Metastatic bone disease--the orthopaedic workload

In 1999, the British Association of Surgical Oncology (BASO) published its guidelines for the management of metastatic bone disease in breast cancer in the UK, highlighting the role of the orthopaedic surgeon as an integral part of the multidisciplinary team.

To establish the workload to our department of metastatic bone disease.

A prospective study was performed over a 6-month period aiming to study factors affecting length of stay, whether BASO recommendations were being adhered to for metastatic breast disease and whether BASO recommendations could be extended to other forms of metastatic bone disease.

36 patients were referred to the orthopaedic department during the study period. The majority of the patients were referred as emergencies, 83% of patients were seen by an orthopaedic consultant on the day of referral but only 27% were seen by the orthopaedic cancer liaison consultant. Only 16 patients required a therapeutic operative intervention and length of in-patient stay was increased by not having a known primary carcinoma at admission. Patients with bone metastases discussed at the breast cancer multidisciplinary meeting were also studied as were patients with bone metastases presenting to the oncology service. It was found that there was little overlap between these groups and our study group.

Metastatic bone disease does form a workload to the orthopaedic department and BASO recommendations are generally followed for breast disease. The BASO recommendations could be extended to other tumours; however, it should be recognised that there is a significant workload involved and a need for sufficient resources to allow a high quality and timely service.