A multidisciplinary team is the best way to provide what bone mets patients need.
A diagnosis of metastatic cancer from one location into the bone (e.g. from breast, prostate, kidney, etc.) is called bone mets. It is different from primary bone cancer that originates in the bone, and is particularly discouraging because the patient has already been dealing with cancer for months or even years. Now this new finding means more doctor visits, different treatments, and the kinds of critical care that are required if there is a sudden bone breakage, such as a compression fracture in the spine.
The reality of bone mets is that it adds numerous complexities and logistical challenges to a situation that already drains the emotional, energy and financial resources of patients and their families. As one article sums it up, “Bone metastasis is a devastating condition that can have a negative impact on the lives of patients with advanced cancer in many ways. Patients may experience limitations in the activities of daily living (ADL), decreases in quality of life (QOL), threat of survival and increases in medical expenses.”i
The needs of patients in such daunting circumstances are best met by a multidisciplinary team approach. While not all patients and families will live in an area where they have access to each type of specialist, here is a list of potential team members, each of whom has a specific contribution toward a total care picture.
- Primary care doctor and nursing staff – this is usually the professional with whom the patient has the longest relationship, and can contribute important information about the patient’s health history as well as be a source of emotional support and encouragement
- Oncologist(s) – as a cancer specialist, the oncologist is sort of the CEO of the patient’s care, knowledgeable about the chemotherapies, local treatments such as radiation or ablation of a tumor, surgeries, other medications and pain relief
- Radiologist (for imaging) and radiation oncologist (for radiation treatment if prescribed) – while these specialists aren’t usually part of ongoing patient management, they provide periodic interventions such as imaging, image-guided treatments or radiation therapy
- Orthopedists – surgeons who specialize in bone diseases and injuries. As with radiologists, they may have periodic involvement with the patient when bone deterioration or damage occurs as a result of the bone tumors
- Rehabilitation doctors and physical therapists – physical rehab can help bone mets patients cope with daily activities, and help “retrain” basic movement, posture and strength with a view to minimize the need for pain medication and movement aids as long as possible
- Medical social workers – these specialists are specially trained in networking and liaison with community services and agencies as well as clinical mental health providers for emotional support. They create a “cocoon” of support resources that pick up where medicine leaves off. Especially if there are financial burdens, a medical social work can help patients wade through the administrative details of seeking some type of aid and assistance.
- Dentists – let’s not forget that while all these other medical appointments are happening, the person who cares for the patient’s teeth should be included in the team. Many biochemical changes occur under the influence of cancer drugs, and things like dry mouth or more acidic saliva are changes in the oral environment that can amplify tooth problems
- Pastoral counselors – for patients who turn to their faith for consolation and perseverance, the presence of pastoral caregivers on their team is essential to help them and their families cope and come to terms with each new turn of clinical events.
- Support groups – it may be hard to find a local support group devoted solely to bone mets patients, but the American Cancer Society can be instrumental in steering patients and caregivers to a broad cancer support group. The types of cancer may be different, but many of the same challenges and concerns confront patients with advanced metastasis.
In short, the idea that “it takes a village” applies to bone mets patients who need to be sustained physically, emotionally, mentally and spiritually. In particular, a hospital or academic medical center almost always has a social worker on staff, and that person can be a useful starting point for identifying nonmedical resources and helping the patient connecting with them.
Finally, for bone mets patients who have trouble “receiving” support and help because they are worried that they are being “selfish”, it’s important to remember that graciously receiving help is a gift to the person in a position to provide it. So take advantage of as much help as possible in your area and hopefully it will improve your quality of life.
iShibata, H et al “Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese Orthopedic Association, Japanese Urological Association, and Japanese Society for Radiation Oncology.” ESMO Open 1.2 (2016): e000037. Web. 18 May. 2017.
- Bone mets