Nathan et al identified a number of prognostic factors associated with a short survival in patients with a pathologic fracture requiring surgery. This can help identify patients who may benefit from palliative care. the authors are from Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University in New York City.
Patient selection: Patient with cancer causing a pathologic fracture requiring orthopedic surgery
Parameters associated with a median survival of <= 7 months:
(1) primary site of the cancer
(2) ECOG performance scale
(3) number of bone metastases
(4) visceral metastases
(5) hemoglobin
Parameter |
Finding |
Points |
primary site of the cancer |
breast, renal or prostate |
0 |
|
lung |
1 |
|
other |
1 |
ECOG performance scale |
0, 1 or 2 |
0 |
|
3 or 4 |
1 |
number of bone metastases |
1 |
0 |
|
>= 2 (multiple) |
1 |
visceral metastases |
none |
0 |
|
present |
1 |
hemoglobin |
> 10 g/dL |
0 |
|
<= 10 g/dL |
1 |
where:
• A patient with a pathologic fracture has to have at least 1 bone metastasis.
• The hemoglobin is based on the untransfused status.
number of risk factors for a short survival =
= SUM(points for all 5 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 5
• A patient with a low hemoglobin or lung cancer may have a median survival < 4 months.
• A survival <= 3 months was short, 3.01 to <= 9 intermediate, and > 9 months long.
Purpose: To identify a patient with a pathologic fracture requiring orthopedic surgery who has a poor prognosis based on the criteria of Nathan et al.
Specialty: Hematology Oncology, Surgery, general
Objective: severity, prognosis, stage
ICD-10: M84.4,