178. Metastatic spine disease: should patients with short life expectancy be denied surgical care?

BACKGROUND CONTEXT Despite our inability to accurately predict survival in cancer patients, a life expectancy of at least three months is historically considered necessary for patients to be considered for surgical treatment of spinal metastases. With a wealth of new surgical and radiation technologies available, why would someone with incapacitating mechanical pain and/or progressive neurological deficit be denied treatment because their life expectancy is believed to be less than 3 months? PURPOSE The primary objective of this study was to compare health related quality of life (HRQOL) outcomes in patients surviving 3 months to assess the validity of this inclusion criteria for surgical consideration. STUDY DESIGN/SETTING International prospective observational cohort study. PATIENT SAMPLE Patients aged 18 to 75 who underwent surgical treatment for spinal metastases between August 2013 and May 2017 were identified from 10 centers in North America and Europe. OUTCOME MEASURES Demographic, histologic, treatment, performance status (ECOG), patient's satisfaction, adverse event and HRQOL data were collected. The primary outcome was the HRQOL at 6 weeks post-treatment measured by the SOSGOQ. Secondary outcome was patient satisfaction at 6 weeks post treatment. Other outcome measures included: NRS pain score, EQ-5D and the SF-36. METHODS Two groups were compared: those with an observed survival of less than 3 months (short survival group, SSG) and those with a survival of more than 3 months (long survival group, LSG). To control for baseline differences, we used an adjusted mixed effect model adjusted for baseline performance status (ECOG). RESULTS A total of 253 patients were included; 40 patients died within the first three months after surgery and 213 patients survived more than 3 months. Patients surviving 3 months. In unadjusted analyses, patients surviving more than 3 months experienced a significantly better HRQOL at 6 weeks compared to patients who survived less than 3 months (p=0.021). However, adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups (p=0.101) at 6 weeks post treatment. No significant difference in patient satisfaction at 6 weeks with regard to their treatment could be detected between both groups (p=0.484). CONCLUSIONS When controlled for baseline performance status, quality of life 6 weeks after surgery for spinal metastasis seems to be independent of survival. Expected survival on its own should not be an absolute exclusion criterion for surgical consideration. To optimize improvement in HRQOL for this patient population, baseline performance status, as well as patient preferences, should take priority over expected survival in the surgical decision-making process. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.