Felasfa M. Wodajo, MD, Discusses How MSTS Is Working to Improve Care for Metastatic Bone Disease

Bone is the third most frequent site of cancer metastasis. As patients are living longer with cancer, metastatic bone lesions represent a significant patient burden. Most orthopaedic surgeons in all subspecialties will see these patients.

In 2022, the Musculoskeletal Tumor Society (MSTS) Executive Committee (EC) chose to create a task force to help direct how the society should continue to address this growing need. AAOS Now Editorial Board member Odion Binitie, MD, FAAOS, sat down with Felasfa M. Wodajo, MD, FAAOS, orthopaedic oncologist at Virginia Cancer Specialists in Fairfax, Virginia, and chair of the MSTS Skeletal Metastasis Task Force, to discuss how the society is working to improve patient care in this area.

Dr. Binitie: Why did MSTS feel it was necessary to focus on metastatic bone disease?
Dr. Wodajo: The Skeletal Metastasis Task Force was created because many MSTS members and those within MSTS leadership felt that the society was not devoting the attention needed toward advancing the care of patients with skeletal metastases. For most of our members, this is a big part of their practice; however, the society historically had not been prioritizing this topic. [Patients with skeletal metastasis present with] overlapping medical and orthopaedic needs but have been sort of “falling through the cracks” in both the medical oncologic and the orthopaedic oncologic worlds. With a focused approach, we felt that MSTS could help advance their treatment with evidence-based practices and perhaps standardize some of the treatment indications for skeletal metastases.

What are the goals of the task force?
There was a lot of discussion at the outset within the EC of the MSTS. The topic is large, and there were clearly many good ways to drive toward our goals. In the end, we decided to convene a multidisciplinary Skeletal Metastasis Task Force to develop a set of recommendations that would be submitted to the society for consideration and, hopefully, implementation. We laid out a series of topic areas for the task force to address and a timeline. We wanted broad input, so we made an open solicitation to the society for task force volunteers. We had a tremendous response, which was gratifying. From the respondents, three EC members reviewed the applicants and chose the members through a blinded process. [In addition to these selections,] we added representatives from existing MSTS committees to provide context and internal communication, then invited advisory members from medical oncology, radiation oncology, interventional radiology, and spine surgery.

The task force submitted its draft report of more than 40 recommendations in 10 subject areas in July 2023. It then continued work, in a smaller format, to complete recommendations in the four remaining subject areas. Anticipating that launching a series of initiatives in multiple subject areas would take continued attention and focus, the society decided to create the Skeletal Metastasis Committee. This will be the first MSTS committee centered around a disease. This new committee is just getting off the ground but is designed to both work on its own and collaborate with existing committees to execute the recommendations of the task force. It will also likely come up with ideas of its own in the future.

What were some of the recommendations or general themes from the task force?
We organized ourselves into groups, and each selected its top recommendation. This way, we were able to push ourselves to think broadly and also get diverse viewpoints represented. Some of the recommendations were straightforward, like including a multidisciplinary section on skeletal metastases at our two annual meetings and developing webinars and other educational materials for our members. Others were a little more long term, such as working toward standardizing indications for some of the novel therapies being used for spinal and non-spinal metastases. There was a theme of working across specialties and organizations; for example, one recommendation was to work in partnership with the American Society of Clinical Oncology and the American Society of Radiation Oncology to form a multidisciplinary cancer disparity committee to understand better and to address the factors (access, culture, genetics) that lead to disparities in outcomes.

What are potential roadblocks to implementation of these recommendations?
Probably the ones you would expect. Roadblocks can be external (for example, difficulty changing established practices) or internal (for example, lack of resources and, as with all volunteer organizations, long-term focus). The secret sauce is always persistence, and as long as there are MSTS members who are willing to volunteer their time and share their enthusiasm, there is a lot of good we can do.

How do you plan to engage the rest of the orthopaedic community and the other specialties who are engaged in taking care of patients with metastatic skeletal disease?
As you well know, the care of patients with skeletal metastases is always multidisciplinary. While the surgeon will always play an important role, we need to collaborate closely with our colleagues and their societies (i.e., interventional radiology, interventional pain management, radiation oncology, and medical oncology) to make sure we are guiding our patients to the best possible outcome at each point in their journey. Of course, partnering closely with AAOS makes it far more likely that these patients will get high-quality care, as only a fraction nationally will be treated by orthopaedic oncologists. Therefore, continuing to build on our AAOS educational portfolio and imagining new ways to share information with our non-oncologic orthopaedic colleagues will have a big impact on patient outcomes.

What can be done with advocacy in this arena?
There is a lot that can be done. What we’ve been talking about so far is a form of advocacy itself: trying to effect changes in medical and surgical societies so that they devote more internal resources to these conditions and patients. We can also advocate externally—for example, in the regulatory and legislative arena to explain how the care of these patients, whose musculoskeletal care is often more complex and time consuming than those without skeletal metastasis, should be reimbursed in a way that reflects its reality. We can advocate in the device regulatory arena to allow for more rapid development of novel devices for these patients, whose lifespans are often limited. We can partner with our own advocacy task forces and patient advocacy groups to encourage the formation of forums where patients can work together and make their voices heard.

How can we better educate our orthopaedic residents on this topic?
As a society, we are lucky that many of our members are deeply involved in residency education, and several serve as residency directors. The task force did not address residency training directly, but it would be reasonable to assume that as the topic of skeletal metastases is emphasized and developed within the society, it may begin to influence orthopaedic resident education in some programs. However, this might be an area we can address more fully in the future.

Odion Binitie, MD, FAAOS, is an associate professor of orthopaedics and oncology at Moffitt Cancer Center and the University of South Florida College of Medicine in Tampa. He is on the Editorial Board of AAOS Now.

AAOS Musculoskeletal Tumor Registry utilizes data to enhance sarcoma care

The Musculoskeletal Tumor Registry (MsTR) is dedicated to enhancing care, outcomes, and quality of life for patients with sarcomas and other aggressive musculoskeletal tumors. By creating a comprehensive, research-quality database that centralizes patient, tumor, treatment, and outcomes data, the MsTR enables advanced study of disease patterns, treatment efficacy, and patient quality of life. Designed for easy participation by members of AAOS and the Musculoskeletal Tumor Society, the registry prioritizes minimal burden for data entry, thorough data capture, as well as flexibility for future updates.

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