bims-rebome 2025-06-08 papers

Acta Orthop. 2025 May 27. 96 401-410

Tom M De Groot, Michelle R Shimizu, David Shin, Olivier Q Groot, Stein J Janssen, Kevin A Raskin, Eric T Newman, Marco L Ferrone, Santiago A Lozano-Calderon, Joseph H Schwab, Paul C Jutte.

BACKGROUND AND PURPOSE: The prevalence of metastatic bone disease as well as the accompanying societal costs are expected to increase due to advances in cancer treatment. While the literature suggests that there is economic value in prophylactic stabilization compared with the fixation of completed pathological fractures in long bone metastases, studies are limited by their small sample sizes and insufficient correction for potential confounders. We aimed to evaluate whether prophylactic treatment of an impending femur fracture was associated with lower healthcare costs compared with completed pathologic fractures. We further aimed to compare prophylactic surgical treatment with completed pathological fractures in terms of postoperative complications, discharge disposition, and postoperative length of stay.
METHODS: This is a retrospective cohort study with propensity score matching (PSM). We included clinical and financial data for 265 patients who received surgery for impending (n = 161) or completed (n = 104) femoral fractures of metastatic lesions, from 2 affiliated urban tertiary care centers between 2016 and 2020 in the United States. After PSM on 13 variables, including demographics and clinical characteristics, 100 impending fractures were matched with 100 completed fractures. The primary outcome was healthcare costs per episode of care, defined as the total cost from admission to 30 days after discharge.
RESULTS: We found no difference in total cost of care between patients undergoing prophylactic surgical treatment and patients who underwent surgical treatment for a completed pathological fracture (median difference 44 cost-units [CU], 95% confidence interval [CI] -294 to 262). No differences were seen when dividing total cost into cost during hospital admission (median difference -25 CUs, CI -152 to 159) and 30 days following discharge (median difference 31 CUs, CI -74 to 88). Patients with completed pathologic fractures were more often discharged to rehabilitation facilities (57/100, vs 30/100, P < 0.01).
CONCLUSION: In contrast to earlier findings, we showed no difference in treatment costs between surgical management of impending and completed pathological fractures of femur metastases after adjusting for confounding factors. However, patients with completed pathological fractures were significantly more likely to require discharge to rehabilitation facilities, highlighting potential out-of-hospital costs related to extended rehabilitation, reduced mobility, and loss of independence.

DOI: https://doi.org/10.2340/17453674.2025.43479

J Bone Oncol. 2025 Jun;52 100685

Analysis of skeletal pain, general symptoms and patient-reported outcome measures and their value in detecting symptomatic progression - An interdisciplinary prospective study in patients with multiple myeloma.

Carlotta Pietsch, Monika Engelhardt, Gabriele Ihorst, Laura Wystrach, Johannes Jung, Hagen Schmal, Andreas Frodl, Ralph Wäsch, Evangelos Terpos, Georg W Herget.

Delayed diagnosis of multiple myeloma (MM) and progressive disease (PD) can both increase the risk of skeletal complications and do affects patients' quality of life (QoL). In this prospective study we analyzed skeletal pain, general symptoms and patient-reported outcome measures (PROMs) in patients with MM and their value in detecting symptomatic progression. We evaluated 502 patients, 47 with initial diagnosis (ID) of MM and 455 follow-up patients. At ID, 74% reported bone pain, mostly in the spine. General symptoms, particularly fatigue, were present in 89% of the patients. 88/455 (19%) of the follow-up patients experienced PD. Of these, 65% reported skeletal pain and 81% exhibited general symptoms, with fatigue being the most common. PD was suspected and confirmed as the cause of clinical symptoms in 59/88 (67%) and not suspected in 29/88 (33%). Occurrence and character of bone pain and general symptoms differed significantly between patients with and without PD, as did QoL and health-related status. Logistic regression analysis demonstrated that bone pain at night, pain in various locations, pain of known character with occurrence in different location, pain in the chest, pelvis, and thigh as well as fatigue and weight loss were associated with an increased risk of PD. In conclusion, bone pain and general symptoms are helpful in identifying both MM and PD. PROMs can aid in the diagnosis of PD through symptom-based patient assessment. Serologic and, especially in the case of skeletal complaints, additional radiologic diagnostics are required to confirm suspected and to detect unexpected PD.

Keywords: Clinical warning signs; Early detection of cancer; General symptoms; Multiple myeloma; PROMs; Skeletal pain

DOI: https://doi.org/10.1016/j.jbo.2025.100685

Laryngorhinootologie. 2025 Jun;104(6): 384-397

[Frailty, Nutritional Status and Prehabilitation in Head and Neck Oncology].

Viktor Kunz, Maximilian Gänzle, Andreas Dietz, Gunnar Wichmann.

Since treatment of patients with head and neck cancer is often challenging due to adverse events and especially severe adverse events, continuous efforts are required optimize patients' health status before therapy in order to achieve as little toxicity as possible, while providing the same therapeutic standards especially for elderly individuals, who statistically represent the largest group of patients with head and neck cancer. Modern prehabilitation concepts, that primarily aim at optimizing the nutritional status of patients before beginning of treatment and during treatment, appear to be of particular interest in order to adequately meet this challenge. In this context, both poor nutritional status and frailty have been established as well known risk factors and predictors of poor outcome in patients with head and neck cancer. Assessment of the nutritional status, pretherapeutic evaluation of frailty and the associated potential optimization of the patient's general health status is barely implemented in German head and neck cancer centers, but should be included in the multidisciplinary treatment of head and neck cancer patients in order to reduce the rate of severe adverse events in particular. This article is therefore intended to contribute to a better understanding of the importance of pretherapeutic assessment of frailty, nutritional status and its optimization, as well as further explain the concept of prehabilitation in head and neck oncology.

DOI: https://doi.org/10.1055/a-2473-3880