Orthopaedic-related complications, financial toxicity, and psychosocial burden in hospitalized cancer patients: A three-year retrospective analysis
Abstract
Hospitalized cancer patients with orthopaedic-related complications experience multidimensional burdens encompassing clinical, financial, and psychosocial domains. This retrospective observational study evaluated 184 patients admitted to The Second People’s Hospital of Yuhang District, Hangzhou, from 2023 to 2025. Patients were classified as orthopaedic-related, including traumatic fractures, primary bone tumours, secondary or metastatic bone lesions, and post-surgical interventions, or non-orthopaedic. Data on skeletal diagnosis type, hospital length of stay, total cost, nursing expenses, and primary treatment outcomes were extracted from electronic medical records. Descriptive statistics characterized patient profiles, while one-way analysis of variance and Chi-square tests assessed differences in hospital utilisation and primary treatment outcomes across groups. Orthopaedic-related patients represented 63.6% of the cohort, with secondary or metastatic bone lesions as the most frequent diagnosis. Compared with non-orthopaedic patients, those with orthopaedic involvement had longer hospitalisation, higher total and nursing costs, and a greater proportion of terminal or ongoing outcomes. Variation in primary treatment outcomes across skeletal diagnosis types suggested differential clinical trajectories and inferred psychosocial strain. These findings underscore the compounded impact of skeletal complications on healthcare resource utilisation and patient well-being. The study highlights the value of integrating psychosocial support, early mobility interventions, and pain management into routine care, and demonstrates the utility of primary treatment outcomes as a pragmatic proxy for psychological burden in retrospective studies.
Copyright (c) 2026 Feng Guo
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Tsuzuki S, Park SH, Eber MR, et al. Skeletal complications in cancer patients with bone metastases. International Journal of Urology. 2016; 23(10): 825–832. doi: 10.1111/iju.13170
2. von Moos R, Body JJ, Egerdie B, et al. Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases. Supportive Care in Cancer. 2015; 24(3): 1327–1337. doi: 10.1007/s00520-015-2908-1
3. Maroni P, Bendinelli P, Fulgenzi A, et al. Mediterranean diet food components as possible adjuvant therapies to counteract breast and prostate cancer progression to bone metastasis. Biomolecules. 2021; 11(9): 1336. doi: 10.3390/biom11091336
4. Kimura T. Multidisciplinary approach for bone metastasis: A review. Cancers. 2018; 10(6): 156. doi: 10.3390/cancers10060156
5. Yabroff KR, Dowling EC, Guy GP, et al. Financial hardship associated with cancer in the United States: Findings from a population-based sample of adult cancer survivors. Journal of Clinical Oncology. 2016; 34(3): 259–267. doi: 10.1200/JCO.2015.62.0468
6. Pisu M, Henrikson NB, Banegas MP, et al. Costs of cancer along the care continuum: What we can expect based on recent literature. Cancer. 2018; 124(21): 4181–4191. doi: 10.1002/cncr.31643
7. Ramsey SD, Bansal A, Fedorenko CR, et al. Financial insolvency as a risk factor for early mortality among patients with cancer. Journal of Clinical Oncology. 2016; 34(9): 980–986. doi: 10.1200/JCO.2015.64.6620
8. Gu L, Gong T, Ma Q, et al. Retrospective study of egfr‐mutant lung adenocarcinoma with bone metastatic clinical features. Cancer Reports. 2022; 6(1). doi: 10.1002/cnr2.1628
9. de Souza JA, Yap BJ, Wroblewski K, et al. Measuring financial toxicity as a clinically relevant patient‐reported outcome: The validation of the comprehensive score for financial toxicity (COST). Cancer. 2017; 123(3): 476–484. doi: 10.1002/cncr.30369
10. D’Antonio C, Passaro A, Gori B, et al. Bone and brain metastasis in lung cancer: recent advances in therapeutic strategies. Therapeutic Advances in Medical Oncology. 2014; 6(3): 101–114. doi: 10.1177/1758834014521110
11. Richards M, Braysher S, Gregory W, et al. Advanced Breast cancer: Use of resources and cost implications. British Journal of Cancer. 1993; 67(4): 856–860. doi: 10.1038/bjc.1993.157
12. Hack TF, Carlson L, Butler L, et al. Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care. Supportive Care in Cancer. 2011; 19(8): 1097–1105. doi: 10.1007/s00520-011-1159-z
13. Sitlinger A, Zafar SY. Health-related quality of life. Surgical Oncology Clinics of North America. 2018; 27(4): 675–684. doi: 10.1016/j.soc.2018.05.008
14. Yang B, Cui Z, Zhu X, et al. Clinical pain management by a multidisciplinary palliative care team. Medicine. 2020; 99(48): e23312. doi: 10.1097/md.0000000000023312
15. Toner E, Khaled A, Ramesh A, et al. Financial impact of inaccurate coding plus cost-effectiveness analysis for surgically managed patients with periprosthetic fractures. Cureus. 2021;13(2). doi: 10.7759/cureus.13060
