Study On Health-related Quality Of Life In Patients With Spinal Metastases Treated With Or Without Spinal Surgery

There has been growing recognition that patient-reported outcome measures, in particular, measures of health-related quality of life (HRQOL), can convey important information for the choosing and decision-making of treatment of cancer. In recent years, successful quality of life (QOL) evaluation has been performed on patients with prostate, breast, lung, and hepatic cancer after treatment. Spine metastases are common among patients with advanced-stage cancer, which can lead to pathologic fracture, hypercalcemia of malignancy, and spinal cord compression. Spinal cord compression is a severe complication of cancer, occurring in 5-14% of the metastatic cancer patients, which can cause intractable pain, loss of mobility, and incontinence. Since most spinal metastases are detected at later stages, by when it is in general incurable, the impact of treatment on QOL should therefore be an important consideration in our treatment decisions.Spinal tumors, including primary spine tumor and metastatic spinal tumor. We compiled 557 patients who underwent spinal surgery in Changzheng Hospital from January,2000 to January 2007. Through retrospective analysis, we found surgical treatment of primary spinal tumors is effective.The surgical treatment of metastatic spinal tumors has been the focus of debate in clinical for quite some time. However, HRQOL data for spinal metastases is limited. To our knowledge, there has been no previous report on the QOL outcome after surgery for spinal metastases. The purpose of this prospective, longitudinal study was to identify and compare the QOL of patients over a certain period of time after spinal surgery.From July 1,2007 to March 31,2009, we identified 312 patients who were eligible for the observational study from Changzheng Hospital, the Second Military Medical University in Shanghai, China. All eligible patients were separated into two groups depending on whether they would undergo the surgery or not (surgery group n=147, non-surgery group n=165). When diagnosed, all eligible patients completed a baseline QOL assessment using the Functional Assessment of Cancer Therapy-General (FACT-G) Questionnaire. The surgery group patients received surgical treatment within 3 days after diagnosis. Patients were assessed again at 4 time points:1 month,3 months,6 months and 9 months during the postoperative period. The non-surgery group QOL assessments were performed at 1 month,3 months,6 months and 9 months following diagnosis.During the course of the study, we added anxiety, depression and pain assessment to the QOL assessment to those patients who enter after January 1,2009.216 patients were eligible, including surgery group 101 and non-surgery group 115. Use Zung's Self-Rating Anxiety Scale (SAS) for anxiety assessment, Zung's Self-Rating Depression Scale (SDS) for depression assessment, and Numeric Rating Scale (NRS) for pain assessment.The results of this study suggest that surgical treatment can improve the QOL of patients with spinal metastases greatly, reduce anxiety and depression, and control pain, but can not prolong the survival time.In order to reveal the impacts of spinal surgery on the QOL, anxiety, depression, and pain of patients with spinal metastases, this prospective, longitudinal study has been designed and implemented, using a non-surgery group as the control group. Metastatic disease is generally incurable, so treatments are usually aimed at the prolongation of survival and palliation of symptoms. QOL assessment in studies helps evaluate the benefits or risks of any therapy. Some researchers claim the standard treatment for spinal metastases is radiotherapy; and surgery is only applied as a second-line treatment when radiotherapy has failed, or sometimes merely for pain control. However, in recent years, with the development of surgical techniques, surgeries have been increasingly applied to treat spinal metastases. Can spinal surgery indeed improve the QOL of patients with spinal metastases? Although the importance of health-related quality of life outcome has been widely recognized, information and study on the impact of surgery on QOL of patients with spinal metastases is far from sufficient. To our knowledge, this study is actually the first attempt to address the issue. This finding supports the use of surgery as an effective treatment for spinal metastases.