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Pre-radiotherapy pain intensity and health-related quality of life in patients with bone metastases at various vertebral levels

Published:December 18, 2020DOI:https://doi.org/10.1016/j.jmir.2020.11.014

      Abstract

      Purpose

      The spine is the most common site of bone metastasis from cancer and can be divided into 5 locational subsections, varying in mobility. The purpose of this research was to determine if the mobility of the metastases-bearing vertebral segment influenced pre-treatment pain intensity or health-related quality of life (HR-QoL) for patients about to receive palliative radiation therapy for painful spine metastasis.

      Methods

      This study was a retrospective chart review of patients referred to the Palliative Radiation Oncology Program, about to receive radiation therapy for vertebral metastasis between January 2014 and June 2016. The main variables included patient-reported Edmonton Symptom Assessment Score pain intensity, the EQ-5D score for HR-QoL and the location of the vertebral metastasis (categorized using the SINS mobility score (mobile, junctional, semi-rigid, or rigid)). Various patient, disease and treatment characteristics were also collected, and entered into a multivariate analysis.

      Results

      The eligible sample included 196 patients. Spinal metastases were distributed with approximately equal frequency (~27%) between the junctional, mobile and semi-rigid spine segments. Rigid spine was the least common site for spinal metastases (19%). Patients with metastatic disease in the mobile spine regions experienced greater pre-treatment pain compared to patients with disease in junctional subsections (Odds Ratio [OR] 1.37; p0.012). No relationship between HR-QOL and spinal mobility was found. Multivariate analysis also revealed that spinal metastases from a primary lung diagnosis reported worse pre-treatment pain compared to those from genitourinary cancers (OR 1.15; p0.05). Only age significantly influenced HR-QoL (75–95yrs vs. 35–55yrs; p0.041).

      Conclusions

      Patients referred to an RT clinic for the treatment of painful spinal metastases have a different distribution of disease throughout the spine compared to those referred for surgery or SBRT. Those with metastases in mobile spine segments were more likely to experience severe pre-treatment pain than those with metastases in junctional segments. Although further corroboration is needed, our results suggest that the mobility of the metastasis-bearing spinal section could be added to the existing list of predictors that aid clinicians in identifying patients that will benefit from closer follow-up or early intervention.

      Résumé

      But

      La colonne vertébrale est le site le plus fréquent de métastases osseuses dues au cancer et peut être divisée en 5 sous-sections de localisation, dont la mobilité varie. L'objectif de cette recherche était de déterminer si la mobilité du segment vertébral porteur de métastases influençait l'intensité de la douleur avant le traitement ou la qualité de vie liée à la santé (QVLS) des patients sur le point de recevoir une radiothérapie palliative pour une métastase douloureuse de la colonne vertébrale.

      Méthodologie

      Cette étude était une revue rétrospective des dossiers de patients référés au programme de radio-oncologie palliative, sur le point de recevoir une radiothérapie pour des métastases vertébrales entre janvier 2014 et juin 2016. Les principales variables comprenaient l'intensité de la douleur rapportée par le patient selon l'Edmonton Symptom Assessment Score, le score EQ-5D pour la QVLS et la localisation des métastases vertébrales (classées selon le score de mobilité SINS (mobile, jonctionnel, semi-rigide ou rigide)). Diverses caractéristiques du patient, de la maladie et du traitement ont également été recueillies et entrées dans une analyse multivariée.

      Résultats

      L'échantillon éligible comprenait 196 patients. Les métastases vertébrales étaient réparties avec une fréquence à peu près égale (~27%) entre les segments vertébraux jonctionnels, mobiles et semi-rigides. La colonne vertébrale rigide était le site le moins fréquent des métastases vertébrales (19%). Les patients atteints de métastases dans les régions mobiles de la colonne vertébrale ont ressenti une plus grande douleur avant le traitement que les patients atteints de maladies dans les sous-sections jonctionnelles (rapport de cotes 1,37; p = 0,012). Aucun lien entre la qualité de vie des patients et la mobilité de la colonne vertébrale n'a été trouvé. L'analyse multivariée a également révélé que les patients présentant des métastases vertébrales à la suite d'un diagnostic pulmonaire primaire souffraient davantage de douleurs avant le traitement que ceux atteints de cancers génito-urinaires (rapport de cotes 1,15; p = 0,05). Seul l'âge a une influence significative sur la QVLs (75–95 ans c. 35–55 ans; p = 0,041).

      Conclusions

      Les patients adressés à une clinique de RT pour le traitement des métastases douloureuses de la colonne vertébrale ont une distribution différente de la maladie dans la colonne vertébrale par rapport à ceux qui sont orientés vers la chirurgie ou la RSC. Ceux qui ont des métastases dans les segments mobiles de la colonne vertébrale sont plus susceptibles de ressentir une douleur intense avant le traitement que ceux qui ont des métastases dans les segments jonctionnels. Bien qu'une corroboration supplémentaire soit nécessaire, nos résultats suggèrent que la mobilité de la section de la colonne vertébrale portant des métastases pourrait être ajoutée à la liste existante des prédicteurs qui aident les cliniciens à identifier les patients qui bénéficieront d'un suivi plus étroit ou d'une intervention précoce.

      Keywords

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