Intended for healthcare professionals


Patients with bone metastases need better care

BMJ 1998; 317 doi: (Published 05 December 1998) Cite this as: BMJ 1998;317:1547
  1. Zosia Kmietowicz
  1. London

    Surgeons have called for better care for women who develop bone metastases after breast cancer; many of these women suffer from excruciating pain, fractures, and even paralysis because of delayed diagnosis and inappropriate treatment.

    In guidelines to be published in the European Journal of Surgical Oncology in February next year, the British Association of Surgical Oncologists calls for a designated orthopaedic surgeon to be present in each cancer unit across the country to offer an opinion on diagnosis and treatment.

    “We want to bring orthopaedic surgeons into the multidisciplinary cancer team so that they can deliver an orthopaedic view on patients with suspected metastases, and improve diagnosis and the coordination of treatment and ultimately the quality of life of these women,” said Mr Hugh Bishop, secretary of the association's breast specialty group and a consultant surgeon in the West Midlands.

    Women with suspected bone metastases are currently referred to a number of different medical services and even though they may have an x ray, bone metastases can be missed.

    A recent survey found that, although 89% of women reporting bone pain should have had an orthopaedic opinion, only 46% had access to the specialty. It was also found that 48% should have undergone surgery, although only 13% actually did.

    “The end of the cancer journey is just as important as the earlier stages but in the past it has not been so well controlled,” said Mr Bishop. Treating bone metastases after breast cancer is worth while since many women live for a considerable time after bone metastases are discovered. Patients survive much longer with bone metastases than they do if they develop lung metastases, Mr Bishop added.

    Every year 35000 people in Britain are diagnosed with breast cancer, and about 9000 develop metastatic disease that affects the bone. The median survival time after diagnosis of bone metastases after breast cancer is 24 months (compared with a survival time of 3-6 months for patients with lung metastases), but many women live for 10 years or more.

    Jan Fanti, a patient with bone metastases, was told that she had arthritis when she complained of bone pain to her general practitioner, and even an x ray cleared her of metastatic bone cancer. It was only after she collapsed because of vertebral compression that doctors believed her when she said that something was wrong.

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