bims-rebome 2025-08-03 papers

bims-rebome

Biomed News

on Rehabilitation of bone metastases

Issue of 2025–08–03
ten papers selected by
Alberto Selvanetti, Azienda Ospedaliera San Giovanni Addolorata

Estimating Bone Metastasis Risk in Prostate Cancer: A Three-Parameter Model using BSP, ISUP Grading, and Tumor Progression.
Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis.
Effectiveness of rehabilitation treatment for bone metastasis patients without surgical intervention: A propensity score matching analysis.
Short-Term Outcomes in Planned Versus Unplanned Surgery for Spinal Metastases.
Extensive thoracic vertebral and chest wall metastases as the initial presentation of breast cancer: a case report and literature review.
Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG.
The transition from oncology to palliative care: barriers and facilitators explored through an integrative review.
Artificial intelligence-assisted nursing in cancer care: A meta-analysis of its impact on pain, anxiety, and quality of life.
Exercise Interventions in Breast Cancer: Molecular Mechanisms, Physical Benefits, and Practical Recommendations.
Assessing the Impact of Exercise on Quality of Life in Advanced-Stage Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Urol Int. 2025 Jul 25. 1-34

Estimating Bone Metastasis Risk in Prostate Cancer: A Three-Parameter Model using BSP, ISUP Grading, and Tumor Progression.

Christos Philippou, Simon Gloger, Burkhard Ubrig, Norman Bitterlich, Emilia Krassimirova Naseva, Hans-Joerg Sommerfeld, Andreas Wiedemann, Dirk Theegarten, Haji Abdulla, Stathis Philippou.

INTRODUCTION: Osseous metastasis is the most common site of distant spread in prostate cancer. Several factors contribute to predicting bone metastasis, including elevated PSA levels, short PSA doubling time, advanced ISUP grading, local tumor progression, and novel biomarkers. However, no clinical scoring system currently exists to assess bone metastasis risk at the time of prostate cancer diagnosis. Furthermore, no study has investigated the correlation between predictive factors and bone sialoprotein (BSP) expression in the primary tumor.
METHODS: Immunehistochemistry was used to evaluate BSP expression in transrectal ultrasound (TRUS)-guided biopsies from prostate cancer patients. Data from 673 patients were analyzed over a 7-9 year follow-up period to assess the development of bone metastases. BSP expression was also evaluated in patients with benign prostatic hyperplasia (BPH). Additionally, BSP expression was analyzed alongside established risk factors using multivariate logistic regression to determine their combined predictive value for bone metastasis.
RESULTS: Bone metastases developed in 12.5% (84/673) of patients. BSP expression was negative (0-5%) in 23.8% of cases, while 22.2% exhibited high expression (>40%). Patients with bone metastases had significantly higher BSP expression than those without (55.5 ± 19.7% vs. 25.7 ± 24.9%; p < 0.001). In contrast, 97% of patients without prostate carcinoma had BSP values below 5%. Among metastatic patients: 82.9% had BSP expression of at least 40%, and none had values below 20%. As a single predictive parameter, BSP showed a sensitivity of 50% and a specificity of 81.6%. However, using multivariate analysis, a three-parameter scoring model integrating BSP expression, ISUP grading, and the number of affected core needle biopsies achieved 88.6% sensitivity and 81.1% specificity for predicting bone metastases.
CONCLUSION: BSP expression serves as a potential indicator for bone metastasis development but lacks sufficient sensitivity as a standalone clinical marker. Similarly, local tumor progression and histopathologic grading (ISUP) fail as single predictors. However, integrating BSP expression with established risk factors significantly enhances predictive accuracy. Given that all three parameters are derived from routine histopathological analysis, BSP immunohistochemistry should be considered for integration into clinical practice for early risk stratification in prostate cancer patients.

DOI: https://doi.org/10.1159/000547556
J Orthop Surg Res. 2025 Jul 26. 20(1): 706

Differential survival outcomes in upper versus lower extremity metastatic bone disease: a retrospective comparative cohort analysis.

