Quality of Life in Relation to Pain Response to Radiation Therapy for Painful Bone Metastases.
OBJECTIVE
To study quality of life (QoL) in responders and nonresponders after radiation therapy for painful bone metastases; and to identify factors predictive for a pain response.


METHODS
The prospectively collected data of 956 patients with breast, prostate, and lung cancer within the Dutch Bone Metastasis Study were used. These patients, irradiated for painful bone metastases, rated pain, QoL, and overall health at baseline and weekly afterward for 12 weeks. Using generalized estimating equations analysis, the course of QoL was studied, adjusted for primary tumor. To identify predictive variables, proportional hazard analyses were performed, taking into account death as a competing risk, and C-statistics were calculated for discriminative value.


RESULTS
In total, 722 patients (76%) responded to radiation therapy. During follow-up, responders had a better QoL in all domains compared with nonresponders. Patients with breast or prostate cancer had a better QoL than patients with lung cancer. In multivariate analysis, baseline predictors for a pain response were breast or prostate cancer as primary tumor, younger age, good performance status, absence of visceral metastases, and using opioids. The discriminative ability of the model was low (C-statistic: 0.56).


CONCLUSIONS
Responding patients show a better QoL after radiation therapy for painful bone metastases than nonresponders. Our model did not have enough discriminative power to predict which patients are likely to respond to radiation therapy. Therefore, radiation therapy should be offered to all patients with painful bone metastases, aiming to decrease pain and improve QoL.
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: p.g.westhoff@umcutrecht.nl.
Paulien G
PG
Westhoff
Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Alexander
A
de Graeff
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Evelyn M
EM
Monninkhof
Department of Radiotherapy, Reinier de Graaf Gasthuis, Delft, The Netherlands.
Jacqueline
J
Pomp
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Marco
M
van Vulpen
Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen, The Netherlands.
Jan Willem H
JW
Leer
Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Corrie A M
CA
Marijnen
Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Yvette M
YM
van der Linden
D000368:Aged; D001859:Bone Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000532:radiotherapy*; D010147:Pain Measurement; D010166:Palliative Care; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome