Assessment of the Quality of Life related

to health in cases of Spinal Metastases

Overview

Spinal tumors significantly affect the quality of life related to health, and this impact can be objectively measured. Patients with tumors affecting the spine have significant impairment in domains that include physical function, neural function, pain, mental health, and social roles.

Clinical Outcome Measures

The available literature on spine tumors and their clinical outcomes is restricted and typically relies on outcome measures such as survival, local recurrence, complications, and gross function measures such as ambulatory status or the Frankel Score. Direct patient self-assessment of their health status is less commonly utilized. Process variables provide limited understanding of a patient’s overall healthcare experience and the extent to which their care improves the quality of their life. Self-assessment tools for patients enable a direct evaluation of the perceived value of care from the recipient’s perspective. The aim of a disease-specific self-assessment tool is to enhance the instrument’s specificity for a particular disorder and its sensitivity to detect changes in the condition.

Prevalence and Morbidity of Bone Metastases

Bone metastases most commonly occur in the spinal column, with autopsy findings indicating that 30% to 70% of cancer patients have evidence of spinal metastases. In 10% to 38% of cases, multiple noncontiguous metastases are detected. Around 25,000 cases of spinal cord compression caused by metastases are believed to occur annually in the United States, with prostate, breast, and lung cancers being the most common underlying malignancies. Morbidity related to spinal metastases encompasses not just pain, hypercalcemia, pathologic fractures, spinal instability, cord compression, and immobility, but also the unique symptoms linked to the primary tumor and the various psychosocial elements of metastatic disease. This is especially significant since the presence of bone metastases in the spine typically indicates an irreversible disease. Nevertheless, thanks to advancements in adjuvant therapies, individuals with spinal metastases are now experiencing considerably longer survival with their ailment.

Advances in HRQOL Outcome Measures

As of late, there has been a growing interest in scrutinizing and enhancing the significance of HRQOL outcome measures for the treatment of metastatic disease of the spine due to the recent surge in enhanced survival rates and advancements in medical treatment such as bisphosphonates and antiangiogenic tumor modulation, stereotactic radiotherapy, and surgical techniques. Patients who have spinal tumors experience a unique impact from their disease that is different from those with degenerative, developmental, or traumatic spinal conditions. Patients who have spinal tumors frequently exhibit symptoms such as advancing neural impairment, functional restrictions, pain, deformity, and significant concerns regarding mental well-being and social function.

Limitations of Current Outcome Measures

Except for a few, most outcome measures used in oncology and spinal disorders are not tailored for patients with spinal tumors and may not accurately capture changes in health status resulting from surgical and non-surgical interventions. The frequently utilized outcome measures for cancer patients typically include ECOG, EORTC QCQ-C30, and EUROQOL 5D. The SF-36, SIP-5, and ADL are among the frequently used Pi-by-no tools. One validated instrument for assessing health status is the SF-36, which has been utilized to evaluate HRQOL in patients with spinal tumors. Disease-specific measures are valuable in disorders of the spine because they can be tailored to the specific impairment caused by the condition, making them more specific, and can also be more sensitive to detecting changes.

The International Classification of Functioning, Disability, and Health (ICF)

The international classification of functioning, disability and health (ICF), which is now available, provides a universal framework and enables comparison of items and scales across various HRQOL questionnaires. The ICF is part of the group of international health classifications developed by the World Health Organization (WHO). The ICF provides a comprehensive and impartial classification based on the bio-psycho-social model of functioning, disability, and health.

Evaluating Health Status in Metastatic Spinal Disease

In the case of metastatic disease of the spine, patients may experience symptoms from both the primary and metastatic lesions, and the burden of the secondary lesion can be expressed through various symptoms such as pain and neurological deficits. This makes it crucial to consider both the primary and secondary lesions when evaluating the health status of these patients. No questionnaire specifically designed for measuring HRQOL in relation to a particular disease has gained widespread acceptance and use. The measures most frequently utilized are process-related variables, rather than indicators of HRQOL. Health status and utility are often indirectly measured by survival, pain, ambulation, neurologic deficit, and sphincter control, which may be misleading in terms of assessing “quality of life.”

Need for Standardized Outcome Measures

Consensus is lacking in the selection of outcome measures used for patients affected by spinal tumors. The absence of standardized outcome measures hinders the ability to combine studies for meta-analysis and reduces the usefulness of published literature in demonstrating the efficacy of operative and nonoperative management for spinal metastatic disease.

