The diagnosis and management of metastatic bone disease in general practice

2021 ◽  
pp. 175573802110103
Author(s):  
Natalie Cheyne ◽  
David Nichols ◽  
Amit Kumar
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
Cancer Treatment ◽  
Bone Disease ◽  
Secondary Care ◽  
Early Recognition ◽  
Survival Rates ◽  
Metastatic Bone Disease ◽  
The Uk

As cancer treatment improves and survival rates continue to increase, clinicians are seeing increasing numbers of patients with metastatic bone disease (MBD). This term describes cancer that has originated in another organ and subsequently spread to the bone. It is a condition that can severely impact the quality of life for an individual and the treatment is often not curative. This article aims to cover the management of MBD, from early recognition to secondary care interventions. The care of individuals with MBD is evolving in the UK, with the development of specialist regional referral pathways to facilitate prompt and timely management.

scholarly journals Electrochemotherapy and Simultaneous Photodynamic Bone Stabilization of Upper Limbs in Metastatic Renal Cancer Disease: Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ugo Albertini ◽  
Andrea Conti ◽  
Nicola Ratto ◽  
Pietro Pellegrino ◽  
Michele Boffano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Invasive Technique ◽  
Bone Lesions ◽  
Disease Case ◽  
Lytic Bone Lesions

Introduction. Metastatic bone disease represents a systemic pathology that heavily affects the quality of life of oncologic patients causing pain and functional disability. Methodology. We present the case of a patient with a history of renal cell cancer presenting pathologic fractures of both humeri and proximal right radius. Results. After a careful multidisciplinary approach, an adjuvant anticancer therapy and a photodynamic bone stabilization procedure were performed with a minimally invasive technique aiming to minimize pain and local disease progression, while restoring functional autonomy and improving the patient’s quality of life. Electrochemotherapy was delivered on the lytic bone lesions with extraskeletal involvement of the proximal left humerus and the proximal right radius, and then polymeric bone stabilization was performed on both humeri. At two months of follow-up, the patient presented satisfactory functional scores (MSTS score: 12/30 bilaterally; DASH scores: 46.7/100 for the right side and 48.3/100 for the left one), and pain was well controlled with opioid analgesics. Radiographs showed good results in terms of ossification of lytic bone lesions and durability of polymeric stabilization. At four months of follow-up, the patient reported a stable clinical scenario. Six months after surgery, due to extremely poor prognosis after the progression of primary disease, the patient was referred to palliative care and died shortly thereafter. Conclusion. Over the last decade, the management of metastatic bone disease has changed. Low-toxicity and minimally invasive procedures such as electrochemotherapy and polymeric bone stabilization might be performed concomitantly in selected patients, as an alternative to radiation therapy and to more demanding surgical procedures such as plating and adjuvant cementing.

Varicose veins—Who should be referred?

2015 ◽  
Vol 30 (2_suppl) ◽  
pp. 4-8 ◽  
Author(s):  
Sarah Onida ◽  
Alun H Davies ◽  
Ian Franklin
Keyword(s):  
Quality Of Life ◽  
Secondary Care ◽  
Varicose Veins ◽  
Venous Disease ◽  
Evidence Based ◽  
Negative Effects ◽  
Referral Criteria ◽  
Assessment And Treatment ◽  
The Uk

Varicose veins are a common, progressive condition in the UK, with significant negative effects on patients’ quality of life. Despite their prevalence, access to secondary care for the assessment and treatment of varicose veins can be variable throughout the country. The National Institute of Health and Care Excellence guidelines developed in 2013 provide evidence-based guidance on the referral, assessment, and management of the patient with venous disease. In this article, we review the development of the guidelines for the management of varicose veins over the last 15 years, highlighting the latest changes in referral criteria.

scholarly journals Chronic asthma in adults

2019 ◽  
Vol 13 (1) ◽  
pp. 29-38
Author(s):  
Laura Wiffen ◽  
Jessica Gates ◽  
Thomas Brown ◽  
Hitasha Rupani ◽  
Jayne Longstaff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Practice ◽  
British Thoracic Society ◽  
Chronic Asthma ◽  
Mortality And Morbidity ◽  
Global Initiative For Asthma ◽  
Global Initiative ◽  
The Uk ◽  
Treatable Condition

There are around 5.4 million people in the UK with asthma. Poorly controlled asthma places a particular burden on the NHS, and diminishes patients’ quality of life. More significantly, there are an estimated 1400 deaths from asthma each year in the UK, many of which are preventable. This is unacceptably high for a treatable condition. General practice carries much of the responsibility for diagnosis and management of asthma, and there is potential to improve the mortality and morbidity rates from asthma by improving knowledge transfer between GPs and their patients and the use of guidelines on compliance with agreed treatment paths. There are three separate sets of guidelines for the diagnosis and treatment of asthma: The British Thoracic Society and Scottish Intercollegiate Guidelines Network guidelines, The National Institute for Health and Care Excellence guidelines, and Global Initiative for Asthma guidelines. These will be reviewed throughout this article.

Role of Pamidronate Disodium in the Treatment of Metastatic Bone Disease

1998 ◽  
Vol 84 (4) ◽  
pp. 442-455 ◽  
Author(s):  
Carla Ripamonti ◽  
Fabio Fulfaro ◽  
Chiara Ticozzi ◽  
Alessandra Casuccio ◽  
Franco De Conno
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Multiple Myeloma ◽  
Bone Resorption ◽  
Bone Metastases ◽  
Bone Disease ◽  
Metastatic Bone Disease ◽  
Pamidronate Disodium ◽  
Phase Ii And Iii

Aims and Background Bone metastases are a common feature of advanced neoplastic disease and are considered to be among the most frequent causes of pain and complications in oncologic patients. The main objective of the treatment of such patients is to control their symptoms and improve their quality of life. Pamidronate disodium is a second-generation bisphosphonate capable of inhibiting bone resorption (particularly osteoclast activity) without affecting bone reminerali-zation. After a brief introduction concerning the pathophysiology of bone metastases and neoplastic bone pain, we herein present data on the clinical pharmacology and toxicity of bisphosphonates in general, and pamidronate in particular. We conclude by reviewing the literature on the use of pamidronate in phase II and III trials involving patients with metastatic bone disease. Methods The paper is based on a review of articles published between 1984 and 1997 selected from the Cancerline and Medline databases. Results In the considered phase II and III studies involving patients with bone metastases (breast cancer and multiple myeloma in particular), pamidronate proved to be efficacious in reducing the incidence of pain and skeletal complications, decreasing the excretion of metabolic markers of bone resorption and improving the quality of life. Intravenous infusions of 60-90 mg over a period of 2 hr every 3-4 weeks did not cause any significant toxic effects and was easily managed. Conclusions Pamidronate is a bisphosphonate that is efficacious in the treatment of symptomatic bone metastases and can be considered an important therapeutic option in association with systemic treatments, radiotherapy and normal supportive care, especially in patients with breast cancer and multiple myeloma. Further randomized studies are necessary to confirm the positive preliminary results in other neoplasms, analyze the cost/benefit ratio of the treatment, and verify the possibility that, in addition to being used for palliative purposes, pamidronate may also prevent or delay the appearance of bone metastases.

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