Measuring health status in patients with skeletal metastases treated by surgery

Quality of life measurement in bone metastases: A literature review

Quality of life (QOL) has become an important consideration in the care of patients with bone metastases as prevalence, incidence and patient survival are on the rise. As a result, more interventional studies now measure patient’s QOL as a meaningful endpoint. However, well-developed bone metastases specific quality of life instruments are lacking. A literature review was conducted to better understand the nature of QOL instruments used in bone metastases trials. A total of 47 articles evaluating QOL in patients with bone metastases were identified. Twenty-five different instruments were used to evaluate QOL with study-designed questionnaires and the EORTC QLQ-C30 being most commonly employed. Many studies used more than one scale or instrument to measure QOL. This makes it difficult to compare QOL in bone metastases patients across studies and come to any formal conclusions. Therefore, this review demonstrates the need to develop a bone module that can be used across countries in future clinical trials.

A comparison of pain and health-related quality of life between two groups of cancer patients with differing average levels of pain

A study was performed to describe and compare pain and Health-Related Quality of Life (HRQOL) in two groups of cancer patients in palliative care as well as to describe the correlation between pain and HRQOL. Forty-seven patients with mild average pain [Visual Analogue Scale (VAS) </= 3] and 28 patients with moderate to severe average pain (VAS > 3) were included. Medical Outcomes Study Short Form (SF-36) was used to evaluate HRQOL, pain intensity levels were measured with the VAS on Pain-O-Meter. Compared to patients with mild pain, patients with moderate to severe pain had statistically significant, higher pain intensity for the items 'pain at time of interview', 'worst pain in the past 24 hours' and 'pain interrupting sleep.' They also had the lowest scores of the SF-36 dimensions: physical functioning, role-physical, and bodily pain. Patients with moderate to severe pain had statistically significant, fewer months of survival. There were statistically significant positive correlations between pain items and negative correlation between pain and SF-36 dimensions. The conclusion is that pain has a negative impact on HRQOL, especially on physical health and that pain increases towards the final stages of life. Even if patients have to endure symptoms such as fatigue and anxiety during their short survival time, dealing with pain is an unnecessary burden, which can be prevented.

Validation of a functional evaluation system in patients with musculoskeletal tumors

The validity and reliability of the Musculoskeletal Tumor Society functional evaluation system were evaluated using the Nottingham Health Profile, the Short Form-36, and the EuroQol protocol to measure the quality of life of patients with malignant musculoskeletal tumors. Forty-nine patients were assessed and osteosarcoma around the knee was the most common type of tumor. Prosthetic reconstructions had been done in 55.1% of patients. In a content validity analysis, neither social nor psychologic domain was identified in the Musculoskeletal Tumor Society system. All items of the lower extremity were related to the same function-walking ability. The Musculoskeletal Tumor Society system had a strong correlation with other quality of life measures in the construct validity and the reliability, but each domain of the system was so comprehensive that it could not represent the quality of life properly. Furthermore, the preoperative and postoperative status of patients could not be compared using this system. The overall validity and reliability of the Musculoskeletal Tumor Society system seemed to be acceptable. However, this system may require additional development of the appropriate domains for evaluating the quality of life in patients with musculoskeletal tumors.

Evaluation of the feasibility of and results of measuring health-status changes in patients undergoing surgical treatment for skeletal metastases

The goal of treating patients with skeletal metastases is to decrease pain and improve or maintain physical function. Assessment of the effectiveness of treatment should therefore include evaluation of patient-rated measures of quality of life. The primary objective of the study was to determine the feasibility of studying the effect of surgical treatment of skeletal metastases on quality of life. The secondary objective was to provide data that begin to characterize this effect. The characteristics of patients with skeletal metastases are heterogeneous, patient enrollment in the study may be low, high attrition occurs secondary to death, and well accepted health-status measures (such as the Short Form-36) may be ineffective at detecting changes in health status; therefore, it is difficult to study these patients. High attrition and adjuvant treatment with radiation or chemotherapy made it impractical to draw firm conclusions about the effect of surgical treatment, but a trend toward improvement in selected health-status measures for both physical and mental health was noted. Analysis of patient-rated health-status scores as predictors of survival indicates that improvement in these scores 6 weeks after surgery is associated with an increase in the length of survival following surgery.