Patients With Spinal Metastases May Be Disappointed After Treatment

High pretreatment expectations may leave patients with spinal metastases feeling underwhelmed afterward, according to a review. One of the goals of treatment for spinal metastases is to improve a patient’s health-related quality of life, which may largely be influenced by a patient’s pretreatment expectations—not just in the case of spinal metastases. However, expectations among patients who are undergoing surgery or radiotherapy for spinal metastases are not well understood. The study was performed under the assumption that patients undergoing spinal metastasis treatment likely have similar expectations as those undergoing other types of spinal surgery, so with that in mind, a literature search was performed using the Medline, Embase, and PsychINFO databases. Studies published between 2000 and September 2019 evaluating patients aged >18 years who were undergoing either spinal surgery or advanced cancer care and reporting on pretreatment expectations about treatment outcomes were included. A total of 7,343 articles were identified, 93 underwent full-text review, and 31 were included in the final analysis. The studies that made it to the final review were published between 2001 and 2019; 17 of them evaluated patients undergoing spinal surgery, and 14 reported on patients receiving advanced cancer care. Patients undergoing spinal surgery, according to the researchers, “had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work.” Expectations were also high among patients with advanced cancer undergoing palliative treatment; in this case, they overestimated their odds of survival and cure rates. Spine surgeons can play an important role in patients’ expectations by giving them information—but not too much, or too little. Some studies noted that patients did not know what to expect after surgery and didn’t feel like they were prepared for the postoperative period; at least two patients said that they would undergo the surgery and be relieved of their pain, more or less, without a significant recovery period. However, the researchers noted that if there’s too much information, the patient may not retain it, or they may forget. Patient demographics may influence expectations, too, but exactly what these associations are varied by study. In the spinal surgery group, two studies found that younger patients with higher physical and functional impairment were more likely to expect to make a complete recovery. One study found that general preoperative health indicated higher preoperative expectations, but another study found this was not the case. The study was published in BMC Cancer.