Pre-treatment expectations of patients with spinal metastases: what do we know and what can we learn from other disciplines? A systematic review of qualitative studies

R Gal; D Oostinga; H Wessels; J J Verlaan; R Charest-Morin; C G Fisher; H M Verkooijen; A L Versteeg

doi:10.1186/s12885-020-07683-7

Pre-treatment expectations of patients with spinal metastases: what do we know and what can we learn from other disciplines? A systematic review of qualitative studies

BMC Cancer. 2020 Dec 9;20(1):1212. doi: 10.1186/s12885-020-07683-7.

Authors

R Gal¹, D Oostinga², H Wessels³, J J Verlaan², R Charest-Morin⁴, C G Fisher⁴, H M Verkooijen⁵, A L Versteeg⁵

Affiliations

¹ Division of Imaging and Cancer, University Medical Center Utrecht, University of Utrecht, Heideberglaan 100, 3584, CG, Utrecht, the Netherlands. R.Gal@umcutrecht.nl.
² Department of Orthopaedic Surgery, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands.
³ Department of Corporate Communications, University Medical Center Utrecht, Utrecht, The Netherlands.
⁴ Department of Orthopaedics, Division of Spine, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Division of Imaging and Cancer, University Medical Center Utrecht, University of Utrecht, Heideberglaan 100, 3584, CG, Utrecht, the Netherlands.

Abstract

Background: Little is known about treatment expectations of patients with spinal metastases undergoing radiotherapy and/or surgery. Assuming that patients with spinal metastases share characteristics with patients who had spinal surgery for non-cancer related conditions and with advanced cancer patients, we performed a systematic review to summarize the literature on patient expectations regarding treatment outcomes of spinal surgery and advanced cancer care.

Methods: A comprehensive search was performed in MEDLINE, EMBASE and PsycINFO for studies between 2000 and sep-2019. Studies including adult patients (> 18 years), undergoing spinal surgery or receiving advanced cancer care, investigating patients' pre-treatment expectations regarding treatment outcomes were included. Two independent reviewers screened titles, abstracts and full-texts, extracted data and assessed methodological quality.

Results: The search identified 7343 articles, of which 92 were selected for full-text review. For this review, 31 articles were included. Patients undergoing spinal surgery had overly optimistic expectations regarding pain and symptom relief, they underestimated the probability of functional disability, and overestimated the probability of (complete) recovery and return to work. Studies highlighted that patients feel not adequately prepared for surgery in terms of post-treatment expectations. Similarly, advanced cancer patients receiving palliative treatment often had overly optimistic expectations regarding their survival probability and cure rates.

Conclusions: Patients tend to have overly optimistic expectations regarding pain and symptom relief, recovery and prognosis following spinal surgery or advanced cancer care. Pretreatment consultation about the expected pain and symptom relief, recovery and prognosis may improve understanding of prognosis, and promote and manage expectations, which, in turn, may lead to better perceived outcomes.

Trial registration: PROSPERO registration number: CRD42020145151 .

Keywords: Advanced cancer; Patient expectations; Spinal metastases; Spine surgery; Treatment outcomes.

Publication types

Systematic Review

MeSH terms

Activities of Daily Living
Adult
Aged
Anticipation, Psychological*
Counseling
Female
Humans
Male
Middle Aged
Motivation*
Neurosurgical Procedures / psychology*
Pain / etiology
Pain / psychology
Patients / psychology*
Qualitative Research
Quality of Life
Radiotherapy / psychology*
Recovery of Function
Socioeconomic Factors
Spinal Neoplasms / psychology
Spinal Neoplasms / radiotherapy
Spinal Neoplasms / secondary*
Spinal Neoplasms / surgery
Treatment Outcome