Глобальная перспектива развития связанных с медсестрой исследований в области первичных злокачественных опухолей костей 2004 в адрес 2025:: Библиометрическое картирование и визуальное исследование.

1. Introduction

Bone tumors refer to tumors that occur in the bone or originate from bone tissue components (bone and accessory tissues), with a broad spectrum of morphology and biological behavior. [ 1 ] The main clinical manifestations in patients include pain and tenderness, local mass or swelling, dysfunction and compression symptoms, and pathological symptoms, which seriously affect the quality of life and survival time of patients. [ 2 ] Although the incidence of bone tumors is relatively low, up to 40% of them are malignant, and they are the third leading cause of death among adolescents with cancer. [ 3 ] As a result, the morbidity and mortality significantly affect the long-term quality of life of patients and cause physical and mental burdens. [ 4 ] Fortunately, with the continuous progress in the treatment of malignant bone tumors, more patients have become long-term survivors. [ 5 ] Meanwhile, nursing professionals play a vital role in patient education, monitoring, symptom management, nursing coordination, and psychosocial support to ensure safe and effective treatment, along with rapidly increasing research about nurse-related practices. [ 6 , 7 ] A significant increase in nurse-related cancer research over the past 2 decades is evident. [ 8 ] The role of the bone tumor nurse has rapidly shifted from routine bedside care to more advanced practice specialist nurses being responsible for performing invasive procedures, screening for cancers, and providing high-quality care based on evidence-based research. The aim of these related projects is to improve the quality of care and services provided to tumor patients by using a research-based approach. Meanwhile, nursing leaders also recognize the need to combine bone tumor nursing practice with research, due to its significant contribution to the improvement and development of bone tumor patient care. [ 8 ] To raise nurses’ voices and promote nurse-related research, it is important to consider the future direction of nurse-related bone tumor research, in terms of what has been done frequently, areas of care that need more research attention, and structural issues that may be endemic in nurse-led bone tumor research. At present, existing studies have presented the knowledge structure, rules, and distribution of nursing research through visual analysis. [ 9 ] However, there is still a gap in the application of visual analysis in bone tumor nursing.

Scientometric analysis enables the assessment of the influence of specific research results and the evolution of literature in particular fields, while also examining the trends in scientific inquiry. This method focuses on quantifiable aspects of literature, distinguishing features such as countries, organizations, journals, authors, and keywords linked to publications within a specific area across a timeline. Consequently, researchers can develop a comprehensive understanding of the present status and advancement patterns of a specific research domain or illness, thus providing valuable insights and directions for future studies. [ 10 , 11 ] Thus, this study sought to understand the research hotspots and frontiers of bone tumor nursing and provide a comprehensive, up-to-date synthesis of all nurse-related bone tumor research publications using bibliometric analysis to fill the gap in visual analysis in bone tumor nursing. Specific objectives for the analysis included the following: to provide an overall picture and systematic mapping of the characteristics of published articles in terms of type and focus; to conduct a performance analysis in terms of trends, key journals for publication, co-authorship, and most productive institutions; and to conduct a keyword analysis to identify research foci and changes in these foci over time.

2. Materials and methods

2.1. Source database and data collection

The Web of Science Core Collection was used to conduct an organized search to find publications that were indexed from January 1, 2004, to September 12, 2025. The database used for this study was the Science Citation Index Expanded, and English was chosen as the study’s language. All authors agreed to the search strategy after consulting senior literature retrieval experts, and the detailed strategy was found in Supplementary Materials-Appendix , Supplemental Digital Content 1. To facilitate further analysis of literature content, only publication types with “article” or “review” were considered. Other types of articles were excluded, including preprints, dissertations, conference proceedings, book chapters, brief surveys, abstracts, gray literature, editorials, letters to the editor, and discussion papers. Duplicate articles were identified and removed utilizing Endnote software (version X9.3.3; Clarivate Analytics). The remaining articles were screened by the second author based on their title and abstract. Those that did not fulfill the eligibility criteria were discarded after consultation with the first author. Additionally, this bibliometric study used only publicly available published data, without involvement of human subjects, animals, or personal information. Therefore, ethical review and informed consent were not required.

