Join Community Oncology Editor-in Chief Dr David H. Henry for an audio tour of the May issue, featuring "Erwinia asparaginase for acute lymphoblastic leukemia in children with hypersensitivity to E. coli-derived asparaginase" and "Creating a community-based, patient-centered cancer survivorship program."

Join Community Oncology Editor-in Chief Dr David H. Henry for an audio tour of the May issue, featuring "Erwinia asparaginase for acute lymphoblastic leukemia in children with hypersensitivity to E. coli-derived asparaginase" and "Creating a community-based, patient-centered cancer survivorship program."

Join Community Oncology Editor-in Chief Dr David H. Henry for an audio tour of the May issue, featuring "Erwinia asparaginase for acute lymphoblastic leukemia in children with hypersensitivity to E. coli-derived asparaginase" and "Creating a community-based, patient-centered cancer survivorship program."

Management of recurrent non-small cell lung cancer (NSCLC) is a clinical challenge. Around one third of patients who are diagnosed with NSCLC will experience a localregional or advanced stage recurrence. The median time to recurrence from initial diagnosis is 11.5 months. The median age of initial diagnosis of NSCLC is 71 years of age, patients with recurrent disease tend therefore to be even older. Treatment is a challenge, as this elderly patient population tends to have multiple comorbidities, polypharmacy and socioeconomic factors, that have not been accounted for in clinical trials in patients that define our current treatment recommendations. This case-based review outlines some of these challenges and outlines the need for further research.

*For a PDF of the full article, click in the link to the left of this introduction.

Management of recurrent non-small cell lung cancer (NSCLC) is a clinical challenge. Around one third of patients who are diagnosed with NSCLC will experience a localregional or advanced stage recurrence. The median time to recurrence from initial diagnosis is 11.5 months. The median age of initial diagnosis of NSCLC is 71 years of age, patients with recurrent disease tend therefore to be even older. Treatment is a challenge, as this elderly patient population tends to have multiple comorbidities, polypharmacy and socioeconomic factors, that have not been accounted for in clinical trials in patients that define our current treatment recommendations. This case-based review outlines some of these challenges and outlines the need for further research.

*For a PDF of the full article, click in the link to the left of this introduction.

Management of recurrent non-small cell lung cancer (NSCLC) is a clinical challenge. Around one third of patients who are diagnosed with NSCLC will experience a localregional or advanced stage recurrence. The median time to recurrence from initial diagnosis is 11.5 months. The median age of initial diagnosis of NSCLC is 71 years of age, patients with recurrent disease tend therefore to be even older. Treatment is a challenge, as this elderly patient population tends to have multiple comorbidities, polypharmacy and socioeconomic factors, that have not been accounted for in clinical trials in patients that define our current treatment recommendations. This case-based review outlines some of these challenges and outlines the need for further research.

*For a PDF of the full article, click in the link to the left of this introduction.

ABSTRACT

Background: Little is known about how young adults (YAs) cope with cancer or about the relationship between coping and psychological distress in YAs with advanced cancer.

Objectives: The goals of this study were to identify coping strategies
used by YAs with advanced cancer and examine the relationship between
these coping strategies and psychological distress.

Methods: Using structured clinical interviews with 53 YAs (aged 20–40 years) with advanced cancer, researchers assessed coping methods, depression, anxiety, and grief. A principal components factor analysis identified underlying coping factors. Regression analyses examined the relationship between these coping factors and depression, anxiety, and grief.

Results: Six coping factors emerged and were labeled as proactive, distancing, negative expression, support-seeking, respite-seeking, and acceptance coping. Acceptance and support-seeking coping styles were used most frequently. Coping by negative expression was positively associated with severity of grief after researchers controlled for depression, anxiety, and confounding variables. Support-seeking coping was positively associated with anxiety after researchers controlled for depression and grief.

Limitations: This study was limited by a cross-sectional design, small sample size, and focus on YAs with advanced cancer.

Conclusions: YAs with advanced cancer utilize a range of coping responses that are uniquely related to psychological distress.

To read this article, click on the FILES link at left.

ABSTRACT

Background: Little is known about how young adults (YAs) cope with cancer or about the relationship between coping and psychological distress in YAs with advanced cancer.

Objectives: The goals of this study were to identify coping strategies
used by YAs with advanced cancer and examine the relationship between
these coping strategies and psychological distress.

Methods: Using structured clinical interviews with 53 YAs (aged 20–40 years) with advanced cancer, researchers assessed coping methods, depression, anxiety, and grief. A principal components factor analysis identified underlying coping factors. Regression analyses examined the relationship between these coping factors and depression, anxiety, and grief.

Results: Six coping factors emerged and were labeled as proactive, distancing, negative expression, support-seeking, respite-seeking, and acceptance coping. Acceptance and support-seeking coping styles were used most frequently. Coping by negative expression was positively associated with severity of grief after researchers controlled for depression, anxiety, and confounding variables. Support-seeking coping was positively associated with anxiety after researchers controlled for depression and grief.

Limitations: This study was limited by a cross-sectional design, small sample size, and focus on YAs with advanced cancer.

