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Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems

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Abstract

Purpose

To document the risk of skeletal complications in patients with bone metastases from breast cancer (BC), lung cancer (LC), or prostate cancer (PC) in routine clinical practice.

Methods

We used data from two large US health systems to identify patients aged ≥18 years with primary BC, LC, or PC and newly diagnosed bone metastases between January 1, 1995 and December 31, 2009. Beginning with the date of diagnosis of bone metastasis, we estimated the cumulative incidence of skeletal-related events (SREs) (spinal cord compression, pathologic fracture, radiation to bone, bone surgery), based on review of medical records, accounting for death as a competing risk.

Results

We identified a total of 621 BC, 477 LC, and 721 PC patients with newly diagnosed bone metastases. SREs were present at diagnosis of bone metastasis in 22.4, 22.4, and 10.0 % of BC, LC, and PC patients, respectively. Relatively few LC or PC patients received intravenous bisphosphonates (14.8 and 20.2 %, respectively); use was higher in patients with BC, however (55.8 %). In BC, cumulative incidence of SREs during follow-up was 38.7 % at 6 months, 45.4 % at 12 months, and 54.2 % at 24 months; in LC, it was 41.0, 45.4, and 47.7 %; and in PC, it was 21.5, 30.4, and 41.9 %. More than one half of patients with bone metastases had evidence of SREs (BC: 62.6 %; LC: 58.7 %; PC: 51.7 %), either at diagnosis of bone metastases or subsequently.

Conclusions

SREs are a frequent complication in patients with solid tumors and bone metastases, and are much more common than previously recognized in women with BC.

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Notes

  1. Primary bone cancer was included in the initial scan of administrative data stores, as the authors have found in prior work that metastatic disease to bone is sometimes miscoded as primary bone cancer.

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Acknowledgment

Dr. Oster, Dr. Edelsberg, and Ms. Lopez are employed by Policy Analysis Inc., Brookline, MA, which received study funding from Amgen Inc., Thousand Oaks, CA. Dr. Lamerato and Mr. Wolff are employed by Henry Ford Health System, Detroit, MI, which received study funding from Amgen Inc. Dr. Glass and Dr. Richert-Boe are employed by Kaiser Permanente Northwest Region, Portland, OR, which received study funding from Amgen Inc.; Ms. Dodge was employed by Kaiser Permanente Northwest Region at the time the study was conducted. Dr. Chung, Dr. Balakumaran, and Ms. Richhariya are employed by Amgen Inc., and may own stock or stock options in the company.

PAI has full control of all primary data and would agree to allow Supportive Care in Cancer to review the data, if requested.

Conflict of Interest

None.

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Authors and Affiliations

  1. Policy Analysis Inc. (PAI), Four Davis Court, Brookline, MA, 02445, USA

    Gerry Oster, Andrea Lopez & John Edelsberg

  2. Henry Ford Health System, Detroit, MI, USA

    Lois Lamerato & Greg G. Wolff

  3. Kaiser Permanente Northwest Region, Portland, OR, USA

    Andrew G. Glass, Kathryn E. Richert-Boe & Tracy Dodge

  4. Amgen Inc, Thousand Oaks, CA, USA

    Karen Chung, Akshara Richhariya & Arun Balakumaran

Authors
  1. Gerry Oster
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  2. Lois Lamerato
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  3. Andrew G. Glass
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  4. Kathryn E. Richert-Boe
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  5. Andrea Lopez
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  6. Karen Chung
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  7. Akshara Richhariya
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  8. Tracy Dodge
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  9. Greg G. Wolff
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  10. Arun Balakumaran
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  11. John Edelsberg
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Corresponding author

Correspondence to Gerry Oster.

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Oster, G., Lamerato, L., Glass, A.G. et al. Natural history of skeletal-related events in patients with breast, lung, or prostate cancer and metastases to bone: a 15-year study in two large US health systems. Support Care Cancer 21, 3279–3286 (2013). https://doi.org/10.1007/s00520-013-1887-3

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  • DOI: https://doi.org/10.1007/s00520-013-1887-3

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