The British Orthopaedic Oncology Management (BOOM) audit.

Area of Science:

• Orthopaedic Oncology
• Health Services Research
• Oncology

Background:

• Bone metastases significantly impact patients with advanced malignancy, posing challenges to orthopaedic services and healthcare economics.
• Adherence to established guidelines is crucial for optimizing patient care and resource allocation in managing metastatic bone disease (MBD).

Purpose of the Study:

• To assess adherence to British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines for patients with metastatic bone disease (MBD) in the UK.
• To identify areas of non-compliance and inform strategies for improving care standards.

Main Methods:

• A prospective, multicentre, national collaborative audit involving 84 UK hospitals.
• Data collected over three months (April-June 2021) from 1,137 eligible patients with MBD.
• Analysis of 846 patients with pelvic and appendicular MBD, comparing practice against BOOS/BOA guidelines.

Main Results:

• Low compliance observed: 39% of centres lacked an MBD lead, 19% had inadequate radiographs, and 29% lacked up-to-date staging CT scans.
• Suboptimal adherence to guidelines for oncological opinion (69%) and prognosis estimation (38%).
• Inadequate pre-surgical investigations and oncology input noted, especially for patients with solitary metastases (only 60% sought tertiary opinion/biopsy).

Conclusions:

• Current UK practice for MBD management does not consistently meet national guidelines.
• Significant improvements are required in pre-surgical investigations and management of solitary metastases.
• Investment and adherence to new standards, such as the BOA Standards for Trauma (BOAST), are essential for enhancing care for patients with MBD.