Impact of reirradiation of painful osseous metastases on quality of life and function: a secondary analysis of the NCIC CTG SC.20 randomized trial

Abstract

Purpose: We previously demonstrated that 48% of patients with pain at sites of previously irradiated bone metastases benefit from reirradiation. It is unknown whether alleviating pain also improves patient perception of quality of life (QOL).

Patients and methods: We used the database of a randomized trial comparing radiation treatment dose fractionation schedules to evaluate whether response, determined using the International Consensus Endpoint (ICE) and Brief Pain Inventory pain score (BPI-PS), is associated with patient perception of benefit, as measured using the European Organisation for Resesarch and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) and functional interference scale of the BPI (BPI-FI). Evaluable patients completed baseline and 2-month follow-up assessments.

Results: Among 850 randomly assigned patients, 528 were evaluable for response using the ICE and 605 using the BPI-PS. Using the ICE, 253 patients experienced a response and 275 did not. Responding patients had superior scores on all items of the BPI-FI (ie, general activity, mood, walking ability, normal work, relations with other people, sleep, and enjoyment of life) and improved QOL, as determined by scores on the EORTC QLQ-C30 scales of physical, role, emotional and social functioning, global QOL, fatigue, pain, and appetite. Similar results were obtained using the BPI-PS; observed improvements were typically of lesser magnitude.

Conclusion: Patients responding to reirradiation of painful bone metastases experience superior QOL scores and less functional interference associated with pain. Patients should be offered re-treatment for painful bone metastases in the hope of reducing pain severity as well as improving QOL and pain interference.

Trial registration: ClinicalTrials.gov NCT00080912.

Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

© 2014 by American Society of Clinical Oncology.

Figures

Fig 1.

CONSORT diagram. BPI, Brief Pain Inventory; QoL, quality of life; SC.20, NCIC Clinical Trials Group Symptom Control trial.

Fig A1.

Average change scores after radiotherapy (and 95% CIs) for responders versus nonresponders defined per protocol (international consensus [int cons]) and by Brief Pain Inventory pain score pain-only methods. Negative change score represents average improvement for given item.

Fig A2.

Average quality of life (QoL) change scores (and 95% CIs) after radiotherapy for responders versus nonresponders based on two methods of defining treatment response: international consensus (int cons) and Brief Pain Inventory pain score pain-only methods. Change scores to left of vertical reference line denote improvement.