Chih-Wei Chen, Chih-Chi Su, Jyun-Hao Chen, Jaw-Lin Wang, Tzu-Hao Tseng, Olivier Q Groot.

   BACKGROUND: The rising prevalence of metastatic bone disease (MBDex) of the extremities substantially affects patient quality of life due to skeletal-related events. Determining whether surgical intervention benefits patient survival is crucial in the management of MBDex. However, there is currently limited evidence regarding the survival impact of upper versus lower extremity involvement. This study aims to evaluate differences in survival outcomes regarding metastatic site, and the impact of operative versus nonoperative management.
METHODS: This retrospective cohort study evaluated 1,719 patients with a two-year follow-up period after treatment for MBDex at a major tertiary medical center in Taiwan from 2010 to 2018. Inclusion criteria included patients aged over 20 who underwent operative or nonoperative management. Exclusion criteria involved patients with concurrent upper and lower extremity metastases. Kaplan-Meier curves and multivariate Cox regression models were used to analyze survival and prognostic factors.
RESULTS: Compared to upper MBDex, lower MBDex patients have poorer pretreatment Eastern Cooperative Oncology Group (ECOG) performance status. Lower MBDex was associated with worse two-year survival, particularly among those receiving nonoperative management. Common prognostic factors included ECOG performance status, Charlson's comorbidities, primary tumor type, and albumin levels, while previous systemic treatment and the presence of visceral and brain metastases were specifically detrimental in lower MBDex.
CONCLUSIONS: Lower MBDex is associated with poorer survival outcomes. Operative management is associated with survival benefit in lower MBDex, a benefit not as pronounced in upper MBDex. These findings highlight the importance of differentiating between upper and lower extremity metastases in survival analyses and prediction.

Keywords:  Metastases of lower extremities; Metastases of upper extremities; Metastatic bone disease; Survival

DOI:  https://doi.org/10.1186/s13018-025-06079-2
J Bone Oncol. 2025 Aug;53 100703

Effectiveness of rehabilitation treatment for bone metastasis patients without surgical intervention: A propensity score matching analysis.

Ryo Yoshikawa, Yasumitsu Fujii, Ryoga Kashima, Wataru Saho, Risa Harada, Daisuke Makiura, Katsuya Fujiwara, Junichiro Inoue, Yoshiki Takeoka, Ryoko Sawada, Naomasa Fukase, Keisuke Oe, Hitomi Hara, Kenichiro Kakutani, Toshihiro Akisue, Yoshitada Sakai.

  Evidence regarding the effectiveness of rehabilitation treatments in patients with bone metastases remains limited. This study evaluated the implementation and effectiveness of rehabilitation in patients with bone metastases who did not undergo surgery. This retrospective study included 200 patients with nonsurgically treated bone metastases at our institution. The patients were categorized into a rehabilitation group (R group, n = 61) and a non-rehabilitation group (N group, n = 139). Over the course of one month, we compared activities of daily living (ADL), assessed using the Barthel Index (BI), quality of life (QOL), measured using the EuroQoL-5 Dimension (EQ-5D), and demographic and clinical characteristics. Propensity score matching was conducted to minimize selection bias. After matching, 31 patients in each group were included in the analysis. No statistically significant differences were observed in baseline BI and EQ-5D scores between the two groups. In the R group, BI improved significantly from 80 (interquartile range [IQR]: 60-100) to 90 (IQR: 70-100), and EQ-5D improved from 0.444 (IQR: 0.282-0.608) to 0.608 (IQR: 0.533-0.768). In contrast, no improvements were observed in either score in the N group. Chemotherapy was identified as a significant factor associated with improvements in BI (odds ratio 4.03) and EQ-5D (odds ratio 5.29). Rehabilitation may be a valuable treatment option for nonsurgically treated patients with bone metastases, warranting further validation in prospective studies.