2.2. Data extraction and analysis

In this study, multiple software tools were employed for bibliometric analysis and visualization, including CiteSpace 6.4.R1 (advanced version, Chaomei Chen, 2023), VOSviewer 1.6.20 (Nees Jan van Eck and Ludo Waltman, 2010), and Microsoft Excel 2021 (part of the Microsoft Office Home and Student 2021 suite), developed by Microsoft Corporation (Redmond). The extracted bibliographic data regarding annual publication trends, distribution across countries/regions, journals, and leading institutions were processed in Excel to illustrate quantitative characteristics and temporal dynamics. VOSviewer was further applied to construct and visualize collaborative networks among countries, institutions, authors, and keywords. In parallel, CiteSpace was mainly utilized for generating dual-map overlays of journals, mapping the knowledge structure, constructing timeline visualizations of cited references, and identifying both top-cited references and keywords with the strongest citation bursts. The relevant setting parameters are consistent with those previously published by our team [ 11 – 13 ] : link retaining factor (3), e for top N (e = 1), time interval (2004–2025), years per slice (1), look-back years (5), link strength measured by cosine similarity within slices, selection criterion set as G-index (k = 25), and minimum duration (1). Prior to analysis, data preprocessing was conducted, which included synonym unification, removal of irrelevant terms, and refinement of keyword sets. For example, terms such as “tumors” were standardized as “tumor,” and “radiation-therapy” was adjusted to “radiotherapy.” Similarly, redundant or meaningless entries were eliminated to ensure data accuracy and consistency.

3. Results

3.1. Annual publication output and growth trend

A total of 686 publications were retrieved and filtered from the targeted database as shown in Figure 1 . During the set timespan, a steadily increasing trend was observed in the annual publication output. In the first decade, the number of related publications grew slowly, and the annual number of publications was below 35, followed by a roughly accelerated growth rate of publications during the second decade. The number of documents issued in 2023 reached the highest peak, with an average annual growth rate of 6.42% (Fig. 2 A and B).

3.2. Countries/regions and institutions analysis

To clearly illustrate the countries/regions that contributed the most to this field, the number of national publications was analyzed. Statistics revealed that a total of 70 countries/regions and 1422 institutions had made substantive intellectual contributions, reflecting the global attention and multi-institutional engagement in this research domain.

In terms of national/regional productivity (Table 1 ), the United States emerged as the most prolific contributor, accounting for 338 publications, demonstrating its dominant position in driving research progress. This output magnitude is substantially higher than those of the second- and third-ranked contributors: the United Kingdom (N = 64) and China (N = 58), respectively. The remaining 67 countries/regions each contributed fewer than 50 publications, indicating a clear hierarchical distribution of research capacity. The United States’ leading status is visually corroborated by the darkest blue area in Figure 3 A. This observation aligns with the nation’s formidable strengths in clinical oncology research, including robust infrastructure, substantial funding support, and extensive interdisciplinary collaboration networks. China’s third-place standing, meanwhile, signals its rapidly growing influence in the field, likely fueled by increased investment in medical research and international academic exchange over the past decade. [ 14 ] Figure 3 B presents the co-occurrence networks of countries/regions and institutions, vividly illustrating the collaborative dynamics within the global research community. This figure distinctly underscores the United States’ prominent position, characterized by a high degree of centrality and extensive participation. Notably, the United States has forged strong collaborative ties with key contributors such as Canada and China, thereby establishing itself as a pivotal collaborative nexus that significantly promotes the dissemination of knowledge. Notably, emerging collaborative clusters involving China, Belgium, Sweden, and other countries have become increasingly active in recent years, suggesting the formation of new regional cooperation networks that may enrich the field’s research perspectives and accelerate innovation.

Turning to institutional contributions, the publication outputs were further analyzed to identify leading research hubs. The top 10 most productive institutions (Table 1 ) are all located in the United States, reinforcing the country’s concentrated research strength. Figure 3 C, the institutional co-occurrence map, visualizes the cooperative architecture of these leading hubs: Memorial Sloan Kettering Cancer Center stood out with 29 publications, not only leading in quantity but also maintaining intensive collaborative ties with other top institutions. Other high-impact contributors include UTMD Anderson Cancer Center (26 publications), Harvard Medical School (19 publications), and Stanford University (19 publications), each renowned for their specialized expertise in oncology, translational research, and clinical care, which underpins their sustained output of high-quality research.

Figure 3 D, tracking the temporal dynamics of institutional engagement, reveals a notable shift in recent years: institutions including Harvard Medical School, Johns Hopkins University, Ohio State University, and the University of Sydney significantly increased their participation in relevant research after 2019. The research direction selections, methodological innovations, and clinical findings of these 4 institutions warrant close attention in future scholarly tracking, as they may drive novel research agendas and expand the field’s global impact.

