Assessment of the Quality of Life related
to health in cases of Spinal Metastases
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.
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.
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.
As of late, there has been a growing interest in scrutinizing and enhancing the significance of HRQOL outcome measures for 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.
Except for a few, most outcomes 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 included 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. However, none of these instruments specifically target the unique concerns and impairments experienced by patients with spinal tumors.
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.
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.”
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.
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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.
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