Prospective analysis of health-related quality of life after surgery for spinal metastases

Short-term assessment of functional outcomes and quality of life after thoracic and lumbar spinal metastasis surgery

Background

Because of improvements in initial tumor identification and treatment, as well as longer life expectancies, more people are receiving diagnoses for spinal metastases.

Objective

The aim of this study was to assess early functional outcomes and quality of life (QOL) after surgical management of patients with spinal metastases.

Patients and Methods

In this prospective cohort study, a total of 33 patients with thoracic and lumbar spine metastases who underwent surgical management between November 2021 and August 2023 were followed up for 1 year or until death. Oswestry Disability Index and the Eastern Cooperative Oncology Group Performance Status were used for the functional outcome; QOL was assessed using European Quality of Life 5-Dimensions (EuroQOL-5D). Scores were recorded preoperatively, 4 weeks postoperatively, and 6 and 12 months postoperatively.

Results

The mean age was 52.12 ± 13.4 years (range: 23-70 years), 22 (66.7%) were females, and 11 (33.3%) were males. Patients were divided into three groups according to the revised Katagiri score: 12 (36.4%) patients were at low risk (0-3), 18 (54.5%) patients were at intermediate risk (4-6), and 3 (9.1%) patients were at high risk (7-10). The mean survival was 5.44 ± 3.46 months (range 1-13), and there was no perioperative death (within 1 month postoperative). Sixteen (48.5%) patients survived for more than 1 year and 17 (51.5%) patients died from different causes related to the natural history of tumor metastasis.

Conclusion

Following surgical treatment of the spinal metastases, improvements in QoL and functional results were seen in the short-term. For patients with a projected life expectancy of longer than 3 months, surgery is a good alternative.

Risk Factors for Poor Outcome after Palliative Surgery for Metastatic Spinal Tumors

Palliative surgery is performed to improve the quality of life of patients with spinal metastases. However, it is sometimes difficult to achieve the expected results because the patient's condition, and risk factors related to poor outcomes have not been well elucidated. This study aimed to evaluate the functional outcomes and investigate the risk factors for poor outcomes after palliative surgery for spinal metastasis. We retrospectively reviewed the records of 117 consecutive patients who underwent palliative surgery for spinal metastases. Neurological and ambulatory statuses were evaluated pre- and post-operatively. Poor outcomes were defined as no improvement or deterioration in functional status or early mortality, and the related risk factors were analyzed using multivariate logistic regression analysis. The results showed neurological improvement in 48% and ambulatory improvement in 70% of the patients with preoperative impairment, whereas 18% of the patients showed poor outcomes. In the multivariate analysis, low hemoglobin levels and low revised Tokuhashi scores were identified as risk factors for poor outcomes. The present results suggest that anemia and low revised Tokuhashi scores are related not only to life expectancy but also to functional recovery after surgery. Treatment options should be carefully selected for the patients with these factors.

Validity and reliability of the Thai version of the Spine Oncology Study Group Outcomes Questionnaire version 2.0 to assess Quality of Life in Patients with Spinal Metastasis

BACKGROUND CONTEXT

The Spine Oncology Study Group Outcomes Questionnaire version 2.0 (SOSGOQ2.0) is a spinal metastasis (SM)-specific quality of life (QoL) questionnaire that was previously reported to have good reliability and validity. There is currently no Thai version of the SOSGOQ 2.0. (TH-SOSGOQ2.0).

PURPOSE

To assess the psychometric properties of the TH-SOSGOQ 2.0.

STUDY DESIGN/SETTING

Cross-sectional study. Faculty of Medicine Siriraj Hospital, Mahidol University.

PATIENT SAMPLE

Patients who were confirmed diagnosis of metastatic spinal disease, age 18 to 75 years, and having already undergone surgery and/or radiotherapy for the treatment of spinal metastasis.

OUTCOME MEASURES

Validity and reliability of the TH-SOSGOQ 2.0 to assess QoL in Patients with SM.

METHODS

Using the forward-backward translation technique, the SOSGOQ2.0 was translated into Thai language to create the TH-SOSGOQ2.0. SM patients were prospectively enrolled and evaluated for patient QoL using both the TH-SOSGOQ2.0 and the EQ-5D-5L (Thai version) at baseline and 3 months after treatment. Construct validity was assessed using multi-trait scaling analysis, confirmatory factor analysis, and correlation with EQ-5D-5L. Test-retest reliability was assessed in a subgroup of patients who took the TH-SOSGOQ2.0 two times one week apart.

RESULTS

Sixty-eight patients (mean age: 57 years; 30 males, 38 females) were included. The Cronbach's alpha values for the total score, physical function, neurological function, pain, mental health, social function, and post-therapy domains were 0.87, 0.89, 0.91, 0.84, 0.82, 0.75, and 0.85, respectively. Good reliability was demonstrated (interclass correlation coefficient range: 0.70-0.84), except for the social function domain (0.60). Regarding concurrent validity, the TH-SOSGOQ2.0 domains demonstrated moderate to good correlation with the corresponding EQ-5D-5L 9 (Thai version) domains (range: -0.32 to -0.78). Physical function was the most well-correlated domain with the EQ-5D-5L (Thai version) (-0.77).

CONCLUSIONS

TH-SOSGOQ2.0 demonstrated good reliability and validity for assessing QoL in Thai SM patients.