3.3. Journals and co-cited academic journals analysis

The top 10 publications in the field from 2004 to 2025 were counted, as shown in Table 2 . In terms of the number of published articles, Pediatric Blood & Cancer emerged as the most prolific journal, accounting for 27 publications. Subsequently, Cancers , Clinical Orthopaedics and Related Research , and Journal of Surgical Oncology emerged as the next most prominent journals. This ranking aligns seamlessly with Figure 4 D, where the magnitude of the nodes directly reflects the publication volume. Notably, these journals are depicted with larger nodes, emphasizing their significant contributions to the field. Regarding co-citation impact, among the top 10 most frequently co-cited journals, Journal of Clinical Oncology , Blood , and Cancer ranked in the top 3, respectively. This aligns with the node size distribution in Figure 4 E, which maps the co-citation frequency of journals. At the same time, the H, G, and M indexes of the journals were also calculated to provide a reference for relevant scholars. The academic influence index of Cancers is higher, with an H-index of 8, a G-index of 10, and an M-index of 1.6. Interestingly, in Figure 4 D, Cancers showed the fastest growth in inclusion after 2022 and had outpaced other journals in 2024, signaling its rising prominence as a key platform for research dissemination in this domain.

To show the distribution of citing and cited journals, we employed a dual-map overlay atlas. In Figure 4 F, the citing journal was represented by the geographic area on the left, and the cited journal was represented by the map on the right. The hues of the lines served as markers for different disciplines. The citing journals mostly dealt with medicine, medical, and clinical fields, whereas the cited journals mainly dealt with health, nursing, and medicine.

3.4. Authors and co-cited authors analysis

A total of 5376 authors have participated in nurse-related research concerning primary malignant bone tumors, with Table 3 showing key contributors to this topic. Oeffinger, Kevin C led the pack with 10 publications, underscoring his prominence in this field. Kremer, Leontien CM, with 7 publications, and Nathan, Paul, with 6, also stood out. To further dissect collaborative dynamics and citation impact among researchers, the VOSviewer tool was utilized to analyze the co-authorship and citation network (Fig. 4 A and C). Figure 4 A visualizes the authors’ co-authorship network, which is structured into 8 clusters. Each cluster encapsulates a group of scholars whose research interests converge, highlighting the thematic coherence within these academic communities. Oeffinger, Kevin C was the top author with the highest number of links in the study, reinforcing his role as a central hub in fostering interdisciplinary and international research partnerships. Consistent with the findings in Table 3 , co-cited authors like Bacci, G and Boriani, S were represented by significantly larger nodes in Figure 4 C. This visualization directly correlates with their higher publication output and citation frequency, as node size in co-citation networks typically denotes an author’s cumulative influence on subsequent scholarly work. Figure 4 B complements these analyses by detailing the annual publication volume and citation counts of the top 10 authors. This temporal perspective enables readers to trace the evolution of individual scholars’ academic impact, identifying peaks of productivity, consistent citation relevance, or emerging impacts, thereby providing actionable insights for academic collaboration and literature tracking.

3.5. Analysis of keywords and thematic map

Keywords, as the concise epitome of core contents and research themes embedded in academic literature, play an irreplaceable role in knowledge mapping. Beyond serving as vital indicators of research focuses, they act as “intellectual anchors” that facilitate the identification of academic hotspots, the tracking of developmental trends, and the construction of thematic networks in a specific research field.

Table 4 shows the top 20 related keywords involved in nurse-related research in primary malignant bone tumors. In addition to the names of certain bone tumors, these top 20 keywords include chemotherapy, management, survival, therapy, outcome, surgery, prognostic-factors, quality-of-life, diagnosis, care, and resection. As illustrated in Figure 5 A, keywords with a frequency exceeding 20 are visualized, providing a comprehensive overview of the field’s central themes. Through cluster analysis, these high-frequency keywords are clearly grouped into 2 interrelated thematic clusters. Cluster 1 (red cluster) centers on the prognostic evaluation of bone tumors, encompassing pivotal concepts such as survival, prognostic-factors, and quality-of-life. This cluster underscores the field’s emphasis on comprehensive patient outcome assessment. Cluster 2 (purple cluster) focuses on clinical intervention strategies, including surgery, radiotherapy, management, and resection. The duality of these clusters, linking “outcome evaluation” (cluster 1) and “intervention methods” (cluster 2), reveals the field’s inherent logic of “treatment-prediction-outcome” research. Figure 5 B highlights emerging keywords in recent years, specifically osteosarcoma, outcome, and Ewing sarcoma.

Figure 5 C specifically focuses on keyword frequency and burstness in nurse-related research on primary malignant bone tumors, offering a specialized perspective on clinical care research. Over the past 2 decades, several keywords have demonstrated remarkable stability and high occurrence, including chemotherapy, survival, management, prognostic-factors, and children. Notably, the concentration of these keywords between 2017 and 2020 aligns with the global emphasis on “patient-centered care” during this period, highlighting a growing recognition of nurses’ contributions to improving bone tumor patient outcomes and care quality.

