Article

OBJECTIVE: To distinguish which patients with bone metastases are at risk for
near-term disablement in order to assist clinicians in assessing the
appropriateness of referrals for rehabilitation services.
DESIGN: Prospective
cohort study. SETTING: National Cancer Institute-designated comprehensive cancer
center imbedded in a tertiary medical center. PARTICIPANTS: Data were collected
from members (n=78) of a patient cohort (N=311) with stage IIIB or IV
non-small-cell lung cancer or extensive-stage small-cell lung cancer who
developed new or progressive imaging-confirmed bone metastases during the 2-year
course of the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Functional capabilities were assessed at 3- to 4-week intervals over the study's
2-year duration with the Activity Measure for Post-Acute Care Computer Adaptive
Testing. RESULTS: Seventy-eight participants developed new or progressive bone
metastases during the study. Most were men, and 83% had non-small-cell lung
cancer. Metastases were most frequently located in the ribs (n=62), pelvis
(n=49), or the thoracic (n=60) and lumbar spine (n=44). While neither the number
of bone metastases nor their specific location was associated with near-term
changes in patient mobility, their association with pain or a focal neurologic
deficit was strongly associated with large declines in mobility. Similarly,
patients whose imaging studies revealed new metastases and the expansion of
established metastases were more likely to lose mobility. CONCLUSIONS: The total
burden, specific locations, and overall distribution of bone metastases did not
predict disablement. Patients with lung cancer-associated bone metastases are at
markedly increased risk for declining mobility when their metastases are
expanding in size and increasing in number, or are associated with pain or with new neurologic deficits.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS