Subspecialized Care at Mass General for Cancer Metastatic to Bone
In This Article
- Interdisciplinary conversations and collaborations produce the best care for cancer metastatic to bone
- The Massachusetts General Hospital's Bone & Spine Metastasis Program expands access to expertise from bone and spine specialists offering care for patients with cancer metastatic to bone
- Program team members act as supportive partners to the patients' existing cancer care team and prioritize ease of access, prompt responses, and good communication
- Mass General bone and spine specialists can answer questions about bone involvement or provide advanced treatments to optimize care
Bone metastasis is common in many cancers (e.g., prostate cancer, breast cancer, lung cancer, and multiple myeloma). Providers in Massachusetts General Hospital's Bone & Spine Metastasis Program offer patients and their care teams an unparalleled level of expertise and dedication for cancer metastatic to bone.
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The Bone & Spine Metastasis Program
Interdisciplinary communication is a vital part of cancer care at Mass General. The ability to reach out for input, expertise, and partnership from other specialists is often crucial for high-quality, comprehensive treatment. If communication is easy along the way, then the barriers to requesting help are much lower.
The Bone & Spine Metastasis Program aims to provide an easy entryway into subspecialized bone cancer care for providers and patients in New England and beyond. Clinicians in the program include cancer-focused orthopedic surgeons, musculoskeletal radiologists, neurosurgeons, and radiation oncologists.
"Pain or the fear of a sudden fracture event has such as profound effect on quality of life. For that reason, it's worth prioritizing bone-specific care," reflects Philip Saylor, MD, medical oncologist and director of Mass General's Cancer Center Infusion Center. Dr. Saylor played an integral role in the development of the program and as a medical oncologist himself frequently collaborates with the team while providing care for his patients.
A Partnership for Metastatic Bone Cancer Treatment
The Bone & Spine Metastasis Program team works to complement—not replace—a patient's existing cancer team. Bone and spine specialists provide expertise and treatment while respecting the longitudinal relationships that patients already have in place.
Dr. Saylor values the supportive nature of the program as a medical oncologist, a role that he likens to a primary care physician within patients' cancer journeys. "I would never want to send a patient elsewhere for subspecialty input without knowing the thoughts and plans of those clinicians and having the opportunity to interact with them," he says.
When partnering with the program's bone specialists, providers like him can give and receive input to facilitate coordinated care. The team prioritizes integrated and truly collaborative decision-making for each patient.
Bone Metastasis Consultations and Referrals: When to Reach Out
While not every cancer case involving bone needs subspecialty expertise, many do. "Those of us who care for patients with cancer are often not experts at the bone aspect of their care, yet some type of bone involvement by cancer is common," says Dr. Saylor. "Anytime there is a question a little outside our primary expertise, we should have a low threshold to reach out for input."
A conversation across disciplines helps determine what treatment plan will provide the fastest result with sustained effects over the long term. The program offers an accessible, responsive resource for any bone-related question or problem, such as:
- Establishment of a new cancer diagnosis brought to medical attention from bone symptoms
- Management of bone metastasis symptoms, such as pain and radiculopathy
- Structurally concerning lesions on imaging tests
Dr. Saylor shares that he often considers fracture risk in patients. Maybe he sees a spot of cancer on an imaging study or a symptom that is evolving in a concerning way. "Does the bone need to be surgically stabilized, or could some external beam radiation quiet down the problem without anything invasive?" he asks.
"I have the passing thought and, because I know colleagues in the program so well, I reach out to them in real-time through an electronic message or phone call," he says. The program aims to offer this opportunity to easily contact expert bone-focused subspecialists to all providers.
Dr. Saylor highlights metastasis of vertebral bodies of the spine as an instance when collaborative care among specialists is key. Spinal metastasis may be recognized on an imaging scan or from symptoms, or both.
"Stabilization or decompression surgery is sometimes needed. In other cases, a noninvasive approach with external beam radiation may be the best fit. Or interventional procedures such as vertebral body augmentation may be a component of treatment," says Dr. Saylor.
An active discussion among multiple specialists and the referring provider produces the best patient-centered decisions.
What to Expect From Care Collaboration
When team members receive a bone metastasis consult or referral, they first want to learn the patient's history. Following that initial conversation, a bone specialist evaluates the patient as soon as possible.
Program providers offer virtual and in-person patient visits. They review any previously completed testing and work with the patient's existing team to determine what additional testing is needed and where it should be done.
The team considers many factors to guide treatment recommendations, including the patient's:
- Symptom profile at the time of evaluation
- Treatment goals and values
- Surgical candidacy and feelings about the possibility of needing surgery
Innovative Bone Cancer Care and Research
The program's primary mission is to improve the care and lives of patients with metastatic bone cancer. As part of this mission, bone specialists offer a range of advanced treatments.
"Having a sense for the entire landscape of what is available for that patient's situation, be it experimental or standard of care, is needed," says Dr. Saylor.
Metastatic bone cancer treatment may involve interventional image-guided therapies, radiation therapy, surgery, or a combination of approaches. The team offers a variety of minimally invasive techniques, including cryoablation and radiofrequency ablation. Surgeons use the latest implant technologies to surgically stabilize bone at risk for fracture, such as carbon fiber implants and photodynamic nails.
Patients can also access new therapies through clinical trials at Mass General Cancer Center. The program's clinicians have dedicated researchers, investigating cancer to improve care for the future. Topics of interest include:
- How bone metastases differ from the primary cancer, both molecularly and genetically
- Why some cancers spread more aggressively than others
- Optimal treatment options that differ from original treatment plans
The team's current research focuses on applying artificial intelligence to create prediction models. These models aim to inform cancer prognosis and outcomes, the occurrence of pathologic fractures, and the prediction of perioperative complications.
Connect With the Team
The Bone & Spine Metastasis Program team prioritizes prompt responses and easy communication. These core aspects of the program allow for meaningful interdisciplinary collaborations in real time.
The team strives to respond to consults and referrals within the same business day; specialists are available to answer questions that often cannot wait for a longer referral process.
To contact the program team directly, email BoneAndSpineMet@mgh.harvard.edu or call 617-726-2222.
Learn more about the Bone & Spine Metastasis Program
Learn more about the Mass General Cancer Center