Figure 5 D, typically a strategic diagram in bibliometrics, further deciphers the maturity and potential of key research topics through quadrant-based classification. The first quadrant (upper right), featuring children, survival, and quality of life, denotes themes with high centrality and strong development maturity. This positioning confirms that research on pediatric bone tumor outcomes, especially the balance between survival rates and quality of life, has a well-established conceptual foundation, robust methodological support, and deep integration into the broader field. The second quadrant (upper left), encompassing radiotherapy, expression, and immunotherapy, represents themes with high maturity but low centrality. These topics, while possessing well-developed theoretical and empirical bases (e.g., radiotherapy techniques and molecular expression profiling), have not yet fully integrated into the core thematic network, suggesting potential for cross-disciplinary linkage with other research areas. The third quadrant (lower left), dedicated to high-dose chemotherapy and the central nervous system, includes themes with low maturity and low centrality, indicating they are either emerging topics in early exploratory stages or declining themes that have gradually been replaced by more advanced research directions. The fourth quadrant (lower right), featuring management and chemotherapy, comprises themes with low maturity but high centrality. These topics are prominently referenced within the field, yet they remain underexplored in terms of in-depth, systematic research. This positioning identifies them as potential future hotspots, as their widespread relevance suggests unmet academic and clinical needs waiting to be addressed.

3.6. Analysis of references and co-cited references

Co-cited references denote 2 or more articles that are simultaneously cited by other articles. This citation pattern serves as a tangible indicator of the intellectual kinship and thematic overlap among the co-cited works, highlighting the interconnectedness of scholarly discourse. Table 5 systematically presents the top 10 references with the highest co-citations and the corresponding total link strength. Notably, a striking 5 out of these 10 high-impact co-cited references were published in Journal of Clinical Oncology , a top-tier peer-reviewed journal in clinical oncology. The significant number of relevant publications from this source underscores its pivotal role in shaping the academic conversation around the study’s central themes. Regarding citation frequency, the 2 most co-cited references originate from 2 prestigious journals: one was published in the New England Journal of Medicine in 2003, and the other in the Journal of Clinical Oncology in 2012, with each accumulating 21 co-citations. This consistent high citation count suggests that these 2 works have become foundational references in the relevant research domain.

In terms of content type, 9 of the 10 references are classified as clinical research articles. These articles primarily focus on therapeutic interventions and long-term prognosis assessment for bone tumor patients. They cover a wide range of topics, including the comparative efficacy of different treatment regimens, prognostic factors affecting patient survival, and optimization of clinical management. The remaining 1 reference is a comprehensive review that synthesizes the current clinical management for Ewing sarcoma and proposes forward-looking collaborative research frameworks, serving as a critical guide for integrating existing knowledge and identifying future research priorities.

In summary, the analysis identified a steadily expanding body of nurse-related research on primary malignant bone tumors, comprising 686 publications contributed by 70 countries/regions and 1422 institutions. The United States occupied a dominant position in publication output, institutional productivity, and international collaboration, while several leading journals, institutions, and authors formed the principal academic network in this field. Keyword and thematic analyses revealed 2 major research domains: prognostic and outcome evaluation, and clinical treatment and management, with chemotherapy, survival, quality of life, and management representing persistent core topics. Osteosarcoma, Ewing sarcoma, and outcome emerged as increasingly prominent themes, indicating a growing emphasis on tumor subtype-specific care and comprehensive patient outcomes.

4. Discussion

4.1. General information

In this bibliometric analysis, based on the 2004 to 2025 research data from the Science Citation Index Expanded in the Web of Science Core Collection, a total of 686 English studies published in 374 academic journals by 1422 institutions from 70 countries/regions, with a total of 32,007 cited references, were identified. Through systematic analysis of these data, we aimed to delineate the current research status, development trends, and future hotspots in the field of nurse-related research on primary malignant bone tumors.

From 2004 to 2025, the annual number of publications in this field has shown a steady upward trend, indicating growing global academic attention to nurse-related roles in primary malignant bone tumor care. Geographically, research contributions are predominantly led by developed countries, with the United States, the United Kingdom, and China securing the top 3 positions in publication volume. This may partly indicate that research in this area may be costly and require a major expenditure of time and effort. Developing countries may have difficulty bearing the cost of these relevant research projects, given their national circumstances.

Among the top 10 most prolific institutions, the United States occupies all positions, indicating that American institutions are in a relatively leading position in research progress in this field. Among these institutions, Memorial Sloan Kettering Cancer Center ranked first in publication output, followed by UTMD Anderson Cancer Center, Harvard Medical School, and Stanford University. Their sustained productivity and expertise make these institutions key potential collaborators for scholars seeking to engage in high-impact research in this field.

At the individual author level, Oeffinger, Kevin C made remarkable contributions to the publication landscape, with a substantial number of outputs that solidify his leadership role in the field of primary malignant bone tumor research. In terms of co-citation, Bacci, G ranked first, while Oeffinger, Kevin C was also among the top 10 professional and co-cited authors, showing his significant academic influence both in terms of productivity and scholarly relevance.

