Course of Quality of Life After Radiation Therapy for Painful Bone Metastases: A Detailed Analysis From the Dutch Bone Metastasis Study.
To study the course of quality of life (QoL) after radiation therapy for painful bone metastases.



The Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 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.



In general, QoL stabilized after 1 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 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions.



Although radiation therapy 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 afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: p.g.westhoff@umcutrecht.nl.
Paulien G
PG
Westhoff
Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Mathilde G E
MGE
Verdam
Research Institute of Child Development and Education, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Frans J
FJ
Oort
Department of Radiotherapy, Medisch Spectrum Twente, Enschede, the Netherlands.
Jan J
JJ
Jobsen
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands.
Marco
M
van Vulpen
Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands.
Jan Willem H
JWH
Leer
Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands.
Corrie A M
CAM
Marijnen
Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
Alexander
A
de Graeff
Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands.
Yvette M
YM
van der Linden
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology*; D010166:Palliative Care / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D020266:Radiotherapy, Conformal / Q000523:psychology*; D016896:Treatment Outcome
D000701:Analgesics, Opioid