Institutional disparities in the treatment of bone metastases by orthopaedic surgeons at training facilities designated by the Japanese orthopaedic association-A nationwide survey.

Background: Bone metastases are the main cause of locomotive syndrome in cancer patients (Cancer Locomo). They should be appropriately managed to improve patients' activities of daily living and quality of life, especially in designated cancer care hospitals (DCCHs). Still, the actual involvement of orthopedic surgeons in managing bone metastases was uncertain.

Materials and methods: In 2018, an online questionnaire of 38 questions was used to conduct a nationwide survey among orthopaedic training facilities. Eleven questions were used to clarify whether orthopaedic surgeons were actively involved in bone metastasis treatment, whether bone metastases were operated equally and actively, and whether there were any barriers to decision-making in bone metastasis treatment.

Results: As much as 36.4 % of the DCCHs answered that they were not actively involved in bone metastasis treatment and would never be. 4,783 surgeries were performed in 1,423 facilities. 316 DCCHs did 2,833 surgeries. The mean ± standard deviation of the number of bone metastasis surgeries at each DCCH was 9.0 ± 7.6, whereas that per 1,000 registered cancer patients was 5.2 ± 3.9. Basic surgical procedures, such as biopsy and internal fixation, were unavailable in approximately 15 % of the DCCHs. The most common barrier to decision-making in bone metastasis treatment was cancers of unknown primary. DCCHs having >6 certified orthopaedic surgeons and ≥1 specialist(s) in bone and soft tissue tumors did more surgeries of a wider variety with fewer concerns.

Conclusion: Overall, orthopaedic surgeons were not actively involved in bone metastasis treatment. Bone metastases were not operated on equally or actively. Various factors, including the burden to handle cancers of unknown primary, disturbed decision-making in bone metastasis treatment. Increasing awareness of the importance of Cancer Locomo management and aligning with in-hospital other departments or outside specialists in bone and soft tissue tumors may improve this situation.