Our analysis of journals and citations revealed distinct patterns: Pediatric Blood & Cancer led in the number of publications, while Journal of Clinical Oncology ranked first in terms of co-citation. These journals serve as pivotal dissemination channels for field researchers. They not only provide an optimal platform for publishing high-caliber research but also offer valuable insights into current publication trends. This enables researchers to strategically target journals with a demonstrated interest in the subject matter, thereby maximizing the visibility and impact of their scholarly contributions. Additionally, the double-map superposition of journal analysis enabled us to pinpoint interdisciplinary research directions and emerging hotspots, providing a roadmap for future inquiry.

The clinical relevance of this research is rooted in the challenges of primary malignant bone tumor care. Currently, surgery, radiotherapy, and chemotherapy remain the main methods to control tumor growth and metastasis. However, these interventions are frequently associated with substantial adverse effects, such as postoperative pain, chemotherapy-induced nausea and vomiting, and immunosuppression. [ 15 ] Concurrently, patients commonly experience negative emotional states, including anxiety and depression. [ 16 ] These physical and psychological burdens severely compromise patients’ quality of survival. Factors including inadequate social support, disease progression, and metastasis exacerbate such negative emotions, which in turn become major risk factors for reduced clinical efficacy and poor prognosis. [ 17 ]

Nursing staff have increasingly focused on addressing patients’ actual needs, providing behavioral support through diverse modalities, and strengthening interventions for health behaviors and lifestyles. [ 18 ] These efforts aim to integrate health awareness with healthy practices, thereby enhancing patients’ self-care abilities and quality of life. Looking ahead, the broader integration of quality care and holistic nursing theory into clinical practice is expected to further mitigate patients’ anxiety and depression, improve their quality of life, and ultimately optimize health outcomes, reinforcing the critical value of advancing nurse-related research in this field. [ 19 ]

4.2. Research keyword analysis

The keyword landscape of nurse-related research in primary malignant bone tumors, decoded through frequency statistics, cluster analysis, and strategic mapping, offers profound insights into the field’s structural logic and core priorities. As the “intellectual anchors” of scholarly discourse, the top 20 high-frequency keywords, encompassing chemotherapy, management, survival, and quality-of-life, collectively reflect a patient-centered, intervention-outcome integrated research framework that aligns with the practical demands of clinical nursing. [ 20 ] Cluster analysis (Fig. 5 A) further distills this framework into 2 interdependent thematic pillars, revealing the field’s inherent treatment-prediction-outcome research logic. The red cluster (prognostic evaluation), anchored by survival, prognostic-factors, and quality-of-life, underscores a paradigm shift from a singular focus on disease cure to comprehensive outcome assessment. [ 21 ] For nursing research, this cluster highlights the profession’s expanding role beyond direct care delivery to active participation in prognostic monitoring, survival follow-up, and quality-of-life optimization. The purple cluster (clinical interventions), including surgery, radiotherapy, and management, complements this by emphasizing nurses’ involvement in executing and coordinating clinical treatment strategies, bridging the gap between medical interventions and patient-centered outcomes. [ 22 ] Together, these clusters validate that nurse-related research in this field is not siloed but deeply embedded in the broader oncology ecosystem, linking clinical practice to patient outcomes.

The strategic diagram (Fig. 5 D) adds nuance to this landscape by classifying topics based on maturity and centrality, offering actionable guidance for future inquiry. The first quadrant’s focus on children, survival, and quality-of -life confirms that pediatric bone tumor nursing outcomes have become a well-established core domain. This is unsurprising given the unique vulnerabilities of pediatric patients and the growing recognition of nurses’ role in long-term follow-up and psychosocial support. In contrast, the second quadrant’s radiotherapy, expression, and immunotherapy, mature but peripherally positioned, expose a critical gap: while these advanced treatment modalities are central to oncology, their integration into nursing research remains limited. This suggests opportunities for cross-disciplinary collaboration to explore how nursing care can optimize the safety and efficacy of emerging therapies. The fourth quadrant’s management and chemotherapy, highly relevant yet underdeveloped, further underscores unmet needs: despite being ubiquitous in nursing practice, systematic research on standardized management protocols or nursing interventions for chemotherapy-related adverse effects remains scarce, marking these as urgent priorities for translational nursing research.

The specialized analysis of nurse-focused keyword dynamics (Fig. 5 C) reinforces these observations. The sustained high frequency of chemotherapy, survival, and children reflects the enduring core of nursing practice in this field, while their concentration between 2017 and 2020 mirrors the global “patient-centered care” movement. This temporal alignment signals that nursing research has increasingly responded to broader healthcare imperatives, positioning nurses as key stakeholders in improving not just clinical outcomes but also patient experience.