Conclusions: YAs with advanced cancer utilize a range of coping responses that are uniquely related to psychological distress.

To read this article, click on the FILES link at left.

ABSTRACT

Background: Little is known about how young adults (YAs) cope with cancer or about the relationship between coping and psychological distress in YAs with advanced cancer.

Objectives: The goals of this study were to identify coping strategies
used by YAs with advanced cancer and examine the relationship between
these coping strategies and psychological distress.

Methods: Using structured clinical interviews with 53 YAs (aged 20–40 years) with advanced cancer, researchers assessed coping methods, depression, anxiety, and grief. A principal components factor analysis identified underlying coping factors. Regression analyses examined the relationship between these coping factors and depression, anxiety, and grief.

Results: Six coping factors emerged and were labeled as proactive, distancing, negative expression, support-seeking, respite-seeking, and acceptance coping. Acceptance and support-seeking coping styles were used most frequently. Coping by negative expression was positively associated with severity of grief after researchers controlled for depression, anxiety, and confounding variables. Support-seeking coping was positively associated with anxiety after researchers controlled for depression and grief.

Limitations: This study was limited by a cross-sectional design, small sample size, and focus on YAs with advanced cancer.

Conclusions: YAs with advanced cancer utilize a range of coping responses that are uniquely related to psychological distress.

To read this article, click on the FILES link at left.

ABSTRACT

Background: Breast cancer survivors receive routine medical follow-up but are screened less frequently to detect symptom severity and interference with function in daily life.

Objectives: Among breast cancer survivors, we describe the usual and worst severity of 5 common symptoms and the extent to which these symptoms interfere with general activity and enjoyment of life, we determine the associations among symptoms and the interference items, and we explore associations of interference with function and the most prevalent symptoms.

Methods: The cross-sectional, descriptive 1-page Breast Cancer Survivor Symptom Survey was mailed to breast cancer survivors identified in a clinical database (ONCOBASE). In total, 184/457 (40.3%) surveys were returned and 162 (35.4%) were used. Participants recorded usual and worst severity of 5 symptoms (fatigue, disturbed sleep, pain, distress, and numbness/tingling) and symptom interference with general activity and enjoyment of life during the past 7 days.

Results: Participants reported usual symptom severity as mild and highest for sleep disturbance, followed by fatigue, distress, numbness/tingling, and pain. Participants recorded worst sleep disturbance and fatigue as moderately severe. Higher pain and fatigue were associated with all other symptoms, whereas disturbed sleep and distress were related to all except numbness/tingling. All symptoms interfered with general activity and enjoyment of life. Pain and numbness/tingling were associated with lower function and disturbed sleep, and made a unique contribution to fatigue.

Limitations: Limitations of the study include relatively low response and use of a modification of an established scale.

Conclusion: Symptoms often coexisted and contributed to interference with daily function. Pain was most consistently associated with interference with function and severity of other symptoms.

To read this study, please click on the Link to the left of this abstract.

ABSTRACT

Background: Breast cancer survivors receive routine medical follow-up but are screened less frequently to detect symptom severity and interference with function in daily life.

Objectives: Among breast cancer survivors, we describe the usual and worst severity of 5 common symptoms and the extent to which these symptoms interfere with general activity and enjoyment of life, we determine the associations among symptoms and the interference items, and we explore associations of interference with function and the most prevalent symptoms.

Methods: The cross-sectional, descriptive 1-page Breast Cancer Survivor Symptom Survey was mailed to breast cancer survivors identified in a clinical database (ONCOBASE). In total, 184/457 (40.3%) surveys were returned and 162 (35.4%) were used. Participants recorded usual and worst severity of 5 symptoms (fatigue, disturbed sleep, pain, distress, and numbness/tingling) and symptom interference with general activity and enjoyment of life during the past 7 days.

Results: Participants reported usual symptom severity as mild and highest for sleep disturbance, followed by fatigue, distress, numbness/tingling, and pain. Participants recorded worst sleep disturbance and fatigue as moderately severe. Higher pain and fatigue were associated with all other symptoms, whereas disturbed sleep and distress were related to all except numbness/tingling. All symptoms interfered with general activity and enjoyment of life. Pain and numbness/tingling were associated with lower function and disturbed sleep, and made a unique contribution to fatigue.

Limitations: Limitations of the study include relatively low response and use of a modification of an established scale.

Conclusion: Symptoms often coexisted and contributed to interference with daily function. Pain was most consistently associated with interference with function and severity of other symptoms.

To read this study, please click on the Link to the left of this abstract.

ABSTRACT

Background: Breast cancer survivors receive routine medical follow-up but are screened less frequently to detect symptom severity and interference with function in daily life.

Objectives: Among breast cancer survivors, we describe the usual and worst severity of 5 common symptoms and the extent to which these symptoms interfere with general activity and enjoyment of life, we determine the associations among symptoms and the interference items, and we explore associations of interference with function and the most prevalent symptoms.

