Presentation (CTI)

OBJECTIVES: Bone marrow biopsy is essential for diagnosing and monitoring hematologic malignancies but imposes physical, emotional, and logistical burden on patients and caregivers. Frail patients may be ineligible, and diagnostic issues such as dry taps and hemodilution can require repeat procedures and intensify burden. These burdens may also influence clinical trial discontinuation. Unaddressed diagnostic burden may undermine adherence and monitoring, potentially leading to delayed detection of disease progression and avoidable downstream costs. This review synthesizes evidence on biopsy-related burden.
METHODS: In accordance with PRISMA guidelines, a systematic review was conducted in PubMed. Eligible studies were peer-reviewed, English-language, conducted in adult hematologic cancer populations and published between 2010 and November 2025. Patient and caregiver perceptions of burden related to bone marrow biopsy were described. A snowball search strategy supplemented database results. Data were extracted on physical, emotional and procedural burden domains, including experiences related to inadequate or unsuccessful biopsies. Study characteristics and outcomes were synthesized narratively.
RESULTS: Among 327 identified articles, 41 were included. Across studies, patients frequently reported procedural pain (71%), anxiety (34%), and emotional distress (24%) related to the bone marrow procedure. Logistical burdens included travel, absence from work, and recovery needs. Caregivers described psychological strain and competing responsibilities. Unsuccessful or inadequate biopsies led to repeated procedures and prolonged diagnostic intervals, increasing stress for both patients and caregivers.
CONCLUSIONS: Bone marrow biopsies contribute substantial burden for patients and caregivers, amplified by diagnostic limitations and repeated procedures. Current diagnostic inadequacies can exacerbate this burden and highlight opportunities for improvement. Emerging non-invasive modalities such as liquid biopsy technologies and imaging may help improve access for frail or vulnerable populations, reduce procedure-related burden for patients and enhance patient-centered care. Incorporating patient and caregiver burden into diagnostic value frameworks may improve health technology assessment and reimbursement decision-making.