Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Abstract

Background: Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD. Methods: Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses. Results: At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power. Conclusions: A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.

Factors Influencing Distress and Coping Strategies Among Patients with Metastatic Spinal Tumor at Cipto Mangunkusumo General Hospital

“…The study showed that 57.7% of patients experienced distress, and this was in line with the prevalence reported in previous reviews (ranging from 19% to 68.8%) [16,20,21]. The result was also in line with the observation of Westhoff et al [22], showing that 27% of metastatic bone tumor patients experienced high distress, while 29% experienced moderate distress. The potential distress in metastatic spinal tumor patients could be attributed to the late-stage tumor phase, accompanied by uncertainty about the future, concerns about physical disabilities, and treatment plans.…”

Analgesia and curative effect of pamidronate disodium combined with chemotherapy on elderly patients with advanced metastatic bone cancer

“…Patients with advanced tumors suffer from bone pain and fracture due to the deterioration of tumors and bone metastases, causing bone cell absorption and osteolysis, or even bone destruction (4,5). Patients with bone metastases endure severe pain resulting in low quality of life and poor mental health, as well as loss of confidence in life (6). Morphine is a routine analgesic in the late stage of clinical treatment but with poor effect for patients with bone metastasis because of short onset time and side effects (7).…”