1. Background Results Patients and methods Conclusions References
THE MULTIDISCIPLINARY APPROACH TO BONE DISEASE: MONO INSTITUTIONAL EXPERIENCE
S. Ahcene Djaballah 1, A.Brunello 1, L.Trentin 2,  S.Galuppo 3, A.Bernabei 4, U.Nena 4, C.Aliberti 5, S.Zovato 6, U.Basso 1, F.Navarria 3, V.Zagonel 1
1 Medical Oncology 1, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy 2 Palliative Medicine, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy 3 Radiotherapy, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
4 Spine Surgery Unit, Azienda Opedaliera - Padova, Italy5 Interventional Radiology, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy 6 Familial Cancer Clinic, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
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Background
Results
Tab 2 – Therapeutic decision after OMG consult
Fig 1 – Variation on Pain Intensity after Local or systemic treatment
Bone metastases are responsible for different clinical complications such as pain, pathological fractures, spinal cord compression, bone marrow suppression and accounts for the high morbidity and deterioration of quality of life in oncological patients. Management of bone disease needs a multidisciplinary approach that integrates diagnosis and treatment of cancer, pain management and bone health during antitumor treatment. In an effort to streamline time to treatment and improve patient access, our Center developed an Osteoncology Multidisciplinary Group (OMG). The OMG meets weekly and focuses on metastatic bone tumours and also on bone health during antitumor treatment . It is coordinated by the Oncologia Medica 1 at IOV and is staffed by medical, and radiation oncologists; orthopaedic surgeon, palliative care specialists; interventional radiologist and endocrinologist.
Here we evaluate the impact of OMG on bone disease management in oncological patients.
Median age was 66 years (range 35-90); 69% females. Ninty-seven patients were symptomatic, while for 50 suspect was based on imaging during follow-up or staging. Main primary tumor sites were: breast (38%) followed by lung and urological tumors. Patients characteristics are reported on Tab 1.
For eleven patients a biopsy was requested. Median WT to biopsy was 6,5 days [range 5-8].
Bone metastases were present in 118 patients (80%). Forty-nine patients underwent RT, median WT from decision to plannig CT scan was 9 days [3-15].
Fifty patients underwent percutaneous vertebroplasty (PV), median WT to PV was 13 days [5-21].
Of the 147 patients who received consultation, 72 were referred to palliative medicine. A significative NRS reduction (≥30%) was registered at first evaluation after local or palliative treatment in 83 patients (86%) [Tab 3, Fig 1].
NRS
Decision N %
Bone lesion biopsy 11 7
Back or neck brace prescription 52 35
Radiotherapy 49 33
Percutaneous Vertebroplasty 15 10
Orthopedic Surgery 4 3
Palliative Medicine Consult 72
Bone Resorption Consult 21 14
Tab 3 – Variation on Pain Intensity
Tab 1 – Patients charatheristics
Patients and methods
N (%)
Female
Male
101 (69)
46 (31)
Median Age at evaluation (IQR)
66(35-90)
Primary Tumour Site
Breast
Lung
Urologic Cancer
Gastrointestinal
Hematological
Gynecological
56 (38)
23 (16)
22 (15)
14(10)
7(5)
6(4)
KPS
70 (50-90)
Pain
Suspect on imaging
97(66)
50(34)
NRS
T0 *
N(%)
T1*
48 (33)
70 (48)
1-3
50 (34)
74 (50)
4-6
32 (22)
0 (0)
7-10
17 (12)
3 (2)
Conclusions
An OMG improves patient care by means of state-of-the-art assessments and interventions.
Minimum waste of time
Future evaluations of benefits of interventions based on OMG in particular settings (disease; stage) are to be performed
Between July 2013 and April 2014, 147 patients were
evaluated:
eighty-four patients were seen as outpatients (57%)
case discussion with imaging was undertaken in 63 patients.
After collegial discussion patients received palliative local and /or systemic treatment.
Methods: Continuous data were described using median values and ranges. Categorical data were described using absolute and percentual frequencies. Pain intensity was evaluated by means of Numeric Rating Scale. Waiting Time (WT) was defined as the time from multidisciplinary evaluation to the date of the treatment.
References 
1- Virk SM, Lieberman JR. Tumor metastasis to bone. Arthritis Research & Therapy. 2007;9(1):S5.5
2- Ibrahim T, Farolfi A, Mercatali L, et al. Metastatic bone disease in the era of bone targeted therapy: clinical impact. Tumori in press
3-Ibrahim T, Flamini E, Fabbri L, et al. Multidisciplinary approach to the treatment of bone metastases: Osteo-Oncology Center, a new organizational model. Tumori. 2009;95:291–297
*T0: Baseline; T1: First evaluation after local or systemic palliative treatment