The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases
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ORIGINAL ARTICLE
The importance of timely treatment for quality of life and survival in patients with symptomatic spinal metastases Floris R. van Tol1 · Karijn P. M. Suijkerbuijk2 · David Choi3 · Helena M. Verkooijen4 · F. Cumhur Oner1 · Jorrit‑Jan Verlaan1,5 Received: 3 June 2020 / Revised: 25 August 2020 / Accepted: 5 September 2020 © The Author(s) 2020
Abstract Purpose A major challenge in metastatic spinal disease is timely identification of patients. Left untreated, spinal metastases may lead to gross mechanical instability and/or neurological deficits, often requiring extensive invasive surgical treatment. The aim of this cohort study was to assess the correlation between delayed treatment of patients with spinal metastases and functional performance, quality of life and survival. Methods All patients surgically treated for metastatic spinal disease at a tertiary care facility were included for analysis. Patients who underwent elective surgery were considered as timely treated, whereas patients requiring emergency surgery were considered to be treated in a delayed fashion. EQ-5D scores, KPS scores and mortality rates were compared between the two groups. Results A total of 317 patients (215 timely treated, 102 delayed) had survivorship data available and 202 patients (147 timely treated, 55 delayed) had clinical data available. Multivariate analyses showed delayed treatment was associated with lower EQ-5D and KPS scores and higher mortality rates, independent of confounders such as baseline EQ-5D/KPS scores, neurological status, tumor prognosis and patient age. Conclusions The results from the present study show delayed treatment of patients with symptomatic spinal metastases has both direct and indirect adverse consequences for functional performance status, quality of life and survival. Optimization of referral pattern may accelerate the time to surgical treatment, potentially leading to better quality of life and survival. Keywords Spinal metastases · Delay · Quality of life · Survival
Introduction Primary cancer care and systemic therapy options have improved considerably over the past few decades, leading to a significant increase in survival and the subsequent * Jorrit‑Jan Verlaan [email protected] 1
Department of Orthopedic Surgery, University Medical Center Utrecht, P.O. Box 85500 (G05.228), 3508 GA Utrecht, The Netherlands
2
Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
3
Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
4
Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
5
University of Utrecht, Utrecht, The Netherlands
prevalence of patients with metastatic disease [1]. One of the most debilitating complications of advanced cancer is metastatic spinal disease, which currently occurs in approximately 20% of all oncological patients [2, 3]. A major challenge in metastatic spinal disease is that presenting symptoms can be very non-specific, leading t
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