bims-rebome 2026-03-22 papers

Arch Rehabil Res Clin Transl. 2026 Mar;8(1): 100549

Clinical Determinants of Functional Independence at Discharge in Patients With Spinal Cord Dysfunction Due to Metastatic Spinal Tumors.

Hiroyuki Ase, Kiyomi Miura, Tsukasa Yoshida, Eriko Kitahara, Tatsuya Takagi, Kaoru Honaga, Akira Tanuma, Mami Tani, Yuhei Murakami, Aiko Ishikawa, Reina Isayama, Toshiyuki Fujiwara.

Objectives: To identify the clinical factors associated with independence in activities of daily living (ADL) at discharge in patients with spinal cord dysfunction resulting from metastatic spinal tumors.
Design: Retrospective cohort study.
Setting: A single university hospital in Japan.
Participants: A total of 153 patients (N=153) (median age 69 [interquartile range: 58.5-75.5]; 67% men) with spinal cord dysfunction caused by metastatic spinal tumors received inpatient rehabilitation during hospitalization between 2012 and 2022. The inclusion criteria were age ≥18 years, a diagnosis of spinal cord dysfunction resulting from metastatic bone tumors, and participation in inpatient rehabilitation.
Interventions: Participants underwent standard inpatient rehabilitation care. No study-specific intervention was provided.
Main Outcome Measures: Independence in ADL was defined as a Barthel index score of ≥85 at discharge. Data on demographics, clinical characteristics, and potential risk factors were extracted from medical records. Logistic regression analysis, adjusted for age, was conducted to identify predictors of independence in ADL at discharge.
Results: Among the participants, 23 (15.0%) achieved independence in ADL at discharge. Logistic regression analysis identified the following 4 significant factors associated with reduced odds of independence in ADL: rapid-growing primary tumor type (odds ratio [OR]=5.93; 95% CI, 1.81-19.43), severe motor impairment at admission (OR=5.83; 95% CI, 1.89-18.00), elevated C-reactive protein/albumin ratio (OR=3.82; 95% CI, 1.53-17.80), and persistent movement-related pain (OR=1.34; 95% CI, 1.01-1.84).
Conclusions: Tumor aggressiveness, neurologic severity, systemic inflammation, and persistent pain significantly influenced independence in ADL at discharge. Early identification of these risk factors may guide individualized rehabilitation planning and optimize functional outcomes in this population.

Keywords: Activities of daily living; Cancer rehabilitation; Metastatic spinal tumor; Prediction of functional independence; Rehabilitation; Spinal cord dysfunction

DOI: https://doi.org/10.1016/j.arrct.2025.100549

Sci Rep. 2026 Mar 19.

Cancer-specific survival patterns in patients with bone metastasis: a registry-based analysis of 13,742 patients.

Zelin Yun, Yanchao Tang, Jie Sun, Juncai Lei, Gangqiang Zhang, Feng Wei, Xiaoguang Liu.

With increasing opportunities for patients with bone metastasis (BM) to benefit from local surgical intervention, accurate survival analysis across different primary cancers remains challenging. Current analytical frameworks commonly rely on single-center, pan-cancer cohorts and provide insufficient integration of cancer-specific characteristics. In this retrospective, multicenter, registry-based cohort study, baseline demographic and clinical characteristics of 13,742 patients with AJCC stage IV or TNM stage M1 metastatic cancer were collected from 42 studies registered in the cBioPortal for Cancer Genomics database. Overall survival (OS) after metastatic diagnosis was the primary outcome. Univariate analyses were performed using Kaplan-Meier methods, log-rank tests, and non-parametric tests. Variables with p < 0.20 were included in multivariable Cox proportional hazards models to examine independent associations with survival. Multiple imputation was applied to address missing data. Among the 25 primary cancers analyzed, approximately half showed observable survival differences between BM and other-site metastasis, with 6 cancers reaching statistical significance. Based on median survival, all cancers could be stratified into 3 distinct survival tiers, ranging from prolonged survival exceeding 15 months to markedly shorter survival of 3-10 months, with multivariable analyses further demonstrating that primary cancer type was the strongest factor associated with survival heterogeneity among BM patients (HR = 1.422-1.758, p < 0.001). Moreover, poorly differentiated or undifferentiated histology was independently associated with worse OS (HR = 1.249, p < 0.001), and age > 60 years was also associated with shorter survival (p < 0.001). No single metastatic site demonstrated a consistent adverse association with survival across cancer types. Overall, BM demonstrates cancer-specific and heterogeneous associations with survival compared with other metastatic sites. All primary cancers could be stratified into 3 groups, representing the most important factor associated with survival differences. Moreover, pathological differentiation was significantly associated with survival among BM patients. Notably, no metastatic site functions as a universal prognostic factor across cancers. Large-scale, multicenter, registry-based analyses provide a valuable framework for cancer-specific survival analysis and for identifying clinically relevant factors that may serve as a reference for risk stratification in surgical decision-making.

Keywords: Bone metastasis; Cancer-specific; Multicenter; Registry-based; Survival

DOI: https://doi.org/10.1038/s41598-026-43780-6

Adv Radiat Oncol. 2026 May;11(5): 102008

Progress in Shortening Treatment Courses for Bone Metastases in a Statewide Quality Consortium.

Michigan Radiation Oncology Quality Consortium as part of the Blue Cross Blue Shield of Michigan and Blue Care Network of Michigan Value Partnerships Program

Purpose: A large body of research has studied various fractionation regimens for radiation therapy (RT) targeting bone metastases, with evidence that courses of 5 or fewer fractions are isoeffective compared with longer courses. We analyzed practice patterns within a statewide quality consortium following the implementation of quality measures promoting single-fraction RT (SFRT) for uncomplicated metastases and ≤5 fractions for all metastases.
Methods and Materials: Consecutive patients receiving RT for bone metastasis from primary breast, lung, melanoma, prostate, or renal cancer(s) between March 1, 2018, and December 31, 2024, were prospectively enrolled in a statewide quality consortium. SFRT and ≤5-fraction quality metrics were implemented on January 1, 2020, and January 1, 2022, respectively. Patient, treatment, physician, and facility characteristics were collected, and multivariable logistic regression, with and without random center intercepts, was used to account for clustering by center and to assess associations with metric adherence.
Results: In total, 4477 patients were enrolled and received 6733 RT treatment plans, with 1105 patients receiving 1465 plans for uncomplicated metastases and 3247 patients receiving 4832 nonstereotactic body RT plans. The use of SFRT and ≤5-fraction RT for uncomplicated and any metastases increased from 17.8% to 38.8% and from 44.2% to 63.9%, respectively, after the implementation of quality measures. In both models, later years of treatment, longer distance to the treating facility, higher baseline fatigue, treatment site other than the spine, and fewer physician years in practice predicted shorter treatment courses. Patients with >1 site treated for uncomplicated metastases had lower odds of receiving SFRT. Forward planning, uncomplicated metastasis, retreatment, palliative intent, age ≥80 years, and an Eastern Cooperative Oncology Group performance status ≥2 independently predicted receipt of ≤5 fractions.
Conclusions: Our efforts to shorten treatment courses for bone metastases have been successful. The number and variety of factors that predict the use of shorter courses reflect the complexity of clinical decision-making in the treatment of bone metastases.

DOI: https://doi.org/10.1016/j.adro.2026.102008