Keywords:  Activities of daily living; Bone metastasis; Propensity score matching; Quality of life; Rehabilitation

DOI:  https://doi.org/10.1016/j.jbo.2025.100703
Cancers (Basel). 2025 Jul 20. pii: 2403. [Epub ahead of print]17(14):

Short-Term Outcomes in Planned Versus Unplanned Surgery for Spinal Metastases.

Ali Haider Bangash, Sertac Kirnaz, Rose Fluss, Victoria Cao, Alexander Alexandrov, Liza Belman, Yaroslav Gelfand, Saikiran G Murthy, Reza Yassari, Rafael De la Garza Ramos.

  Background/Objectives: Metastatic spine disease (MSD) affects a significant proportion of patients with advanced malignancies and often necessitates surgical intervention to preserve neurological function, alleviate pain, and maintain spinal stability. While oncologic spine surgery is ideally performed in a planned, semi-elective setting, a substantial number of patients require unplanned (urgent or emergent) surgery due to acute deterioration. The impact of surgical planning status on postoperative outcomes following metastatic spine tumor surgery remains underexplored. This study aimed to compare the patient characteristics and short-term outcomes of those undergoing planned versus unplanned surgery for spinal metastases. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2018 to 2023. Patients with disseminated cancer undergoing tumor surgery were identified. Case types were grouped into planned (elective) and unplanned (urgent or emergent). The primary endpoint was failure to rescue (FTR); secondary endpoints included 30-day major complications, 30-day mortality, and length of hospital stay. Univariable and multivariable regression analyses were performed. Results: A total of 2147 patients met our inclusion criteria, out of whom 60% (n = 1284) underwent planned and 40% (n = 863) underwent unplanned surgery. Patients in the unplanned surgery group had a significantly higher prevalence of severe hypoalbuminemia, severe anemia, and ASA class IV status (p ≤ 0.001 for all). For our primary endpoint, a multivariable analysis showed a significant association between unplanned surgery and FTR (OR 2.11 [95% CI 1.24 to 3.56]; p = 0.005). Significant associations were also found with 30-day mortality (OR 1.84 [95% CI 1.25 to 2.72]; p = 0.002) and length of hospital stay (β 2.7 [95% CI 1.97 to 3.43]; p < 0.001). However, unplanned surgery could not independently predict 30-day major complications (OR 1.21 [95% CI 0.97 to 1.51]; p = 0.08). Conclusions: Our study found that unplanned surgery for spinal metastases was associated with significantly higher rates of FTR, 30-day mortality, and extended hospital stay, independent of other covariates. These findings highlight the importance of the timely identification of patients requiring surgery and the potential benefits of semi-elective care.

Keywords:  Clavien–Dindo; failure to rescue; length of stay; metastatic spine disease; mortality; unplanned surgery

DOI:  https://doi.org/10.3390/cancers17142403
Front Oncol. 2025 ;15 1632700

Extensive thoracic vertebral and chest wall metastases as the initial presentation of breast cancer: a case report and literature review.

Yergen N Kenzhegulov, Daniyar K Zhamoldin, Victor G Aleinikov, Talgat T Kerimbayev, Berik Zhetpisbaev, Serik Akshulakov.

  Metastatic involvement of the bones remains the most common form of distant metastasis in breast cancer, largely due to the anatomical and functional characteristics of the thoracic spine, ribs, and sternum. These structures are notable for their high content of red bone marrow, rich vascularization, and their connection to Batson's venous plexus, all of which facilitate their early involvement in oncologic dissemination. In certain cases, multiple metastases in the thoracic skeleton may represent the first and sole clinical manifestation of an undiagnosed malignant process, presenting considerable diagnostic challenges at the initial presentation in patients without a known oncologic history. A 60-year-old female patient presented with severe thoracic back pain. Imaging revealed multiple lytic lesions in the vertebral bodies of the thoracic spine, ribs, and sternum. The initial differential diagnosis included multiple myeloma and bone metastases. The patient underwent minimally invasive neurosurgical intervention involving spinal canal decompression and percutaneous vertebral biopsy. A percutaneous vertebral biopsy confirmed the presence of undifferentiated carcinoma. Subsequent PET-CT identified a metabolically active lesion in the breast, establishing the primary diagnosis, followed by the initiation of systemic therapy. This case, in conjunction with a review of the current literature, highlights the diagnostic complexity of presentations where pain is the sole initial symptom of an undetected malignancy. Such situations demand a high index of oncologic suspicion from the outset, timely application of advanced imaging modalities such as MRI and PET-CT, mandatory histological verification of affected regions, and strong interdisciplinary coordination to achieve accurate diagnosis and formulate a personalized treatment strategy.

