Project to Assess Feasibility of a Rapid Access Metastatic Bone Disease Program
Project to Assess Feasibility of a Rapid Access Metastatic Bone Disease Program
The skeletal system is one of the most common sites for metastatic spread of many
 malignancies. Metastatic bone disease (MBD) can be associated with a significant reduction in
 quality of life due to debilitating pain and pathologic fractures. Multiple providers are
 involved in treating patients with MBD which can result in fragmented and delayed delivery of
 care. This fragmentation also leads to poor outcomes and patient experience. This project
 will assess whether it is feasible to integrate a multidisciplinary Rapid Access Metastatic
 Bone Disease Program (RAMP) at the Investigator's institution to improve the delivery of care
 to patients presenting with pelvic and lower extremity MBD. The goals of RAMP are: 1) Improve
 outcome and quality of care provided to MBD patients. 2) Improve patients experience through
 the participant's treatment journey. 3) Avert extra health care costs caused by unplanned
 admissions through ER and decrease redundancies due to unnecessary multiple clinic visits and
 double-ordering of diagnostic tests. This project will be designed to optimize the use of
 existing clinic resources more efficiently. Cancer patients and their loved ones will be
 actively engaged in the design of this project to better achieve its goals.
More than 140,000 new cases of cancer are diagnosed annually in Canada, with nearly half of
 which metastasize to bone. The skeletal system is one of the most common sites for metastatic
 spread of many visceral malignancies, especially cancers originating from breast, prostate,
 lung, thyroid and kidney. Hematologic malignancies, such as multiple myeloma and lymphoma,
 also primarily manifest with multiple aggressive lytic lesions in the bone. A Skeletal
 Related Event (SRE) is the term given when a metastatic lesion arises in bone. With advances
 in effective systemic treatment and supportive care, the duration of survival of patients
 with bone metastases has improved substantially. This improvement in survival can be
 accompanied by significant morbidity and reduction in quality of life secondary to pain,
 pathologic fracture, and spinal cord compression from SREs. Pain and impaired mobility occur
 in approximately 65%-75% of patients with bone metastases. SREs are also associated with high
 economic burden secondary to increased costs of treatment and high rates of hospitalizations.
 It is estimated that a single episode of SRE can cost the medical system 36,462 USD. The
 current literature reflects significant diversity in the approach of diagnosing and treating
 MBD. Therefore, numerous studies have advocated the need for a multidisciplinary clinic to
 co-ordinate the diagnosis, treatment, and rehabilitation of patients with MBD patients. This
 strategy has also been proposed to improve the delivery of early and multimodal palliative
 management for patients in a cost effective approach.

 Aims and Objectives: The aims of this project are: 1) Assess feasibility of establishing and
 integrating a multidisciplinary Rapid Access Metastatic Bone Disease Program (RAMP) at the
 Investigator's institution to improve the delivery of care to patients presenting with pelvic
 and lower extremity MBD. 2) Centralize referrals and streamline clinical care pathways for
 patients diagnosed with MBD to pelvis and lower extremity. 3) Assess improvement in outcome
 and patient experience. The objectives of this project are: 1) Establish a core
 multidisciplinary RAMP team to develop a patient-centered clinical care pathway for diagnosis
 and treatment. 2) Establish a standardized and rapid referral process for RAMP. 3) Triage
 consults and coordinate their integration into pre-existing weekly "musculoskeletal oncology"
 clinic at the cancer center. 4) Develop a centralized registry for patients presenting to
 RAMP to assess provider performance and evaluate the success of established clinical care
 pathways.
Inclusion Criteria:

 -  Patient is 18 years of age or older and able to provide informed consent.

 -  Patient with an established tissue diagnosis of cancer.

 -  Patient with diagnosis of metastatic bone lesion which requires a referral to an
 Orthopedic Oncology Specialist.

 -  Patient will receive their care and treatment for this metastatic disease at The
 Ottawa Hospital.

 Exclusion Criteria:

 -  Patient does not speak or understand adequate French or English to complete the
 functional outcome questionnaires.

 -  Patient has a documented cognitive impairment precluding questionnaire completion
 (e.g. dementia).