International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationQuality of Life After Palliative Radiation Therapy for Patients With Painful Bone Metastases: Results of an International Study Validating the EORTC QLQ-BM22
Introduction
Radiation therapy (RT) is an efficacious, clinically efficient, and cost-effective method of palliating painful bone metastases. The rates of overall response and complete response to RT when all randomized controlled trial data are pooled are approximately 70% and 28%, respectively, and in cases of “uncomplicated” bone metastases, where there is no fracture or neurologic compromise, single-dose treatment provides a response equivalent to multiple treatments (1). As such, significant savings are made in both cost and resource use 2, 3, 4.
In patients with advanced disease, treatment strategies aim to improve or maintain quality of life (QOL) over traditional endpoints such as survival. RT not only manages pain resulting from bone metastases but can also help reduce analgesic intake and the side effects of analgesics, which may negatively impact QOL (5).
Assessment of QOL is most frequently conducted with validated tools either by the patients themselves or by proxy, although the reliability of the latter is controversial (6). Both the European Organisation for Research and Treatment of Cancer (EORTC) and Functional Assessment of Cancer Therapy (FACT) groups offer questionnaires for assessment of QOL in cancer patients. Issues common among all patients are typically assessed by use of a “core measure,” such as the EORTC QLQ-C30 (7) or FACT-G (8). Because these may not address specific issues that are important to certain subpopulations, disease-specific instruments are also available.
The EORTC QLQ-BM22 was designed to be used in conjunction with the core QLQ-C30 and addresses issues expected in patients with bone metastases. Domains covered include painful sites, painful characteristics, functional interference, and psychosocial aspects relating to bone metastases. In a 400-patient sample, the validity, reliability, cross-cultural applicability, and sensitivity of the QLQ-BM22 were successfully established (9).
Previous studies of QOL in patients with bone metastases have shed useful light on the patients' QOL and pain 10, 11. However, some of these studies' results may have been limited, because only more general assessments of QOL were available and many may not have been rigorously validated tools for this population. Hence the aim of this study was to determine the changes in bone metastasis-specific QOL scores in patients undergoing palliative RT, using robust and specific QOL measures for patients with bone metastases.
Section snippets
Patient population
Patients with bone metastases undergoing various treatments were enrolled in an international trial validating the QLQ-BM22 from March 2010-January 2011 (9); this study includes a subset of patients who received RT. The QLQ-BM22 and QLQ-C30 were administered at baseline and at 1 month after treatment for all patients; in addition, the worst pain score in the past 24 hours at the site to be treated was determined. All patients were 18 years or older and had histologically confirmed primary
Results
A total of 79 patients received RT and had recorded pain medication use and scores at baseline (Table 1). The mean age was 63 years, and the median Karnofsky Performance Status was 70. The majority of patients were enrolled from Canada (44%), followed by Cyprus, Egypt, Brazil, India, and France. Primary cancers of the breast (21 [26.6%]), prostate (17 [21.5%]), and lung (16 [20.2%]) were most common. Of these patients, 59 had complete follow-up QOL data and were used for further analysis.
There
Discussion
Patients who achieve pain relief from palliative RT also report better QOL in symptom and functional domains related to painful bone metastases. This is the first international study that analyzed QOL changes after palliative RT using a bone metastasis-specific instrument. We also showed that the QLQ-BM22 is able to differentiate patients who respond to treatment from those who do not.
Prior studies assessing QOL in this population have used generalized tools such as the core EORTC QLQ-C30 or
Acknowledgment
The authors are thankful for the generous support of the Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.
References (17)
- et al.
Update on the systematic review of palliative radiotherapy trials for bone metastases
Clin Oncol (R Coll Radiol)
(2012) - et al.
Costing the components of pain management: analysis of Trans-Tasman Radiation Oncology Group trial (TROG 96.05): one versus five fractions for neuropathic bone pain
Radiother Oncol
(2005) - et al.
Update of the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases
Int J Radiat Oncol Biol Phys
(2012) - et al.
Pain relief and quality of life following radiotherapy for bone metastases: a randomised trial of two fractionation schedules
Radiother Oncol
(1997) - et al.
Oral ibandronate improves bone pain and preserves quality of life in patients with skeletal metastases due to breast cancer
Pain
(2004) - et al.
Switching breast cancer patients with progressive bone metastases to third-generation bisphosphonates: measuring impact using the Functional Assessment of Cancer Therapy-Bone Pain
J Pain Symptom Manage
(2009) - et al.
Psychosocial issues in lung cancer patients (part 1)
Chest
(1991) - et al.
Patients' and health care professionals' evaluation of health-related quality of life issues in bone metastases
Eur J Cancer
(2009)
Cited by (81)
Pain Response Rates After Conventional Radiation Therapy for Bone Metastases Assessed Using International Consensus Pain Response Endpoints: A Systematic Review and Meta-Analysis of Initial Radiation Therapy and Reirradiation
2023, International Journal of Radiation Oncology Biology PhysicsHip reconstruction with a combination of prosthesis and recycled autograft treated with liquid nitrogen in metastatic subtrochanteric fracture can improve quality of life: A case report
2022, International Journal of Surgery Case ReportsComputed Tomography‒Guided Microwave Ablation Combined with Osteoplasty for the Treatment of Bone Metastases: A Multicenter Clinical Study
2021, Journal of Vascular and Interventional RadiologyPalliative care for patients with bone metastases
2021, Bone Cancer: Bone Sarcomas and Bone Metastases - From Bench to BedsidePain control with palliative radiotherapy in patients with bone metastases
2021, Bone Cancer: Bone Sarcomas and Bone Metastases - From Bench to BedsideThe use of patient reported outcome measures (PROMs) in palliative radiotherapy: A topical review
2020, Radiotherapy and Oncology
Conflict of interest: Andrew Bottomley is a coauthor of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group measurement system. The tools are provided free to academic researchers, but the EORTC charges a user fee for the use of the EORTC QLQ-C30 in industry-sponsored research to cover the cost of future psychometric validation, testing, and translation of quality-of-life tools. There are no other conflicts of interest.