4.3. Emerging topics

The identification of emerging keywords and dynamic thematic shifts provides critical foresight into the field’s evolutionary trajectory, highlighting areas where innovation and investment are most needed. Two key emerging trends stand out.

First, the emergence of subtype-specific keywords, such as osteosarcoma and Ewing sarcoma (Fig. 5 B), indicates a transition from broad “bone tumor” research to precision nursing care tailored to specific subtypes. Both osteosarcoma and Ewing sarcoma are aggressive, high-morbidity subtypes with distinct treatment trajectories and patient populations. [ 23 , 24 ] Their emergence as focal keywords suggests that nursing research is increasingly recognizing the need for personalized care strategies tailored to subtype-specific challenges, such as fertility preservation counseling for young Ewing sarcoma patients or limb-sparing surgery recovery support for osteosarcoma patients. [ 25 , 26 ] This trend aligns with precision medicine’s growth in oncology and offers a clear path for advancing nursing’s contribution to specialized cancer care.

Second, the growing prominence of outcome as an emerging keyword (Fig. 5 B) reflects a deeper, more holistic understanding of treatment success. Beyond traditional metrics such as survival, outcome now encompasses quality of life, functional recovery, and psychosocial well-being. This shift dovetails with the first quadrant’s established focus on pediatric outcomes (Fig. 5 D) but extends it to broader populations, suggesting that future research will prioritize integrating patient-reported outcomes into nursing assessment and intervention. [ 27 , 28 ]

4.4. Strengths and limitations

Our study offers several notable strengths. Primarily, it represents the first bibliometric analysis of nurse-related research in primary malignant bone tumors, to our understanding. While there are currently other bibliometric studies on cancer care, [ 8 , 29 ] they focus on the overall cancer field, particularly on tumor types with high incidence rates. They advocate for international health cooperation, quality of life management, and pain management. However, due to the characteristics of bibliometric research, this often results in the neglect of cancer types that are not the most prevalent but are still very important. These are of great significance to specialist doctors and nurses. Second, it presents annual trends in a precise and impartial manner, offering comprehensive information to surgeons, nurses, and researchers working in this field. A range of bibliometric software tools was utilized to explore the relationships among various entities, including countries, authors, institutions, journals, funding agencies, keywords, citations/co-citations, and references, across multiple dimensions, thereby bolstering the robustness of our results. However, it is important to recognize several limitations. First, the search strategy of this study is insufficient. To obtain the target literature more comprehensively, our search strategy was relatively broad and did not strictly limit the types of bone tumors. Although the literature was screened, it may still lead to inaccurate results. Additionally, the language of the search literature is limited to English. This could indeed lead to the omission of important nursing practice research results published in non-English journals in Asia and other regions. These studies may contain valuable insights related to specific cultures or medical environments. Second, incomplete data in 2024 may have impacted the comprehensiveness of our findings. It is worth noting that while the Web of Science database was chosen for its advanced analytical capabilities, rigorous methodology, standardized publication records, and enhanced visualization effects, this decision may have restricted our ability to conduct searches in other literature database.

5. Conclusion

This bibliometric analysis provides an updated overview of the development and knowledge structure of nurse-related research on primary malignant bone tumors from 2004 to 2025. The field has expanded steadily, with its major research themes centered on prognostic evaluation, clinical interventions, and patient outcomes. Emerging attention to subtype-targeted nursing care and multidimensional outcome assessment indicates a shift toward more individualized and patient-centered care.

These findings clarify the current research landscape and may help clinicians, nurses, and researchers identify important knowledge gaps and prioritize future investigations. Further studies should strengthen international and interinstitutional collaboration, develop and evaluate standardized nursing interventions, and incorporate functional, psychosocial, quality-of-life, and patient-reported outcomes into the care of patients with different bone tumor subtypes.

Author contributions

Conceptualization: Nianzhe Sun, Laiyu Xu.

Data curation: Nianzhe Sun, Laiyu Xu, Jinfei Fu, Liming Qing, Lingli Peng, Juyu Tang.

Formal analysis: Nianzhe Sun, Jinfei Fu, Liming Qing, Lingli Peng, Juyu Tang.

Funding acquisition: Nianzhe Sun, Liming Qing, Lingli Peng, Juyu Tang.

Investigation: Nianzhe Sun, Laiyu Xu, Panfeng Wu.

Methodology: Nianzhe Sun, Jinfei Fu, Panfeng Wu, Lingli Peng, Juyu Tang.

Project administration: Nianzhe Sun, Liming Qing, Lingli Peng, Juyu Tang.

Resources: Nianzhe Sun, Laiyu Xu, Lingli Peng.

Supervision: Liming Qing, Lingli Peng, Juyu Tang.

