Beyond Pain: Understanding Sources of Distress in Metastatic Spine Disease

Introduction: Psychosocial distress in cancer patients can negatively impact survival, quality of life, and treatment adherence. Patients with metastatic spine disease (MSD) are especially vulnerable to distress, but the specific contributing factors remain unclear. This study aims to identify the sources of distress in MSD patients and the factors associated with clinically significant distress.

Methods: We retrospectively analyzed electronic medical records of MSD patients who underwent surgery from 2015 to 2023. Baseline National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT) scores and Problem List items were reviewed. The frequency of each problem and the proportion of patients with clinically significant distress (DT score ≥4) were examined. Chi-Square tests were used to analyze associations between problem items and significant distress, with p < 0.05 as the significance threshold.

Results: Among 160 patients who completed the NCCN DT and Problem List, 93.8% reported Physical concerns, 55.6% Emotional concerns, and 31.9% Practical concerns. Pain (72.5%) was the most common issue, followed by fatigue (48.1%) and worry (41.2%). Overall, 51.9% of patients had clinically significant distress. Elevated distress was significantly associated with Emotional (p=0.001), Practical (p=0.04), and Social (p=0.039) concerns. Specific Emotional and Practical concerns—such as appearance (p=0.003), changes in eating (p=0.002), depression (p=0.003), fear (p=0.03), sadness (p=0.001), and worry (p < 0.001)—were strongly linked to distress, while Physical concerns, including pain, were not.

Conclusion : Although physical concerns are common, emotional and practical challenges are more strongly associated with significant distress in MSD patients. These findings highlight the need for multidisciplinary care addressing emotional and practical issues to enhance patient well-being.