Cancer survivorship continues to improve, but incidence for many of the most common diagnoses is also increasing leading to an increased prevalence of metastatic bone disease. Many objective tools exist for predicting survival but require continued updates as the landscape of treatment evolves rapidly with new systemic therapies. Survival among the five most common carcinomas that metastasize to bone is also improving, but the presence and management of metastatic bone disease appear to impact survival. The implications of increased survivorship affect decision-making in surgical management of disease which continues to evolve especially as quality of life is increasingly prioritized. Survivors’ quality of life is multifactorial and requires multidisciplinary management. Early involvement of palliative care may improve outcomes in some scenarios.