Software: Nianzhe Sun, Jinfei Fu, Liming Qing, Lingli Peng, Juyu Tang.

Validation: Panfeng Wu, Lingli Peng, Juyu Tang.

Visualization: Nianzhe Sun, Panfeng Wu, Lingli Peng, Juyu Tang.

Writing – original draft: Nianzhe Sun, Laiyu Xu, Jinfei Fu, Panfeng Wu, Liming Qing, Lingli Peng, Juyu Tang.

Writing – review & editing: Lingli Peng, Juyu Tang.

This work was supported by the National Natural Science Foundation of China (NSFC, Grant No. 82102177 to Prof. Peng, No. 82272508 and 82572774 to Prof. Tang), the Fundamental Research Funds for the Central Universities of Central South University (2026ZZTS0012), and the Natural Science Foundation of Hunan Province, China (Grant No. 2026JJ50291 to Prof. Peng, No. 2023JJ30935 to Prof. Qing).

This study did not involve human participants, animal experimentation, or cell-based research. All data were sourced from publicly available databases and existing published literature. As such, ethical approval from an institutional review board or ethics committee was not required for this work.

The authors have no conflicts of interest to declare.

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Supplemental Digital Content is available in the online version of this article ( http://dx.doi.org/10.1097/MD.0000000000050476 ).

How to cite this article: Sun N, Xu L, Fu J, Wu P, Qing L, Peng L, Tang J. The global perspective on the evolution of nurse-related research in primary malignant bone tumors from 2004 to 2025: A bibliometric mapping and visual analysis study. Medicine 2026;105:35(e50476).

NS and LX contributed to this article equally.

References

[1] Choi JH Ro JY . The 2020 WHO classification of tumors of bone: an updated review. Adv Anat Pathol . 2021 ; 28 : 119 – 38 . 33480599 10.1097/PAP.0000000000000293

[2] McMahon KM Eaton VP Srikanth KK . Survey of palliative care use in primary malignant bone tumors: a national cancer database review. J Palliat Med . 2023 ; 26 : 1139 – 46 . 37093019 10.1089/jpm.2022.0365

[3] Siegel RL Giaquinto AN Jemal A . Cancer statistics, 2024. CA Cancer J Clin . 2024 ; 74 : 12 – 49 . 38230766 10.3322/caac.21820

[4] Ferguson JL Turner SP . Bone cancer: diagnosis and treatment principles. Am Fam Physician . 2018 ; 98 : 205 – 13 . 30215968

[5] Mohty M Avet-Loiseau H Malard F Harousseau J-L . Potential future direction of measurable residual disease evaluation in multiple myeloma. Blood . 2023 ; 142 : 1509 – 17 . 37471603 10.1182/blood.2023020284

[6] Gupta A Dagar G Rehmani MU . CAR T-cell therapy in cancer: integrating nursing perspectives for enhanced patient care. Asia Pac J Oncol Nurs . 2024 ; 11 : 100579 . 39315365 10.1016/j.apjon.2024.100579 PMC11417177

[7] Heare T Hensley MA Dell’Orfano S . Bone tumors: osteosarcoma and Ewing’s sarcoma. Curr Opin Pediatr . 2009 ; 21 : 365 – 72 . 19421061 10.1097/MOP.0b013e32832b1111

[8] Molassiotis A Yorke J McCarthy AL Wengstrom Y Gibson F Abu-Odah H . The evolution of worldwide nurse-led cancer research in the last 2 decades (2004–2022): a bibliometric mapping and visual analysis. Cancer Nurs . 2024 ; 47 : E308 – 17 . 37552219 10.1097/NCC.0000000000001260

[9] Kahwa E Dodd A Conklin JL . A bibliometric analysis of nursing and midwifery research in the Caribbean. J Nurs Scholarsh . 2022 ; 54 : 226 – 33 . 35129290 10.1111/jnu.12721

[10] Sun N Liu Q Wu P Qing L Zeng L Tang J . Immunotherapeutic innovations in Alzheimer’s disease: a bibliometric landscape of global research trends and evolution [published online ahead of print May 22, 2026]. Curr Neuropharmacol . doi: 10.2174/011570159X407781251023061519 . 10.2174/011570159X407781251023061519 42227404

[11] Sun N Xing Y Jiang J Wu P Qing L Tang J . Knowledge mapping and emerging trends of ferroptosis in ischemia reperfusion injury research: a bibliometric analysis (2013–2022). Heliyon . 2023 ; 9 : e20363 . 37767486 10.1016/j.heliyon.2023.e20363 PMC10520329

[12] Lu Y Sun N Wu P Zhou G Peng L Tang J . The application of infrared thermography technology in flap: a perspective from bibliometric and visual analysis. Int Wound J . 2023 ; 20 : 4308 – 27 . 37551726 10.1111/iwj.14333 PMC10681462