Do you have more questions? 

What symptoms should I watch out for if I suspect a spinal tumor?

Symptoms include back pain, neurological deficits (such as numbness or weakness), difficulty walking, loss of bowel or bladder control, and unexplained weight loss.

How are spinal tumors diagnosed?

Diagnosis typically involves imaging studies like MRI or CT scans, and may include biopsy to determine the nature of the tumor.

What are the treatment options for spinal tumors?

Treatment options include surgery, radiation therapy, chemotherapy, and newer treatments like stereotactic radiotherapy and targeted therapies.

What is the survival rate for patients with spinal tumors?

Survival rates vary widely based on the type of tumor and its stage. Advances in treatment have led to longer survival times for many patients.

How effective are the current treatments for spinal tumors?

Effectiveness varies depending on the type, location, and stage of the tumor, but advancements in treatment have improved survival rates and quality of life.

Can spinal tumors be cured?

Some spinal tumors, especially benign ones, can be cured with appropriate treatment. Malignant tumors may not be curable but can often be managed effectively.

What are the potential complications of spinal tumor treatments?

Complications can include infection, bleeding, nerve damage, and reactions to anesthesia or chemotherapy.

What is spinal cord compression and how is it related to spinal tumors?

Spinal cord compression occurs when a tumor presses on the spinal cord, leading to pain, neurological deficits, and sometimes paralysis. It is a medical emergency requiring prompt treatment.

How do spinal tumors cause pain?

Pain can result from the tumor pressing on nerves or the spinal cord, causing inflammation, or leading to spinal instability or fractures.

What role does physical therapy play in the treatment of spinal tumors?

Physical therapy can help improve mobility, strengthen muscles, reduce pain, and enhance overall quality of life.

Are there any lifestyle changes I should make if I have a spinal tumor?

Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and avoiding smoking, can help improve overall health and aid in recovery.

How do I cope with the mental and emotional impact of having a spinal tumor?

Seeking support from mental health professionals, joining support groups, and staying connected with loved ones can help manage the emotional burden.

What is the role of self-assessment tools in managing spinal tumors?

Self-assessment tools enable patients to directly report their health status, helping healthcare providers better understand the patient’s experience and adjust treatment plans accordingly.

What is the role of self-assessment tools in managing spinal tumors?

Self-assessment tools enable patients to directly report their health status, helping healthcare providers better understand the patient’s experience and adjust treatment plans accordingly.

How do bone metastases affect the spine?

Bone metastases can weaken the spine, leading to fractures, spinal instability, and compression of the spinal cord or nerves.

What is hypercalcemia and how is it related to spinal tumors?

Hypercalcemia is a condition of elevated calcium levels in the blood, often caused by bone metastases, leading to symptoms like nausea, vomiting, confusion, and cardiac issues.

What are the psychosocial impacts of having a spinal tumor?

Psychosocial impacts include anxiety, depression, social isolation, and changes in family dynamics and employment status.

Why is there a lack of standardized outcome measures for spinal tumor patients?

The variability in tumor types, locations, and individual patient conditions makes it challenging to develop universally applicable outcome measures.

How does the International Classification of Functioning, Disability, and Health (ICF) help in managing spinal tumors?

The ICF provides a comprehensive framework for evaluating the impact of spinal tumors on a patient’s life, helping to standardize assessments and improve treatment planning.

What are bisphosphonates and how do they help with spinal tumors?

Bisphosphonates are medications that help strengthen bones and reduce the risk of fractures in patients with bone metastases.

What advancements have been made in the surgical treatment of spinal tumors?

Advances include minimally invasive techniques, better imaging for preoperative planning, and enhanced postoperative care, which improve outcomes and reduce recovery times.

What is antiangiogenic tumor modulation?

Antiangiogenic therapy aims to inhibit the growth of new blood vessels that tumors need to grow, thereby slowing tumor progression.

How can stereotactic radiotherapy benefit spinal tumor patients?

Stereotactic radiotherapy delivers precise, high-dose radiation to the tumor while sparing surrounding healthy tissue, offering effective treatment with fewer side effects.

What should I discuss with my orthopedic surgeon during a consultation about spinal tumors?

Discuss the type and stage of the tumor, treatment options, potential risks and benefits, expected outcomes, pain management strategies, and the impact on quality of life.

Dr Vedant Vaksha

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.