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Quality of life issues in patients with bone metastases: A systematic review

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Abstract

Introduction

Bones are frequent sites of metastatic disease, observed in 30–75% of advanced cancer patients. Quality of life (QoL) is an important endpoint in studies evaluating the treatments of bone metastases (BM), and many patient-reported outcome tools are available. The primary objective of this systematic review was to compile a list of QoL issues relevant to BM and its interventions. The secondary objective was to identify common tools used to assess QoL in patients with BM, and the QoL issues they fail to address.

Methods

A search was conducted on Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases between 1946 and 27 January 2023 with the keywords “bone metastases”, “quality of life”, and “patient reported outcomes”. Specific QoL issues in original research studies and the QoL tools used were extracted.

Results

The review identified the QoL issues most prevalent to BM in the literature. Physical and functional issues observed in patients included pain, interference with ambulation and daily activities, and fatigue. Psychological symptoms, such as helplessness, depression, and anxiety were also common. These issues interfered with patients’ relationships and social activities. Items not mentioned in existing QoL tools were related to newer treatments of BM, such as pain flare, flu-like symptoms, and jaw pain due to osteonecrosis.

Conclusions

This systematic review highlights that QoL issues for patients with BM have expanded over time due to advances in BM-directed treatments. If they are relevant, additional treatment-related QoL issues identified need to be validated prospectively by patients and added to current assessment tools.

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Data availability

The search strategy and results can all be found in the tables and figures in the manuscript. All included articles can be found referenced in Appendix 2.

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Acknowledgements

Consortium members and affiliations

Henry CY Wong MBBS2, 20, Samantha KF Kennedy BSc(C)1, 20, Hany Soliman MD1, 20, Vassilios Vassiliou MD, PhD3, 20, Dirk Rades MD, FASTRO4, 20, Pierluigi Bonomo MD5, 20, Shing-Fung Lee MBBS, MSc6,7, 20, Adrian Wai Chan MBBS7, 20, Agata Rembielak MD, PhD8, 9, 20, Eva Oldenburger MD10, 20, Ernesto Maranzano MD11,12, 20, Joel A Finkelstein MD, MSc14, 20, Jeremie Larouche MD, MSc14, 20, Gustavo N Marta MD, PhD16, 20, Albert JM Yee MD, MSc14, 20, Joanne M van der Velden PhD18, 20, Edward Chow MBBS1, 20, On behalf of the EORTC Quality of Life Group20

20Quality of Life Department, EORTC, Avenue E. Mounier, 83/11, 1200 Brussels, Belgium

Funding

This research was funded by the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG), grant number 005/2023. The EORTC QLG business model involves license fees for commercial use of their instruments. Academic use of EORTC instruments is free of charge.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Thenugaa Rajeswaran, Elwyn Zhang, Samantha K. F. Kennedy, Milena Gojsevic, Hany Soliman & Edward Chow

  2. Department of Oncology, Princess Margaret Hospital, Hospital Authority, Kowloon, Hong Kong

    Henry C. Y. Wong

  3. Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus

    Vassilios Vassiliou

  4. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany

    Dirk Rades

  5. Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Pierluigi Bonomo

  6. Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore

    Shing-Fung Lee

  7. Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, New Territories, Hong Kong

    Shing-Fung Lee & Adrian Wai Chan

  8. The University of Manchester, Manchester, UK

    Agata Rembielak

  9. Department of Clinical Oncology, The Christie HNS Foundation Trust, Manchester, UK

    Agata Rembielak

  10. Department of Radiation Oncology, University Hospitals Leuven, Louvain, Belgium

    Eva Oldenburger

  11. Radiotherapy Oncology Centre, Santa Maria Hospital, Terni, Italy

    Ernesto Maranzano

  12. Department of Medicine and Surgery, University of Perugia, Perugia, Italy

    Ernesto Maranzano

  13. Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy

    Stefano Pergolizzi

  14. Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Joel A. Finkelstein, Jeremie Larouche & Albert J. M. Yee

  15. Liaoning Cancer Hospital and Institute, Shenyang, Liaoning, China

    Na Zhang & **ao**g Zhang

  16. Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil

    Gustavo N. Marta

  17. Department of Orthopedics, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei**g, China

    Shengji Yu

  18. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands

    Joanne M. van der Velden

  19. Department of Radiotherapy, Leiden University Medical Center, University of Leiden, Leiden, Holland

    Yvette M. van der Linden

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  1. Thenugaa Rajeswaran
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On behalf of the EORTC Quality of Life Group

Contributions

Data extraction was conducted by TR, HCYW, and EZ. Figures and tables were prepared by TR and HCYW. The first draft of the manuscript was written by TR and HCYW and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Edward Chow.

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Thenugaa Rajeswaran and Henry CY Wong contributed equally to this work as joint first authors.

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Rajeswaran, T., Wong, H.C.Y., Zhang, E. et al. Quality of life issues in patients with bone metastases: A systematic review. Support Care Cancer 32, 18 (2024). https://doi.org/10.1007/s00520-023-08241-0

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