Author
Archer, James EChauhan, Govind S
Dewan, Varun
Osman, Khabab
Thomson, Calum
Nandra, Rajpal S
Ashford, Robert U
Cool, Paul
Stevenson, Jonathan
Affiliation
The Royal Orthopaedic Hospital NHS Foundation Trust; University Hospitals of Leicester NHS Trust; University of Leicester; Robert Jones and Agnes Hunt Orthopaedic Hospital; Keele University; Cambridge University Hospitals NHS Foundation Trust; Wirral University Hospital Trust; Royal Free London NHS Foundation Trust; Belfast Trust; Blackpool Victoria Hospital; Royal Bolton Hospital; Bradford Royal Infirmary; Broomfield Hospital; East Suffolk and North Essex NHS Foundation Trust; Royal Cornwall Hospital; Countess of Chester NHS Foundation Trust; University Hospitals of Derby and Burton NHS Foundation Trust; The Dudley Group NHS Foundation Trust; East Lancashire Hospitals Trust; Victoria Hospital Kirkcaldy; Newcastle Freeman Hospital; Royal Victoria Infirmary; Furness General Hospital; Royal Lancaster Infirmary; Forth Valley Royal Hospital; Glasgow Royal Infirmary; Gloucestershire Hospitals NHS Foundation Trust; Aneurin Bevan University Health Board; Guy's and St Thomas; Great Western Hospital; Hereford County Hospital; Hull University Teaching Hospitals; East Suffolk and North Essex NHS Foundation Trust; James Paget University Hospitals NHS Foundation Trust; Kettering General Hospital; Sherwood Forest Hospitals NHS Foundation Trust; NHS Lanarkshire; Leeds Teaching Hospitals NHS Trust; University Hospitals Leicester; Mid Cheshire NHS Foundation Trust; East and North Hertfordshire NHS Trust; Manchester University Hospitals; Musgrove Park Hospital; North Bristol NHS Trust; Norfolk and Norwich University Hospitals NHS Foundation Trust; Northampton General Hospital NHS Trust; Northumbria Healthcare; Nottingham University Hospitals NHS Trust; Royal Oldham Hospital; Oxford Sarcoma Service; Princess Alexandra Hospital; United Lincolnshire Hospitals NHS Trust; The Mid Yorkshire Hospitals NHS Trust; Poole Hospital NHS Foundation Trust; Princess Royal Hospital; Princess Royal University Hospital; Queen Alexandra Hospital; Queen Elizabeth Hospital; Queen Elizabeth The Queen Mother Hospital; Barking, Havering and Redbridge University Hospitals NHS Trust; Royal Devon and Exeter NHS Trust; The Royal Orthopaedic Hospital; Royal Preston Hospital; Royal Surrey County Hospital; Royal United Hospital; Sheffield Teaching Hospitals; South Tees Hospitals NHS Foundation Trust; Sandwell and West Birmingham NHS Trust; Torbay and South Devon NHS Trust; University College London Hospital; University Hospital Ayr & Crosshouse; University Hospitals Birmingham; University Hospitals of North Midlands; University Hospital of North Tees; University Hospitals Plymouth NHS Trust; University Hospital of Wales; Belfast Trust; Walsall Healthcare NHS Trust; The Walton Centre; Warrington and Halton Teaching Hospital; William Harvey Hospital; West Middlesex University Hospital, Chelsea & Westminster NHS Trust; Worcestershire Acute Hospitals NHS Trust; Western Sussex Trust; Wrexham Maelor Hospital; Manchester University Hospitals; Ysbyty Gwynedd; Aston UniversityPublication date
2023-10-01
Metadata
Show full item recordAbstract
Aims: Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in the UK. Methods: A prospective, multicentre, national collaborative audit was designed and delivered by a trainee-led collaborative group. Data were collected over three months (1 April 2021 to 30 June 2021) for all patients presenting with MBD. A data collection tool allowed investigators at each hospital to compare practice against guidelines. Data were collated and analyzed centrally to quantify compliance from 84 hospitals in the UK for a total of 1,137 patients who were eligible for inclusion. Results: A total of 846 patients with pelvic and appendicular MBD were analyzed, after excluding those with only spinal metastatic disease. A designated MBD lead was not present in 39% of centres (33/84). Adequate radiographs were not performed in 19% of patients (160/846), and 29% (247/846) did not have an up-to-date CT of thorax, abdomen, and pelvis to stage their disease. Compliance was low obtaining an oncological opinion (69%; 584/846) and prognosis estimations (38%; 223/846). Surgery was performed in 38% of patients (319/846), with the rates of up-to-date radiological investigations and oncology input with prognosis below the expected standard. Of the 25% (215/846) presenting with a solitary metastasis, a tertiary opinion from a MBD centre and biopsy was sought in 60% (130/215). Conclusion: Current practice in the UK does not comply with national guidelines, especially regarding investigations prior to surgery and for patients with solitary metastases. This study highlights the need for investment and improvement in care. The recent publication of British Orthopaedic Association Standards for Trauma (BOAST) defines auditable standards to drive these improvements for this vulnerable patient group.Citation
Archer JE, Chauhan GS, Dewan V, Osman K, Thomson C, Nandra RS, Ashford RU, Cool P; BOOM Audit Group; Stevenson J. The British Orthopaedic Oncology Management (BOOM) audit. Bone Joint J. 2023 Oct 1;105-B(10):1115-1122.Type
ArticlePMID
37777202Journal
The Bone & Joint Journalae974a485f413a2113503eed53cd6c53
10.1302/0301-620X.105B10.BJJ-2023-0443.R1