Skip to main content

Advertisement

SpringerLink
Log in

Ten-year experience of the multidisciplinary Osteoncology Center

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Bone metastases (BMs) are responsible for high morbidity in patients. A multidisciplinary approach involving a team of specialists offers an effective therapeutic strategy based on disease characteristics, medical history, and performance status. We evaluated the impact of our 10-year multidisciplinary experience on the management of patients with BM.

Methods

We retrospectively analyzed 2194 medical reports of 1628 patients referred to our Osteoncology Center from 2005 to 2015. Cases were discussed weekly by a multidisciplinary team.

Results

Eight hundred thirty-eight (38.2%) of the 2194 visits were requested because of a risk of complications from BM. Antiblastic treatment and bone-targeted therapy were modified in 709 (66.3%) and 309 (31%) of cases, respectively. Radiotherapy was scheduled in 220 (20%) of the 1099 patients for whom information was recorded. Patients completed the Brief Pain Inventory (BPI) during their first visit, 1296 (59.1%) reporting pain (median intensity 4), and 537 (41.4%) experiencing a level that interfered substantially with daily activities. New ortheses and/or antalgic therapy was prescribed accordingly. After 7 days, 208 (16%) patients were re-evaluated and a new BPI administered. A significant improvement in the worst (p < 0.0001) and current pain (p = 0.03) was seen, together with a favorable impact on daily activities (p = 0.02). Two thousand fifty-one patients completed an anonymous questionnaire on the quality of the service, the majority (69.4%) expressing high satisfaction.

Conclusions

Our 10-year osteoncology experience confirms the importance of a multidisciplinary approach to optimize BM management. Further evaluations are needed in relation to quality of life, outcome, and costs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hart KB, Weiss K, Tekyi-Mensah S, Porter AT (1998) The epidemiology of bony metastases: a comparison of metastatic disease rates of the past 20 years. J Oncol Manag 7:26–28

    CAS  PubMed  Google Scholar 

  2. Mundy GR (2002) Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer 2:584–593

    Article  CAS  PubMed  Google Scholar 

  3. Hosono N, Yonenobu K, Fuji T, Ebara S, Yamashita K, Ono K (1995) Orthopaedic management of spinal metastases. Clin Orthop Relat Res 312:148–159

    Google Scholar 

  4. Coleman RE (2006) Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin Cancer Res 12:6243–6249

    Article  Google Scholar 

  5. Harris K, Chow E, Zhang L, Velikova G, Bezjak A, Wu J, Barton M, Sezer O, Eek R, Shafiq J, Yee A, Clemons M, Brundage M, Hoskin P, van der Linden Y, Johnson CD, Bottomley A, EORTC Quality of Life Group (2009) Patients’ and health care professionals’ evaluation of health-related quality of life issues in bone metastases. Eur J Cancer 45:2510–2518

    Article  PubMed  Google Scholar 

  6. Plunkett TA, Rubens RD (1999) The biology and management of bone metastases. Crit Rev Oncol Hematol 31:89–96

    Article  CAS  PubMed  Google Scholar 

  7. Caraceni A, Mendoza TR, Mencaglia E, Baratella C, Edwards K, Forjaz MJ, Martini C, Serlin RC, de Conno F, Cleeland CS (1996) A validation study of an Italian version of the Brief Pain Inventory (Breve Questionario per la Valutazione del Dolore). Pain 65:87–92

    Article  CAS  PubMed  Google Scholar 

  8. Gerber LH, Vargo MM, Smith RG (2004) Rehabilitation of the cancer patient. In: DeVita VT Jr, Hellman S, Rosenberg SA (eds) Principles and practice of oncology, 7th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  9. Casadei R (2003) Terapia chirurgica. In: Amadori D, Cascinu S, Conte PF (eds) Osteoncologia, un approccio multidisciplinare. Excerpta Medica, Milan

    Google Scholar 

  10. Ibrahim T, Mercatali L, Amadori D (2013) Bone and cancer: the osteoncology. Clin Cases Miner Bone Metab 10:121–123

    PubMed  PubMed Central  Google Scholar 

  11. Ibrahim T, Flamini E, Fabbri L, Serra P, Mercatali L, Ricci R, Sacanna E, Falasconi MC, Casadei R, Galassi R, Giannini M, Bazzocchi O, Calzolari F, Nunziatini R, Gaudio M, Maltoni M, Amadori D (2009) Multidisciplinary approach to the treatment of bone metastases: Osteo-Oncology Center, a new organizational model. Tumori 95:291–297

    Article  PubMed  Google Scholar 

  12. Bongiovanni A, Foca F, Fantini M, Forcignano R, Silvestris F, Artioli F, Campadelli E, Daniele B, Ciotti F, Marcantognini G, Recine F, Fausti V, Vespignani R, Amadori D, Ibrahim T (2016) Italian perspective bone metastases (BM) database: the first one-year experience. ASCO Ann Meet 34:e13075

    Google Scholar 

  13. Atkinson TM, Halabi S, Bennett AV, Rogak L, Sit L, Li Y, Kaplan E, Basch E, Cancer and Leukemia Group B (2012) Measurement of affective and activity pain interference using the Brief Pain Inventory (BPI): Cancer and Leukemia Group B 70903. Pain Med 13:1417–1424

