Radiotherapy reduces pain from bone metastases but barely lifts quality of life

Radiation treatments help relieve pain from bone metastases, but the alleviation isn’t pronounced enough to improve patients’ overall quality of life, according to a Dutch study posted online March 29 in the International Journal of Radiation Oncology*Biology*Physics.

Led by Paulien Westhoff, MD, of Radboud University in the Netherlands, the research team randomized 1,157 patients with painful bone metastases who received doses between a single fraction of 8 Gy and six fractions of 4 Gy between 1996 and 1998.

The patients filled out weekly questionnaires for 13 weeks, then monthly for two years. From these data the researchers analyzed physical, psychosocial and functional quality-of-life domain scores, along with scores of general health.

They found that, while pain relief was measurable and meaningful, only psychosocial quality of life improved after treatment, and then only slightly.

Additionally, quality of life tracked closely with actual survival, stabilizing for most of the survival time before taking a sharp downturn a few weeks prior to death.

The team recorded no difference in quality of life between patients receiving a single fraction of 8 Gy and six fractions of 4 Gy, although the six-fraction group experienced a temporary worsening of quality of life that persisted up to four weeks after the start of treatment.

In their discussion, Westhoff et al. acknowledge as a limitation their reliance on data from the Dutch Bone Metastasis Study of the late 1990s, noting that there have been changes in treatments over the years since then that, in some cases, have altered the course of cancer treatment and, with it, outcomes.

“On the other hand, in the current paper we showed that, irrespective of survival, the pattern of quality of life is similar in all patient groups,” the authors write, stressing that quality of life remains stable for a long period and only deteriorates briefly before the end of life.

“Although the systemic treatment of patients with painful bone metastases and their survival has changed over time, the standard local treatment has remained palliative radiotherapy, with a single fraction of 8 Gy. Therefore, we believe these quality of life results are still applicable to current patients with painful bone metastases.”