Keywords:  bone metastases; breast cancer; rib metastases; spinal pain; sternal metastases; thoracic spine

DOI:  https://doi.org/10.3389/fonc.2025.1632700
J Bone Oncol. 2025 Aug;53 100694

Management of aromatase inhibitor-associated bone loss (AIBL) in women with hormone-sensitive breast cancer: An updated joint position statement of the IOF, CABS, ECTS, IEG, ESCEO, IMS, and SIOG.

Peyman Hadji, Matty Aapro, Nasser Al-Dagri, Majed Alokail, Emmanuel Biver, Jean-Jacques Body, Maria Luisa Brandi, Janet Brown, Cyrille Confavreux, Bernard Cortet, Matthew Drake, Peter Ebeling, Erik Fink Eriksen, Ghada El-Hajj Fuleihan, Theresa A Guise, Nick C Harvey, Andreas Kurth, Bente Langdahl, Willem Lems, Radmila Matijevic, Eugene McCloskey, Rossella Nappi, Santiago Palacios, Georg Pfeiler, Jean-Yves Reginster, René Rizzoli, Daniele Santini, Sansin Tuzun, Catherine Van Poznak, Tobias De Villiers, M Carola Zillikens, Robert Coleman.

   Background: Women with hormone-responsive breast cancer who receive adjuvant endocrine treatment with aromatase inhibitors (AI) are known to be at higher fracture risk due to a marked increase in bone resorption. In 2017, several interdisciplinary cancer and bone societies involved in the management of women with AI-associated bone loss (AIBL) published a joint position statement comprising evidence-based recommendations and a practical management algorithm for the assessment of fracture risk and optimal treatment of this patient population.
Patients and methods: In order to provide updated recommendations that reflect recent advances in the assessment and management of AIBL since publication of the 2017 joint position statement, a systematic literature review was undertaken to identify relevant studies for analysis, including systematic reviews and meta-analyses. Individual trials identified were assessed for their level of evidence based on design, size, follow-up, and evaluation of safety, as well as the impact of bone directed treatments on breast cancer outcomes.
Results: New evidence was combined with the existing recommendations to provide an updated joint position statement regarding fracture risk assessment and implementation of bone-directed therapy.
Conclusion: Current published literature, including recent clinical trial reports, systematic reviews and meta-analyses, continue to affirm the high risk of fractures in women with breast cancer who are receiving adjuvant AI treatment, a risk which has been observed to increase with the commonly used approach of extended duration AI therapy (>5 years). Risk factors for fracture and risk assessment in this patient population as well as the most suitable treatment modalities have been updated. Finally, the influence of bone protective treatments on breast cancer outcomes such as incidence of bone metastasis and breast cancer related overall survival have been included.

Keywords:  Aromatase Inhibitor; Bisphosphonate; Breast cancer; Denosumab; Fracture; Osteoporosis

DOI:  https://doi.org/10.1016/j.jbo.2025.100694
BMC Palliat Care. 2025 Jul 26. 24(1): 215

The transition from oncology to palliative care: barriers and facilitators explored through an integrative review.

Barbara Gonçalves, Tamara Radojičić, Carlos Centeno, Eduardo Garralda, Marina Martínez, Nancy Preston, Jeroen Hasselaar, María Arantzamendi.

