Associations Between Problem List Items and Clinically Significant Distress in Patients with Metastatic Spine Disease

Dana G Rowe; Joshua Woo; Seeley Yoo; Jacqueline M Emerson; Ellen O'Callaghan; Michael Goodin; Kerri-Anne Crowell; Victoria Bradley; Jeremy Reynolds; Margaret O Johnson; Melissa M Erickson; C Rory Goodwin

doi:10.1097/BRS.0000000000005343

Associations Between Problem List Items and Clinically Significant Distress in Patients with Metastatic Spine Disease

Spine (Phila Pa 1976). 2025 Mar 25. doi: 10.1097/BRS.0000000000005343. Online ahead of print.

Authors

Affiliations

¹ Duke University School of Medicine, Durham, NC, USA.
² Duke Center for Brain and Spine Metastasis, Duke University Medical Center, Durham, NC, USA.
³ Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC.
⁴ Department of Palliative Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁵ Oxford Spine Service, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
⁶ Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
⁷ Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.

PMID: 40130335
DOI: 10.1097/BRS.0000000000005343

Abstract

Study design: Retrospective cohort study.

Objective: This study aimed to identify sources of distress in patients with metastatic spine disease and elucidate factors associated with clinically significant distress.

Summary of background data: Distress is associated with poorer outcomes and lower quality of life in cancer patients. Patients with metastatic spine disease are particularly vulnerable to clinically significant levels of distress. However, specific factors contributing to distress in these patients have been largely unexplored.

Methods: We retrospectively reviewed medical records of patients with metastatic spine disease (MSD) who underwent surgery from 2015 to 2023. We analyzed National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) scores and Problem List items within 30 days prior to surgery, which was defined as "baseline" distress. We calculated the frequency of each problem and the proportion of patients with clinically significant distress (DT score ≥4). We used chi-square tests to analyze associations between Problem List items and significant distress, with a significance threshold of P<0.05.

Results: Among 160 patients with MSD, 48.1% reported clinically significant distress. Patients most frequently reported Physical concerns (93.8%), followed by Emotional (55.6%) and Practical concerns (31.9%). The most common individual Problem List item was pain (72.5%), followed by fatigue (48.1%) and worry (41.2%). Emotional (P=0.001), Practical (P=0.04), and Social concerns (P=0.039) were significantly associated with clinically significant distress, but Physical concerns were not (P=0.05).

Conclusion: Though physical concerns were most common for patients with MSD, emotional and practical concerns were more strongly associated with significant distress among patients with metastatic spine disease. These findings highlight the need for multidisciplinary care focused on emotional and practical issues to enhance patients' quality of life.