Abstract
Background
A dedicated referral pathway for patients with bony metastases was introduced at Guy's and St Thomas’ Hospitals (GSTT) in 2009. The aim was to facilitate prompt, consultant-led decision-making and intervention for patients at risk of pathological fracture of long bones.
Methods
We performed a clinical audit and service evaluation of the referral pathway through retrospective review of referrals over 3.5 years.
Results
75 patients referred from 7 different specialties, (34:41 male:female), mean age 64. 16 different types of primary cancer identified, the most common being breast (22/75). Location of metastasis was most commonly the femur (59/75). 24 patients underwent surgery, with femoral nail the most common procedure (13/24). Patients in the surgery group were younger, with higher Mirel's score, less visceral metastases and survived longer after surgery than patients treated non-operatively. Median referral-clinic time was 10 days and referral-surgery time was 14 days.
Conclusions
Our data demonstrate the importance of this service and the growing demand. We have updated trust guidelines and improved our referral process through GSTT's Electronic Patient Record system. We have presented this data at local level to improve awareness and intend to reduce referral-clinical review time and have recently established a multidisciplinary meeting to improve patient outcome.
Level of Evidence
3