   BACKGROUND: Patients with advanced cancer often experience difficult symptoms near the end of life, yet the beneficial integration of oncology and palliative care is frequently lacking or poorly coordinated. Transitioning from curative treatments to palliative care focused on symptom relief and quality of life remains a common challenge. Palliative care is often underused or introduced late in the cancer treatment process, leading to suboptimal care outcomes. Understanding the factors influencing this transition is crucial for improving patients' overall care experience. This review aims to explore barriers and facilitators involved in a comprehensive transition process from oncology to palliative care of patients with advanced cancer.
METHODS: This integrative review explored empirical research from 2010 to 2023 sourced from PubMed, PsycINFO, CINAHL and Cochrane databases, adhering to PRISMA guidelines. Search strategy combined concepts of advanced cancer, transition in palliative care, palliative care, and barriers and facilitators. Blind review software facilitated article selection based on criteria, with data extracted using a predefined sheet. Themes were identified through inductive thematic analysis.
RESULTS: 38 studies met inclusion criteria out of 180 screened records. These studies were conducted in 13 countries and data collection methods ranged from interviews and focus groups to surveys and analysis of electronic medical records. In the analysis, six key themes emerged: (1) knowledge and understanding about the disease trajectory and palliative care, (2) cultural aspects of providing palliative care, (3) shortcomings in economic coverage for services, (4) characteristics of the patients' clinical situation, (5) relational dynamics between patients and professionals and among professionals and (6) organisational issues involving limitations and fragmentation of care.
CONCLUSIONS: This review highlights the multifaceted factors affecting the transition to palliative care. Addressing these challenges requires improvements in communication, cultural competence, financial support and organisational structure. Effective integration of palliative care into oncology practices requires collaboration among various stakeholders, including healthcare professionals, policymakers, patients, and caregivers. Through enhanced education initiatives, a more patient-centric approach to managing advanced cancer can be achieved.

Keywords:  Barriers; Cancer; Facilitators; Palliative care; Patient transfer; Supportive care; Transitional care

DOI:  https://doi.org/10.1186/s12904-025-01819-x
Appl Nurs Res. 2025 Aug;pii: S0897-1897(25)00089-8. [Epub ahead of print]84 151987

Artificial intelligence-assisted nursing in cancer care: A meta-analysis of its impact on pain, anxiety, and quality of life.

Merve Gozde Sezgin, Hicran Bektas.

   BACKGROUND: In recent years, artificial intelligence (AI) applications have been recognized as a supportive technological method for effectively managing the challenges faced by patients with cancer. AI applications are anticipated to be beneficial in improving the quality of life (QoL) of patients with cancer by enhancing the management of pain and anxiety.
AIM: The aim of this study is to examine the effects of AI-assisted nursing practices on pain, anxiety, and QoL in patients with cancer.
DESIGN: This study has been prepared and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 checklist.
METHODS: Randomized controlled trials (RCTs) were searched in nine databases and grey literature, without any year restriction, from the inception date until January 2025. Fixed-effect and random-effect models were used in the meta-analysis process. Cochran's Q chi-squared test and I2 statistics were employed to assess heterogeneity. Data analysis was performed using the CMA 3 software.
RESULTS: Six studies (567 patients) were included in this meta-analysis. AI-assisted nursing practices were found to have medium and positive effects on anxiety (Hedge's g = 0.46, p < 0.001), pain (Hedge's g = 0.48, p < 0.001), and in patients with cancer. High and positive effects were found on the QoL of patients with cancer (Hedge's g = 1.63, p = 0.020).
CONCLUSION: This study reveals that AI-assisted nursing practices have significant and beneficial effects on pain, anxiety, and QoL in patients with cancer.
IMPLICATIONS FOR PRACTICE: AI-assisted nursing practices have the potential to improve cancer patients' symptoms and QoL, which will enhance oncology nurses' awareness.

