A Promise to Our Patients with Metastatic Bone Disease

Excerpt

In the United States alone, the prevalence of cancer is approximately 5 million cases per year. There will be greater than 1.2 million new cases of cancer diagnosed this year, the majority of these patients will be older than age 40 years. Approximately half of these newly diagnosed cases will involve the skeleton. Accordingly, metastatic bone disease (MBD) is a major source of morbidity and mortality for patients afflicted with advanced cancers of the breast, prostate, lung, kidney, thyroid, as well as myeloma and other cancers. As of 2007, the cost to U.S. society was approximately $12.6 billion and made up almost 20 % of societal cancer costs as estimated by the National Institutes of Health.1 These numbers are continuing to wax as the population ages and are not restricted to the United States. MBD is a major global health care issue. While progress has been made in the medical management of MBD and patients are living longer with their cancers more than ever before, the challenges to optimize quality of life in these patients has never proven more prevalent. Specifically bisphosphonates and denosumab have improved the quality of life for many patients with MBD, yet surgical management remains a cornerstone of skeletal stabilization and local disease control.2,3 How beneficial is the role of surgery? We as surgeons believe it is important; but just how important is it given the potential inflicted morbidity of an invasive procedure in a patient with a limited life span? We need to better understand the quality of our interventions. …