates: incidence and risk factors. According to the location of BM, we also divided the patients into the following three subgroups: axial skeleton, appendicular skeleton, and multiple sites. Xgeva and Prolia (denosumab) is a monoclonal antibody (man-made antibody) which can reduce complications (such as fractures) associated with bone metastases. Select personalised ads. Intravenous radiation. The NCCN guidelines recommend combining induction therapy for MM with bone-targeted treatment (bisphosphonates or denosumab) and supportive care as necessary. The results demonstrated that the overall mortality is lower in the surgery group than in the non-surgery group; moreover, the surgery group is associated with a significantly lower risk of mortality (aHR = 0.7) than the non-surgery group after adjustment for sex, age, and comorbidities. The original data can be obtained exclusively under the authorization of NHIRD. Select basic ads. Both classes of medications carry an uncommon risk of osteonecrosis of the jaw, and a careful dental exam looking for signs of gum disease is recommended before starting these drugs. Bamias A, Kastritis E, Bamia C, et al. doi:10.1016/j.jse.2011.06.019, 16. 2013;16(2):66–69. Kakhki VR, Anvari K, Sadeghi R, Mahmoudian AS, Torabian-Kakhki M. Pattern and distribution of bone metastases in common malignant tumors. After the axial skeleton, the pelvic bone is the second most common site of BM.12 Pelvic bone surgery is a demanding operation both for the surgeons and the patients. J Thorac Oncol. For this reason, taking a supplement of calcium and vitamin D is often recommended. All presented ICD-9-CM codes and National Health Insurance order codes are displayed in the appendix (Table S1). Cancer that has spread to bones (bone metastasis) is very common and can cause a great deal of pain and disability related to fractures and other complications. The non-surgery group included more patients with multiple sites of BM than the surgery group (90.8% versus 65.5%). BM was defined as ICD-9-CM code 198.5, corresponding to the following ICD-9-CM codes for primary cancer, eg, ICD-9-CM: 162 for lung cancer, ICD-9-CM: 174 for breast cancer, and ICD-9-CM: 185 for prostate cancer. We also performed a stratified analysis for sex, age subgroups, each comorbidity, and certain cancers to compare the aHRs of mortality between the surgery and non-surgery groups (Table 3). Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Fractures are more likely to occur in bones with osteolytic metastases than osteoblastic metastases. Bisphosphonates are medications which were first used to treat osteoporosis and later noted to help with bone metastases. Medications for Treating Cancer That Has Spread to Bones. Below are the guidelines for joining the registry. The health insurance system in Taiwan enrolls > 99% of the population (around 23,000,000 insurants per year). 2. From editorial acceptance to publication. Thus, 74,900 patients were selected for subsequent analysis; all were at least 18 years old and had BM that was recently diagnosed between 2000 and 2015. The opinions expressed in all articles published here are those of the specific author(s), and do not necessarily reflect the views of Dove Medical Press Ltd or any of its employees. doi:10.1097/TA.0b013e3181622bca. In a previous prospective study, pathological fracture, visceral metastases, hemoglobin < 7 mmol/L, and lung cancer were identified as independent negative prognostic factors for 1-year survival. The trends for cancer management were multidisciplinary. Unique strengths of the study are the inclusion of a demographically broad population, a follow-up period substantially longer than that in previously published outcome studies, and an insight into the effect of surgical intervention for BM stratified by various subgroups. ", Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 8. In this study, we performed a large-scale investigation using data from the NHIRD. Studies have shown that BRIs provide clinical benefits to patients with BM.17,18 To date, zoledronic acid is the most promising bisphosphonate, while denosumab is another potent agent that prevents bone destruction. Under the microscope, bone cancer would show cancerous bone cells. However, the risks and possible complications associated with surgery may have a negative effect on the patient’s health. Krishnan CK, Han I, Kim HS. Among people with bone metastases from lung cancer, 22 to 59 percent will experience a "skeletal-related event" such as a fracture. If you’re a possible match for a patient, we’ll discuss your health history further and arrange for a … A