Keywords:  Anxiety; Artificial intelligence; Cancer; Meta-analysis; Nurse; Nursing; Pain; Quality of life; Randomized controlled trials

DOI:  https://doi.org/10.1016/j.apnr.2025.151987
Medicina (Kaunas). 2025 Jun 27. pii: 1167. [Epub ahead of print]61(7):

Exercise Interventions in Breast Cancer: Molecular Mechanisms, Physical Benefits, and Practical Recommendations.

Vasiliki Michou, Stefanos Zervoudis, Panagiotis Eskitzis, Georgios Tsamos, Dimitra Vasdeki, Andriani Vouxinou, Anisa Markja, Georgios Iatrakis.

  Exercise interventions are increasingly recognized as effective non-pharmacological strategies to improve clinical outcomes in patients with breast cancer. This review provides a comprehensive framework linking physical activity with breast cancer risk reduction, disease progression, and survivorship. We first outline the robust epidemiological evidence demonstrating that regular exercise significantly reduces breast cancer incidence, recurrence, and disease-specific mortality. The review then delves into the molecular mechanisms by which exercise exerts its protective effects, including modulation of sex hormones, metabolic hormones, systemic inflammation, oxidative stress, circulating microRNAs, and breast cancer-related DNA methylation. Furthermore, we summarize findings from clinical trials evaluating the effects of exercise on cardiorespiratory fitness, functional capacity, and quality of life in breast cancer patients. Emerging research on the synergistic potential of exercise with conventional cancer treatments and bioactive dietary components, particularly polyphenols such as saffron and curcumin, is also discussed. Finally, we present evidence-based exercise recommendations tailored to breast cancer patients, emphasizing the importance of individualized prescriptions to optimize safety and therapeutic benefit. Collectively, this review highlights the multifaceted role of exercise in breast cancer prevention, treatment, and survivorship.

Keywords:  breast cancer; exercise; functional capacity; molecular mechanisms; quality of life

DOI:  https://doi.org/10.3390/medicina61071167
Cancers (Basel). 2025 Jul 14. pii: 2329. [Epub ahead of print]17(14):

Assessing the Impact of Exercise on Quality of Life in Advanced-Stage Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Yang-Yi Chang, Hung-Chun Hsiao, Ting-Wei Wang.

  Background/Objectives This systematic review and network meta-analysis aimed to determine the most effective therapeutic exercise modality for improving quality of life (QoL) in patients with advanced-stage cancer. Specifically, the study compared the effects of aerobic training, strength training, and combined aerobic and strength training on QoL outcomes. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane Reviews, and the Cochrane Central Register of Controlled Trials up to 24 February 2023. The review adhered to PRISMA guidelines. Included studies were randomized controlled trials (RCTs) involving adult patients with advanced-stage cancers (e.g., pancreatic, colorectal, lung, breast, prostate, gastrointestinal, gynecological, hematological, head and neck, melanoma, or cancers with bone metastases). The primary outcome was post-intervention QoL, while the secondary outcome assessed was the dropout rate across exercise modalities. Results Aerobic training demonstrated the greatest improvement in QoL with a standardized mean difference (SMD) of 0.30 (95% CI: 0.00 to 0.61), followed by strength training (SMD = 0.13; 95% CI: -0.41 to 0.66) and combined training (SMD = 0.07; 95% CI: -0.11 to 0.24). However, none of the interventions showed statistically significant superiority. Dropout rates were comparable across all exercise modalities and control groups, suggesting strong adherence and feasibility of these interventions in advanced cancer populations. Conclusions While all exercise modalities were associated with improved QoL in patients with advanced-stage cancer, no single intervention emerged as significantly superior. Aerobic exercise may offer a slight advantage, although this effect was not statistically significant. These results highlight the importance of individualized exercise prescriptions based on patient preference, functional status, and treatment context. Further research is warranted to identify patient subgroups that may benefit most from specific exercise interventions and to explore QoL subdomains such as fatigue, emotional well-being, and physical functioning.

Keywords:  advanced-stage cancer; aerobic exercise; exercise interventions; network meta-analysis; quality of life (QoL); randomized controlled trials (RCTs)

DOI:  https://doi.org/10.3390/cancers17142329