16. Wagoner CW, Capozzi LC, Culos-Reed SN. Tailoring the evidence for exercise oncology within breast cancer care. Current Oncology. 2022; 29(7): 4827–4841. doi: 10.3390/curroncol29070383
17. Papadakos J, Urowitz S, Olmstead C, et al. Informational needs of gastrointestinal oncology patients. Health Expectations. 2014; 18(6): 3088–3098. doi: 10.1111/hex.12296
18. Mjelstad A, Zakariasson G, Valachis A. Optimizing antiresorptive treatment in patients with bone metastases: Time to initiation, switching strategies, and treatment duration. Supportive Care in Cancer. 2019; 27(10): 3859–3867. doi: 10.1007/s00520-019-04676-6
19. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clinical Cancer Research. 2006; 12(20): 6243s–6249s. doi: 10.1158/1078-0432.ccr-06-0931
20. Weycker D, Li X, Barron R, et al. Hospitalizations for osteoporosis-related fractures: Economic costs and clinical outcomes. Bone Reports. 2016; 5: 186–191. doi: 10.1016/j.bonr.2016.07.005
21. Nooh A, Goulding K, Isler MH, et al. Early improvement in pain and functional outcome but not quality of life after surgery for metastatic long bone disease. Clinical Orthopaedics & Related Research. 2018; 476(3): 535–545. doi: 10.1007/s11999.0000000000000065
22. Kendal JK, Heard BJ, Abbott AG, et al. Does surgical technique influence the burden of lung metastases in patients with pathologic long bone fractures? BMC Musculoskeletal Disorders. 2022; 23(1). doi: 10.1186/s12891-022-05067-5
23. Decroisette C, Monnet I, Berard H, et al. Epidemiology and treatment costs of bone metastases from lung cancer: A french prospective, observational, multicenter study (GFPC 0601). Journal of Thoracic Oncology. 2011; 6(3): 576–582. doi: 10.1097/jto.0b013e318206a1e3
24. Wilson MA, Zhong J, Johannet P, et al. Preliminary analysis of distinct clinical and biologic features of bone metastases in melanoma. Melanoma Research. 2020; 30(5): 492–499. doi: 10.1097/cmr.0000000000000691
25. Qian Y, Arellano J, Bhowmik D, et al. Healthcare resource use and costs associated with renal impairment in us patients with bone metastases from solid tumours. Journal of Oncology Pharmacy Practice. 2017; 23(3): 195–202. doi: 10.1177/1078155216629826
26. Shabani M, Binesh F, Behniafard N, et al. Clinicopathologic characteristics and survival of patients with bone metastasis in Yazd, iIran. Medicine. 2014; 93(28): e317. doi: 10.1097/md.0000000000000317
27. Abdulnabi S F, Mostafa M, Jabbari A, et al. A comparative study of maternal and neonatal outcomes in obese and non-obese Iraqi pregnant women undergoing caesarean section. Cureus, 2025, 17(3). doi: 10.7759/cureus.81039
28. van der Doelen MJ, Oving IM, Wyndaele DNJ, et al. Health-related quality of life, psychological distress, and fatigue in metastatic castration-resistant prostate cancer patients treated with radium-223 therapy. Prostate Cancer and Prostatic Diseases. 2022; 26(1): 142–150. doi: 10.1038/s41391-022-00569-8
29. Guo YQ, Ju QM, You M, et al. Depression, anxiety and stress among metastatic breast cancer patients on chemotherapy in China. BMC Nursing. 2023; 22(1). doi: 10.1186/s12912-023-01184-1
30. DiCaprio MR, Murtaza H, Palmer B, et al. Narrative review of the epidemiology, economic burden, and societal impact of metastatic bone disease. Annals of Joint. 2022; 7: 28–28. doi: 10.21037/aoj-20-97
31. Mattson R, Henderson M, Carlson SS. Assessing grief in cancer care: A systematic review of observational studies using psychometric instruments. Healthcare. 2025; 13(14): 1722. doi: 10.3390/healthcare13141722
32. Delgado-Guay M, Ferrer J, Rieber AG, et al. Financial Distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist. 2015; 20(9): 1092-1098. doi: 10.1634/theoncologist.2015-0026
33. Yu H, Li H, Zuo T, et al. Financial Toxicity and psychological distress in adults with cancer: a treatment-based analysis. Asia-Pacific Journal of Oncology Nursing. 2022; 9(9): 100069. doi: 10.1016/j.apjon.2022.04.008
34. Chakraborty R, Majhail NS, Abraham J. Psychosocial and patient support services in comprehensive cancer centres. In: The comprehensive cancer center. Springer International Publishing; 2022. pp. 93–106.
35. Németh N, Davidescu L, Lazăr L, Voiță-Mekeres F, Racoviță M, Hozan CT. Impact of rehabilitation intervention for cancer patients with spinal bone metastasis: Psychosocial and clinical outcomes. Geriatrics. 2025; 10(2): 56. doi: 10.3390/geriatrics10020056
36. Ann-Yi S, Bruera E. Psychological aspects of care in cancer patients in the last weeks/days of life. Cancer Research and Treatment. 2022; 54(3): 651–660. doi: 10.4143/crt.2022.116
37. Liu Y, Chen Z, Lin N, et al. Evaluating the psychosocial effects of cancer on sleep quality and mental health in elderly populations. BMC Psychiatry. 2025; 25(1): 933. doi: 10.1186/s12888-025-07425-8
38. Caminiti C, Annunziata MA, Verusio C, et al. Effectiveness of a psychosocial care quality improvement strategy to address quality of life in patients with cancer. JAMA Network Open. 2021; 4(10): e2128667. doi: 10.1001/jamanetworkopen.2021.28667
