Every kind of cancer can spread to the spine, yet two physician-scientists who treat these patients describe a paucity of guidance for effectively providing care and minimizing pain.

To resolve the confusion and address the continually changing landscape of spine oncology, a recent Michigan Medicine-led publication details a guide to explain the management of spinal metastases.

Published in The Lancet Oncology, the work is the result of reviewing all of the existing studies and pulling in experts from across the world to provide insight. The goal, says senior author Nicholas Szerlip, M.D., a neurosurgeon at the University of Michigan, is to get all providers on the same page.
First author Daniel Spratt, M.D., who with Szerlip co-founded U-M's multidisciplinary spine oncology clinic, says patients with spine metastases are commonly managed in silos without integrated care. A patient with a spine metastasis might see a variety of subspecialty doctors. Recommendations could range from pain management to more aggressive treatment, and referring providers don't always know what will come out of a referral to spine oncology experts, or when a referral is necessary.

"Spine oncology is such a multidisciplinary pathology," says Szerlip, an associate professor. "We wanted to form a transparent understanding so everyone, from the oncologists and primary care providers to fellow neurosurgeons who aren't specifically trained on this, could lean on one algorithm in language we can all understand."

Spratt describes the algorithm, a report from the researchers' new International Spine Oncology Consortium, as a step-by-step method designed to help comprehensively manage these patients as they grow in number and their life spans lengthen after diagnosis. He says the goal is to help providers treat the patient and not just the tumor, taking into account the patient's performance status, life expectancy, burden of systemic disease and available treatment options.

"Most of the frameworks that have been available prior to this have focused on just surgery or just radiation," Spratt says. "This algorithm integrates all of the specialties together, including PM&R, radiology and medical oncology, to provide a much more personalized treatment approach for patients with metastatic cancer to the spine."

A different approach

Cancer can spread widely through the body, yet this algorithm specifically focuses on metastases to the spine. Researchers say a metastasis in the spine throws a wrench in typical treatment plans because of the sensitivity of the spinal cord. Quality of life can worsen much faster.

Rad Oncology Homepage