Current diagnostic and therapeutical approaches to bone metastases in patients with non-small cell lung cancer: A cross-sectional study

Abstract

Introduction: The current study aims to investigate the current practice of bone metastasis management in patients with non-small cell lung cancer.

Methods: An online questionnaire was administered to 92 oncologists. A survey was developed and revised by dedicated experts and was composed of five sections: i) general and work characteristics, ii) diagnostic issues, ii) bone-targeted agents issues, iii) radiotherapy issues, and iv) supportive care issues. Descriptive statistics was applied.

Results: The 18F-FDG PET is the preferred evaluation for skeletal assessment for both patients with (62 %) and without (54 %) bone lesions at the CT scan; MRI (63 %) and 18F-FDG PET (61 %) are the most chosen radiographic assessments when a bone oligoprogression is suspected. The number of bone metastatic lesions was the main factor considered when deciding whether to start bone-targeted agents (57 %). In choosing between bone-targeted agents, renal toxicity was the most considered factor (62 %). Over half of the participants did not stop the systemic treatment during stereotactic radiotherapy (68 %) and considered re-irradiation on progressive bone metastases at least 6 months after prior radiotherapy (55 %). Overall, 64 % and 41 % of participants assessed patients' body weight and physical activity, respectively. Oral nutritional supplements or a specific diet were recommended by 34 % and 46 % of clinicians; 40 % of them also advised their patients to increase their physical activity levels, while 54 % were worried that exercise might increase the risk of skeletal-related adverse events.

Conclusions: Lung-cancer dedicated clinicians pay great attention to bone metastases-related diagnostic, bone-targeted agents, and radiotherapy issues, whereas the integration of supportive care approaches seem less standardized.

Keywords: Bone metastases; Bone-targeted agents, radiotherapy; Diagnosis; Nutrition; Physical activity.