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17.10.2016 | Clinical Research | Ausgabe 2/2017

Clinical Orthopaedics and Related Research® 2/2017

What Factors are Associated With Quality Of Life, Pain Interference, Anxiety, and Depression in Patients With Metastatic Bone Disease?

Zeitschrift:
Clinical Orthopaedics and Related Research® > Ausgabe 2/2017
Autoren:
BSc Q. M. J. van der Vliet, MD N. R. Paulino Pereira, MD S. J. Janssen, MD, MS, PhD F. J. Hornicek, MD M. L. Ferrone, MD, PhD J. A. M. Bramer, MD, PhD C. N. van Dijk, MD, MS J. H. Schwab
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11999-016-5118-3) contains supplementary material, which is available to authorized users.
One of the authors certifies that he (SJJ), or a member of his or her immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from the Anna Foundation (Oegstgeest, The Netherlands), an amount of less than USD 10,000 from the De Drie Lichten Foundation (Hilversum, The Netherlands), an amount of less than USD 10,000 from the KWF Kankerbestrijding (Amsterdam, The Netherlands), and an amount of less than USD 10,000 from the Michael van Vloten Foundation (Rotterdam, The Netherlands).
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This study was performed at Massachusetts General Hospital & Brigham and Women’s Hospital, Boston, MA, USA.
A comment to this article is available at http://​dx.​doi.​org/​10.​1007/​s11999-016-5185-5.

Abstract

Background

It would be helpful for the decision-making process of patients with metastatic bone disease to understand which patients are at risk for worse quality of life (QOL), pain, anxiety, and depression. Normative data, and where these stand compared with general population scores, can be useful to compare and interpret results of similar patients or patient groups, but to our knowledge, there are no such robust data.

Questions/Purposes

We wished (1) to assess what factors are independently associated with QOL, pain interference, anxiety, and depression in patients with metastatic bone disease, and (2) to compare these outcomes with general US population values.

Methods

Between November 2011 and February 2015, 859 patients with metastatic bone disease presented to our orthopaedic oncology clinic; 202 (24%) were included as they completed the EuroQOL-5 Dimension (EQ-5DTM), PROMIS® Pain Interference, PROMIS® Anxiety, and PROMIS® Depression questionnaires as part of a quality improvement program. We did not record reasons for not responding and found no differences between survey respondents and nonrespondents in terms of age (63 versus 64 years; p = 0.916), gender (51% men versus 47% men; p = 0.228), and race (91% white versus 88% white; p = 0.306), but survey responders were more likely to be married or living with a partner (72%, versus 62%; p = 0.001). We assessed risk factors for QOL, pain interference, anxiety, and depression using multivariable linear regression analysis. We used the one-sample signed rank test to assess whether scores differed from US population averages drawn from earlier large epidemiologic studies.

Results

Younger age (β regression coefficient [β], < 0.01; 95% CI, 0.00–0.01; p = 0.041), smoking (β, −0.12; 95% CI, −0.22 to −0.01; p = 0.026), pathologic fracture (β, −0.10; 95% CI, −0.18 to −0.02; p = 0.012), and being unemployed (β, −0.09; 95% CI, −0.17 to −0.02; p = 0.017) were associated with worse QOL. Current smoking status was associated with more pain interference (β, 6.0; 95% CI, 1.6–11; p = 0.008). Poor-prognosis cancers (β, 3.8; 95% CI, 0.37–7.2; p = 0.030), and pathologic fracture (β, 6.3; 95% CI, 2.5–7.2; p = 0.001) were associated with more anxiety. Being single (β, 5.9; 95% CI, 0.83–11; p = 0.023), and pathologic fracture (β, 4.4; 95% CI, 0.8–8.0; p = 0.017) were associated with depression. QOL scores (0.68 versus 0.85; p < 0.001), pain interference scores (65 versus 50; p < 0.001), and anxiety scores (53 versus 50; p = 0.011) were worse for patients with bone metastases compared with general US population values, whereas depression scores were comparable (48 versus 50; p = 0.171).

Conclusions

Impending pathologic fractures should be treated promptly to prevent deterioration in QOL, anxiety, and depression. Our normative data can be used to compare and interpret results of similar patients or patient groups. Future studies could focus on specific cancers metastasizing to the bone, to further understand which patients are at risk for worse patient-reported outcomes.

Level of evidence

Level III, prognostic study.

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11999_2016_5118_MOESM1_ESM.doc
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