[13] Sun N Sun Y Xing Y . Knowledge mapping and research trends of stem cell in wound healing: a bibliometric analysis. Int Wound J . 2024 ; 21 : e14587 . 42052950 10.1111/iwj.14587 PMC10830390

[14] Maomao C He L Dianqin S . Current cancer burden in China: epidemiology, etiology, and prevention. Cancer Biol Med . 2022 ; 19 : 1121 – 38 . 36069534 10.20892/j.issn.2095-3941.2022.0231 PMC9425189

[15] Tsukamoto S Errani C Angelini A Mavrogenis AF . Current treatment considerations for osteosarcoma metastatic at presentation. Orthopedics . 2020 ; 43 : e345 – 58 . 32745218 10.3928/01477447-20200721-05

[16] Soong RY Low CE Ong V . Exercise interventions for depression, anxiety, and quality of life in older adults with cancer: a systematic review and meta-analysis. JAMA Netw Open . 2025 ; 8 : e2457859 . 39903465 10.1001/jamanetworkopen.2024.57859 PMC11795328

[17] Yi JC Syrjala KL . Anxiety and depression in cancer survivors. Med Clin North Am . 2017 ; 101 : 1099 – 113 . 28992857 10.1016/j.mcna.2017.06.005 PMC5915316

[18] Ystaas L Nikitara M Ghobrial S . The impact of transformational leadership in the nursing work environment and patients outcomes: a systematic review. Nurs Rep . 2023 ; 13 : 1271 – 90 . 37755351 10.3390/nursrep13030108 PMC10537672

[19] Artan Y Sezgin G , Yildirim Y . From pain interference to hope: exploring spiritual well-being as a pathway for patients with cancer: a cross-sectional study [published online ahead of print June13, 2025]. Cancer Nurs . doi:10.1097/NCC.0000000000001523 . 10.1097/NCC.0000000000001523 40511916

[20] Ross H Tod AM Clarke A . Understanding and achieving person-centred care: the nurse perspective. J Clin Nurs . 2015 ; 24 : 1223 – 33 . 25047737 10.1111/jocn.12662

[21] Ong ZX Poon E . Functional outcomes of bony sarcoma (BS) in Adolescent and Young Adult Oncology (AYAO) patients–a scoping review. Chin Clin Oncol . 2024 ; 13 : 50 . 38859605 10.21037/cco-23-30

[22] Elizondo RN Ambrosio L La Rosa-Salas V . Role of the nurse in the design, delivery, monitoring and coordination of cancer survivorship care plans: an integrative review. J Adv Nurs . 2022 ; 78 : 48 – 62 . 34235775 10.1111/jan.14962

[23] Tirtei E Campello A Asaftei SD Mareschi K Cereda M Fagioli F . Precision medicine in osteosarcoma: MATCH trial and beyond. Cells . 2021 ; 10 : 281 . 33572496 10.3390/cells10020281 PMC7911557

[24] Smolle MA Seidel MG Kashofer K . Precision medicine in diagnosis, prognosis, and disease monitoring of bone and soft tissue sarcomas using liquid biopsy: a systematic review. Arch Orthop Trauma Surg . 2025 ; 145 : 121 . 39797974 10.1007/s00402-024-05711-w PMC11724793

[25] Gargallo P Juan A Yanez Y . Precision medicine in Ewing sarcoma: a translational point of view. Clin Transl Oncol . 2020 ; 22 : 1440 – 54 . 32026343 10.1007/s12094-020-02298-7

[26] Gotta J Bielack S Hecker-Nolting S . When your ankle becomes a knee - long-term functional outcome and quality of life with a rotationplasty after resection of malignant limb tumors. Klin Padiatr . 2022 ; 234 : 154 – 62 . 34902872 10.1055/a-1681-1916

[27] Fernando-Canavan L Abraham P Devlin N Tran-Duy A . Health-related quality of life in patients with extremity bone sarcoma after surgical treatment: a systematic review. Qual Life Res . 2024 ; 33 : 1157 – 74 . 38079025 10.1007/s11136-023-03554-3

[28] Greenzang KA Montgomery KE DuVall A . Incorporation of patient-reported outcomes in pediatric cancer clinical trials: design, implementation, and dissemination. J Natl Cancer Inst . 2025 ; 117 : 1764 – 73 . 40163691 10.1093/jnci/djaf083 PMC12415959

[29] Damar HT Bilik O Ozdagoglu G Ozdagoglu A Damar M . Scientometric overview of nursing research on pain management. Rev Lat Am Enfermagem . 2018 ; 26 : e3051 . 30183876 10.1590/1518-8345.2581.3051 PMC6136548