retrospective study of 83 patients who underwent surgery for metastases to the pelvis concluded that primary cancer type, serum albumin level, and visceral metastases influence survival.13 Considering that no standard procedures have been established, en bloc resection is generally performed with the intent to reduce tumor burden and cure patients with solitary metastases at accessible sites. For many of these people, bone metastases are the first sign that the cancer has recurred after years or even decades of remission. Of the 4,549,226 individuals in the inpatient database of NHIRD, 83,536 patients with BM were enrolled in this study. The Journal of Pain and Symptom Management is an international, peer-reviewed journal and is the leading forum for publication of new research and clinical information related to palliative care and pain management. There are two primary types of bone metastases: osteolytic and osteoblastic. Symptoms include back pain that radiates down the leg, weakness, and numbness of the legs, and loss of bowel and/or bladder control. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms. Ann Oncol. Most liver metastases from breast cancer do not occur as isolated metastases; they are usually associated with systemic disease at other sites, such as lung or bone. Figure 1 Flowchart of the study design and participant selection. Verywell Health's content is for informational and educational purposes only. Camnasio F, Scotti C, Peretti GM, Fontana F, Fraschini G. Prosthetic joint replacement for long bone metastases: analysis of 154 cases. What Treatments Work Best for HER2-Positive Breast Cancer? Beth-Tasdogan, N., Mayer, B., Hussein, H., and O. Zolk. It also appears to delay the development of bone metastases, reduce skeletal tumor growth, and improved survival time by a little over a month. Thus, this study focused on all-cause mortality rather than cancer-related mortality to minimize the confounding effect of these variables. Second, the patients possibly had good control of the primary malignancy and a relatively healthy status. For primary induction therapy in patients with MM who are candidates for transplantation, NCCN guidelines recommend the following as preferred regimens : There are many cancers which can spread to bone the most common being breast cancer, lung cancer, prostate cancer, and multiple myeloma. To the best of our knowledge, this is the first nationwide cohort study investigating the effect of surgical intervention for BM on mortality in advanced cancer. 2008;128(8):787–793. Many of the treatments used for breast cancer and prostate cancer, can increase the risk of osteoporosis, and along with bone metastases predispose people to fractures. • Associations & Partners Loss of mobility due to fractures not only reduces your quality of life but can put you at risk of other problems. Multiple myeloma is usually found in larger bones such as the spine, the skull, the pelvis, the ribs, and the larger bones of the legs. Figure 3 The number of surgeries done for BM by years of follow-up presents an upward trend. Myeloma was the only positive factor identified, based on the skeletal metastasis registry of the Scandinavian Sarcoma Group.6 Recently, non-surgical treatments, such as targeted therapy (eg, gefitinib for epidermal growth factor receptor mutant non-small cell lung cancer), have improved the survival of cancer patients,7 with pertuzumab and trastuzumab increasing the median overall survival of patients with HER2-positive metastatic breast cancer.8 Evidence of prolonged survival time after surgery may change the attitude of both surgeons and patients towards surgical intervention, leading to an increased demand for surgery, particularly in cases with BM. Developing an adequate supply of health services: taiwan’s path to universal health coverage. The risk of bone metastases was lowered by up to one third, while the mortality rate dropped by one-sixth. It may initially cause no symptoms. Apply market research to generate audience insights. Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T. Surgical strategy for spinal metastases. Recently, the number of breast and colorectal cancer survivors has increased globally. In fact, the reported survival rates vary widely between different studies because of the difference in primary tumor selection.3,4 Studies that have demonstrated survival rates of patients presenting with BM from a variety of primary tumors with short-term follow-up also showed heterogeneous results.5,6 Thus, this study aimed to conduct a long-term investigation on the difference in mortality rates between patients who underwent surgical resection for skeletal metastases and those who did not, while considering sex, age, comorbidities, and use of bone resorption inhibitors (BRIs). This site is owned and operated by Informa PLC ( “Informa”) whose registered office is 5 Howick Place, London SW1P 1WG. For example, a breast cancer which has spread to bones is not called bone cancer but rather "breast cancer metastatic to bones'" or breast cancer with bone metastases. Emergent treatment with radiation or surgery can stabilize the spine to avoid permanent disability. Surgical strategies for BM must be individualized. Bone metastases are also common in advanced prostate cancer. In a 2016 review of studies, denosumab was evaluated in three separate clinical trials looking at its role in breast cancer, prostate cancer, and a third study with people who had multiple myeloma or solid tumors other than breast or prostate cancer. In this setting, these drugs not only reduce the risk of fractures but may, in some cases, improve survival. Osteosarcoma and undifferentiated pleomorphic sarcoma (UPS) (formerly called malignant fibrous histiocytoma [MFH]) of bone treatment usually involves surgery to remove the tumor. In numerous countries, the 5-year survival rate for prostate cancer is > 95%.2. Both IV bisphosphonates and denosumab appear to have significant anti-cancer activity, increasing the benefits for people who choose to use these drugs. Bulk reprints for the pharmaceutical industry. NICE has issued rapid update guidelines in relation to many of these. When a fracture occurs in bones with metastatic cancer they are referred to as a pathologic fracture. We appreciate the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW), Taiwan, for providing the National Health Insurance Research Database (NHIRD). Registered in England and Wales. The stratified analysis in our study also demonstrated that the risk of mortality in the surgery group decreased consistently in certain cancers and each comorbidity subgroup, except in those of hyperthyroidism and sepsis. At the end of the follow-up period, a total of 28,691 patients died: 2798 (31.8%) in the surgery group and 25,893 (39.2%) in the non-surgery group. The bones most commonly affected are the spine, pelvis, and upper leg and arm bones. Nucl Med Rev Cent East Eur. 2012;21(8):1049–1055. A Pre-implementation Study of Volumetric Modulated Arc Therapy for Same-day Planning and Treatment of Vertebral Bone Metastases Within a Rapid-access Palliative Radiotherapy Programme K. Dennis, K. Linden, R. Zohr, C. McGrath, M. MacPherson, J. Renaud, D. Granville, M. Gaudet, E. Ali The last set of WHO guidelines focused on cancer pain management were issued in 1996. Number 3099067. 2005;438:215–220. • Top, © Copyright 2021 • Dove Press Ltd Treatment for breast cancer with distant metastasis is generally palliative, and usually systemic treatment is selected. None of the BRIs had significant influence on the aHR of mortality. Based on the results, the percentage of patients receiving radiotherapy or chemotherapy was higher in the surgery group than in the non-surgery group (83.1% versus 78.6%). doi:10.1097/01.NOR.0000320543.90115.d5, 17. 2005;87(5):608–617. Back to Journals » International Journal of General Medicine » Volume 14, Effects of Surgical Intervention for Bone Metastases on Survival in Patients with Advanced Cancer: A Nationwide Population-Based Cohort Study, Authors Shih JT, Yeh TT, Shen PH, Wang CC, Wang SH, Chien WC, Chung CH, Wu CC, Published 3 May 2021 The follow-up period from surgery to death ranged from 1 to 15 years. What do you need to know about drugs such as Zometa and denosumab if you're living with metastatic cancer? 19 Coombes RC, Dady P, Parsons C, et al. On applying the exclusion criteria, 8636 patients were excluded. In our study, comorbidities (except for pneumonia and sepsis) were more prevalent in the surgery group. Block GA, Bone HG, Fang L, Lee E, Padhi D. A single-dose study of denosumab in patients with various degrees of renal impairment. 2014;110(4):360–365. Due to their effects on the microenvironment of bones, bone-modifying agents may reduce the risk of bone metastases occurring in the first place (with breast cancer and possibly prostate cancer thus far). doi:10.1097/01.blo.0000170721.07088.2e, 15. However, it was difficult to match individual courses of treatment in this study. A p-value < 0.001 was considered statistically significant. Most of the time when people talk about "bone cancer" they are referring to bone metastases; cancers that began in another region of the body and spread to the bones.
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