Methods: The cross-sectional, descriptive 1-page Breast Cancer Survivor Symptom Survey was mailed to breast cancer survivors identified in a clinical database (ONCOBASE). In total, 184/457 (40.3%) surveys were returned and 162 (35.4%) were used. Participants recorded usual and worst severity of 5 symptoms (fatigue, disturbed sleep, pain, distress, and numbness/tingling) and symptom interference with general activity and enjoyment of life during the past 7 days.

Results: Participants reported usual symptom severity as mild and highest for sleep disturbance, followed by fatigue, distress, numbness/tingling, and pain. Participants recorded worst sleep disturbance and fatigue as moderately severe. Higher pain and fatigue were associated with all other symptoms, whereas disturbed sleep and distress were related to all except numbness/tingling. All symptoms interfered with general activity and enjoyment of life. Pain and numbness/tingling were associated with lower function and disturbed sleep, and made a unique contribution to fatigue.

Limitations: Limitations of the study include relatively low response and use of a modification of an established scale.

Conclusion: Symptoms often coexisted and contributed to interference with daily function. Pain was most consistently associated with interference with function and severity of other symptoms.

To read this study, please click on the Link to the left of this abstract.

To read the entire article in pdf format, please click on the FILE at left.

To read the entire article in pdf format, please click on the FILE at left.

To read the entire article in pdf format, please click on the FILE at left.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

Perceived Social Support as a Predictor of Disease-Specific Quality of Life in Head-and-Neck Cancer Patients

Frank J. Penedo, PhD; Lara Traeger, PhD; Catherine Benedict, MS; Giovana Thomas, MD; Jason R. Dahn, PhD; Madeline Hernandez Krause, MS; and W. Jarrard Goodwin, MD

ABSTRACT

Background: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes.

Objective: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease-and treatment-related factors.

Methods: Participants (n equals 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy–Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL.

Results: Perceived social support decreased significantly from pre-to posttreatment (F[31] equals –2.71, P less than .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (Beta equals 0.47, P less than .01).

Limitations: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships.

Conclusions: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

To read the article, please see the attached pdf file.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Early detection and advances in cancer treat­ments have resulted in improved control over progression of malignancies, turning cancer into a chronic disease for many long-term cancer survivors. Approximately 12 million people with a previous diagnosis of cancer are living in the United States, and more than two-thirds of individuals diagnosed with cancer are expected to live at least 5 years after diagnosis. The National Coalition for Cancer Survivorship notes that from “the moment of diagnosis and for the balance of life, an individual diagnosed with cancer is a survivor.” Cancer survivorship may also be described as constituting three distinct phases of treatment: the acute phase (from diag­nosis until completion of the initial treatment), the extended phase (the period of partial or com­plete remission after the initial treatment), and the permanent survival phase (a period of low likelihood of primary disease returning). Despite the advances in cancer therapies, sur­vivors face a number of challenges, including an increased risk of recurrent cancer and other med­ical treatment-related toxicities. Mariotto et al estimated that as of January 1, 2005, there were more than 300,000 survivors of childhood cancer in the United States. Of these survivors, approx­imately one-quarter have lived for more than 30 years; however, only a small fraction of survivors (3%) exceeded 60 years of age. The most com­mon cancer diagnoses among the survivors were brain cancer, acute lymphoblastic leukemia, germ cell tumors, and Hodgkin’s lymphoma. An­other report showed that 75% of childhood can­cer survivors experienced at least one adverse event.

*For a PDF of the full article and accompanying viewpoints by Tom Strouse and Howard Rosner along with Laura Audell, click in the links to the left of this introduction.

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.

Background: Patients with advanced cancer and bone metastases frequently experience skeletal-related events (SREs) including pathologic fracture, spinal cord compression, and radiation or surgery to bone. This prospective, observational study characterized health-resource utilization (HRU) associated with each SRE type across tumor types.
Methods: Patients with bone metastases secondary to breast, prostate, or lung cancer as well as patients with multiple myeloma were enrolled within 97 days of experiencing an SRE and were followed prospectively for up to 18 months. Data on hospitalization, length of hospital stay, outpatient visits, emergency department visits, nursing home or long-term care facility stays, home health visits, procedures, and medication usage were collected and attributed to SREs by investigators.
Results: In all, 238 patients were prospectively followed for a median of 9.5 months after enrollment. Bisphosphonates were prescribed in 77% of patients. Of 510 SREs recorded, 442 were included in the HRU analyses. Spinal cord compression and surgery to bone were associated with the highest rates of inpatient stays (mean, 0.6 hospitalizations per SRE), and length of stay was longest for pathologic fracture (mean, 16 days per SRE). Radiation to bone had the most outpatient visits (mean, 10 visits per SRE) and procedures (mean, 12 per SRE).
Limitations: HRU was likely underestimated because patient charts may not have been comprehensive, and the study design did not capture all potential HRU sources. Sample sizes were small for some SRE types.
Conclusions: Each SRE type was associated with substantial HRU, and patterns of HRU were unique across SRE type. The HRU burden of SREs in patients with bone metastases is considerable, even with bisphosphonate treatment.

*For a PDF of the full article, click in the link to the left of this introduction.