Doorways to Discovery
November 11, 2014
A cancer surgeon strives to give patients the gift of hope, tempered by honesty, and Daniel Sciubba
is pushing to give patients a more accurate idea of what they can expect after surgery. “A realistic prognosis impacts patients’ decision-making and quality of life,” says Sciubba, who looks at preoperative factors that contribute to postsurgical survival.
Sciubba specializes in the surgical treatment of spinal tumors. To study outcomes related to surgery of metastatic cancers of the spine, he and his fellow researchers consider factors like the type of tumor, age of the patient, nature of the surgical procedure, adjuvant therapies and possible complications.
The scientists discovered, for example, that breast cancer patients with spinal metastases had better postsurgical survival if their cancer was hormone receptor-positive (dependent on estrogen and/or progesterone for its growth), that postsurgical survival of patients with prostate metastases is also hormone-dependent, and that en bloc resection of a spinal sarcoma—removal of the main tumor and surrounding portions of the spinal column—confers a survival advantage over intralesional resection, a more modest approach.
“The goal of a surgeon, to my mind, is to be able to tell patients the reality of their options,” says Sciubba. “We don’t have a crystal ball, but our data are enabling us to say to the patients, with added confidence, that if you choose this path, the likely outcome is X, versus this path, where the likely outcome is Y.”
Over time, Sciubba and his colleagues are getting better at predicting outcomes, based on experience and data from many sources. “We are finding more and more granular ways to predict surgical outcomes that go beyond the usual,” he says. Smoking, arthritis, osteoporosis, amount of pain and scoliosis are just a few critical factors to consider. “If we have 10 things that we can use to predict good or poor outcomes, we eliminate as much of the gray area as possible, and the patient can make an informed decision.” By this, he means whether to undertake the surgery, and even which surgery is the best choice, given the best available information.
Challenge: To provide patients with a more accurate idea of what to expect from spinal tumor surgery to help them in decision-making.
Approach: Sciubba is undertaking large-scale studies to link surgical approaches and patient characteristics to survival following spinal tumor surgery.
Progress: Based on the research data, Sciubba and his colleagues are increasingly better able to advise patients on their options and outcomes.