Course of quality of life after radiotherapy for painful bone metastases - a detailed analysis from the Dutch Bone Metastasis Study

Publication date: Available online 29 March 2016
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Paulien G. Westhoff, Mathilde G.E. Verdam, Frans J. Oort, Jan J. Jobsen, Marco van Vulpen, Jan Willem H. Leer, Corrie A.M. Marijnen, Alexander de Graeff, Yvette M. van der Linden
BackgroundIn palliative care, quality of life (QoL) is an important endpoint. We studied the course of QoL after radiotherapy for painful bone metastases.MethodsThe Dutch Bone Metastasis Study randomized 1,157 patients with painful bone metastases between a single fraction of 8 Gray and six fractions of 4 Gray between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. In these analyses, physical, psychosocial and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics.ResultsIn general, QoL stabilized after a month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (-0.11 to -0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gray and six fractions of 4 Gray, except for a temporary worsening of physical QoL after six fractions.ConclusionAlthough radiotherapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterwards a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gray lead to a temporary worse physical QoL compared to a single fraction of 8 Gray.

Teaser

Although radiotherapy for painful bone metastases often leads to a meaningful pain response, most domains of QoL do not improve after treatment. In general, QoL stabilizes after a month and deteriorates towards the end of life. Psychosocial QoL improves slightly after treatment. For most QoL domains, a high pain score and intake of opioids are associated with worse QoL. A poor performance score is associated with worse functional QoL.


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