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mirels FI (1986) Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathologic fractures. Clin Orthop Relat Res 249:256–264

    Google Scholar 

  15. Asdourian PL (1997) Metastatic disease of the spine. In: Bridvvell KH, De Wald R (eds) The text- book of spinal surgery. Lippincott-Raven Publishers, Philadelphia

    Google Scholar 

  16. Kostuik JP, Weistein IN (1991) Differential diagnosis and surgical treatment of metastatic spite tumors. In: Frymoyer JW (ed) The adult spine: principles and practice. Raven Press, New York

    Google Scholar 

  17. Tokuhashi Y, Matsuzaki H, Toriyama S, Kawano H, Ohsaka S (1990) Scoring system for the preoperative evaluation of metastatic spine tumor prognosis. Spine 15:1110–1113

    Article  CAS  Google Scholar 

  18. Ibrahim T, Barbanti F, Giorgio-Marrano G, Mercatali L, Ronconi S, Vicini C, Amadori D (2008) Osteonecrosis of the jaw in patients with bone metastases treated with bisphosphonates: a retrospective study. Oncologist 13:330–336

    Article  CAS  PubMed  Google Scholar 

  19. Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS (2012) Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13 722 women. BMJ 344:e2718

    Article  PubMed  PubMed Central  Google Scholar 

  20. Junor EJ, Hole DJ, Gillis CR (1994) Management of ovarian cancer: referral to a multidisciplinary team matters. Br J Cancer 70:363–770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Rubenstein LZ, Josephson KR, Wieland GD, English PA, Sayre JA, Kane RL (1984) Effectiveness of a geriatric evaluation unit: a randomized clinical trial. N Engl J Med 311:1664–1670

    Article  CAS  PubMed  Google Scholar 

  22. Chang JH, Vines E, Bertsch H, Fraker DL, Czerniecki BJ, Rosato EF, Lawton T, Conant EF, Orel SG, Schuchter L, Fox KR, Zieber N, Glick JH, Solin LJ (2001) The impact of multidisciplinary breast cancer center on recommendations for patient management: the University of Pennsylvania experience. Cancer 91:1231–1237

    Article  CAS  PubMed  Google Scholar 

  23. Ruhstaller T, Roe H, Thürlimann B, Nicoll JJ (2006) The multidisciplinary meeting: an indispensable aid to communication between different specialities. Eur J Cancer 42:2459–2462

    Article  PubMed  Google Scholar 

  24. Raman S, Ding K, Chow E, Meyer RM, Nabid A, Chabot P, Coulombe G, Ahmed S, Kuk J, Dar AR, Mahmud A, Fairchild A, Wilson CF, Wu JS, Dennis K, DeAngelis C, Wong RK, Zhu L, Brundage M (2016) A prospective study validating the EORTC QLQ-BM22 bone metastases module in patients with painful bone metastases undergoing palliative radiotherapy. Radiother Oncol 119:208–212

    Article  PubMed  Google Scholar 

  25. Raman S, Ding K, Chow E, Meyer RM, van der Linden YM, Roos D, Hartsell WF, Hoskin P, Wu JSY, Nabid A, Haas R, Wiggenraad R, Babington S, Demas WF, Wilson CF, Wong RKS, Zhu L, Brundage M (2018) Minimal clinically important differences in the EORTC QLQ-C30 and brief pain inventory in patients undergoing re-irradiation for painful bone metastases. Qual Life Res 27:1089–1098

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Gráinne Tierney and Cristiano Verna for editorial assistance.

Author information

Authors and Affiliations

  1. Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Alberto Bongiovanni, Federica Recine, Valentina Fausti, Roberto Casadei, Maria Cristina Falasconi, Venetia Zavoiu, Laura Mercatali, Dino Amadori & Toni Ibrahim

  2. Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Flavia Foca

  3. Radiology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Devil Oboldi

  4. Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Elisabetta Sansoni & Laura Fabbri

  5. Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Simona Micheletti

  6. Nuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Via P. Maroncelli 40, 47014, Meldola, Italy

    Stefano Severi & Federica Matteucci

Authors
  1. Alberto Bongiovanni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federica Recine
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valentina Fausti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Flavia Foca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roberto Casadei
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maria Cristina Falasconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Devil Oboldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Elisabetta Sansoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura Fabbri
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Simona Micheletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stefano Severi
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Federica Matteucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Venetia Zavoiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Laura Mercatali
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Dino Amadori
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Toni Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AB, GM, and TI conceived the idea for this study. CL, ADV, GM, and VF performed the literature search. MC provided the images and a detailed description. FF performed the statistical analysis. AB, LM, and FR co-drafted the manuscript. TI and DA critically evaluated the manuscript for important intellectual content. All authors read and approved the final version of the paper.

Corresponding author

Correspondence to Alberto Bongiovanni.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bongiovanni, A., Recine, F., Fausti, V. et al. Ten-year experience of the multidisciplinary Osteoncology Center. Support Care Cancer 27, 3395–3402 (2019). https://doi.org/10.1007/s00520-019-4635-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-4635-5

Keywords

Search

Navigation