title: Metastatic bone disease: the requirement for improvement in a multidisciplinary approach.
abstract: The purpose of this study was to assess the referral system, clinical notes and radiographs of patients presenting with metastatic disease of long bones. The study demonstrated that 93% of oncologists did not use a reliable scoring system to assess risk of pathological fracture, and 60% felt an improvement in communication was required. Notes and radiographs were reviewed for 37 patients presenting with femoral metastatic lesions. Sixteen patients had a Mirels' score of greater than 8. Four patients were referred for an orthopaedic opinion. Twelve patients with a score of greater than 8 were not referred; seven of these patients suffered a pathological fracture. Sixteen patients had a Mirels' score of less than 8; none of these patients were referred for an orthopaedic opinion. No pathological fractures occurred. In conclusion, the majority of patients who score above 8 in the Mirels' scoring system are at risk of fracture and do require prophylactic surgery. In keeping with the British Orthopaedic Association (BOA) guidelines, "Metastatic Bone Disease: A Guide to Good Practice", we would recommend a multidisciplinary approach and the use of a recognised scoring system.
authors.affiliation: Addenbrooke's Hospital, University of Cambridge NHS Hospitals Trust, Cambridge, UK. jdcumming1@aol.com
authors.forename: D
authors.initials: D
authors.lastname: Cumming
authors.forename: J
authors.initials: J
authors.lastname: Cumming
authors.forename: A
authors.initials: A
authors.lastname: Vince
authors.forename: R
authors.initials: R
authors.lastname: Benson
mesh_terms: D001707:Biopsy, Needle; D001847:Bone Diseases / Q000175:diagnosis / Q000628:therapy; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005598:Fractures, Spontaneous / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D019538:Health Care Surveys; D006801:Humans; D007150:Immunohistochemistry; D033183:Interdisciplinary Communication; D008297:Male; D020380:Needs Assessment; D009367:Neoplasm Staging; D009985:Orthopedics / Q000592:standards / Q000639:trends; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D018570:Risk Assessment; D011795:Surveys and Questionnaires