Bone cancer chaos set for reform

Bone cancer is often a secondary symptom of breast cancer

Doctors are to receive new guidelines to ensure that women who suffer from bone disease due to breast cancer get appropriate treatment and support.

In the UK approximately 9,000 women with breast cancer develop secondary bone cancer (bone metastases) every year.

Many of these patients will have several years to live yet the responsibility for different stages of the disease falls between up to seven or eight different specialties, including orthopaedic surgeons, oncologists and radiologists.

This has lead to a lack of co-ordinated care for women who badly need care.

Hugh Bishop, Secretary of the British Association of Surgical Oncologists breast specialty group, said: "Patients with bone metastases suffer a great deal of pain.

"The pain is so excruciating that in many cases they are bed-bound, either at home or in hospital.

"With proper coordination, which includes surgery, radiotherapy and drug treatment, you can fix that, so that the patients can be self-caring."

According to Mr Bishop, a consultant surgeon in the West Midlands, implementation of the guidelines will ensure that breast cancer patients see the right people at the right time and get the treatment they need. This will inevitably improve their quality of life.

Bone is the site of first recurrence in up to 40% of women with relapsing or metastatic breast cancer.

Tumour-induced bone loss causes significant bone pain, fractures and hypercalcaemia (excessive calcium in the blood).

These problems are normally associated with an accelerated loss of bone or an imbalance between the body's bone formation and resorption mechanisms.

Women can be bed bound by the disease

A recent review of women with breast cancer and bone metastases showed that less than half of those patients who may have benefited from a clinical review by an orthopaedic surgeon were referred.

Mr Bishop said: "One objective of these guidelines is that each cancer unit designates an orthopaedic surgeon who then takes an interest in how these patients are managed."

Roger Tillman, a consultant orthopaedic oncologist in Birmingham, added: `We know that a number of patients undergo unnecessary operations and people are confined to hospital wards, hospices and other institutions because they are immobile. The cost is huge in terms of money and of suffering."

The guidelines also recommend the use of supportive drug therapy which provide acute treatment for hypercalcaemia and severe bone pain, and may decrease the risk of developing further bone metastases.

The British Association of Surgical Oncologists' (BASO) Guidelines for the Management of Bone Metastases in Breast Cancer will be published in The European Journal of Surgical Oncology in February next year.