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. 2023 Oct 1;105-B(10):1115-1122.
doi: 10.1302/0301-620X.105B10.BJJ-2023-0443.R1.

The British Orthopaedic Oncology Management (BOOM) audit

James E Archer  1 , Govind S Chauhan  1 , Varun Dewan  1 , Khabab Osman  1 , Calum Thomson  1 , Rajpal S Nandra  1 , Robert U Ashford  2   3 , Paul Cool  4   5 ; BOOM Audit Group; Jonathan Stevenson  1   6
Affiliations

The British Orthopaedic Oncology Management (BOOM) audit

James E Archer et al. Bone Joint J. .

Abstract

Aims: Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in the UK.

Methods: A prospective, multicentre, national collaborative audit was designed and delivered by a trainee-led collaborative group. Data were collected over three months (1 April 2021 to 30 June 2021) for all patients presenting with MBD. A data collection tool allowed investigators at each hospital to compare practice against guidelines. Data were collated and analyzed centrally to quantify compliance from 84 hospitals in the UK for a total of 1,137 patients who were eligible for inclusion.

Results: A total of 846 patients with pelvic and appendicular MBD were analyzed, after excluding those with only spinal metastatic disease. A designated MBD lead was not present in 39% of centres (33/84). Adequate radiographs were not performed in 19% of patients (160/846), and 29% (247/846) did not have an up-to-date CT of thorax, abdomen, and pelvis to stage their disease. Compliance was low obtaining an oncological opinion (69%; 584/846) and prognosis estimations (38%; 223/846). Surgery was performed in 38% of patients (319/846), with the rates of up-to-date radiological investigations and oncology input with prognosis below the expected standard. Of the 25% (215/846) presenting with a solitary metastasis, a tertiary opinion from a MBD centre and biopsy was sought in 60% (130/215).

Conclusion: Current practice in the UK does not comply with national guidelines, especially regarding investigations prior to surgery and for patients with solitary metastases. This study highlights the need for investment and improvement in care. The recent publication of British Orthopaedic Association Standards for Trauma (BOAST) defines auditable standards to drive these improvements for this vulnerable patient group.

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Conflict of interest statement

J. Stevenson reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Adler, Implantcast, and Stryker, unrelated to this study. K. Osman reports an unpaid leadership or fiduciary role on the Birmingham Orthopaedic Network. P. Cool reports an investigator-initiated grant from Stryker, a grant from Bone Cancer Research Trust, and a grant from Institute Orthopaedics, Oswestry, all of which are unrelated to this study. P. Cool is also a statistical advisor for the Journal of Hand Surgery and a trustee for the British Sarcoma Group.

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