Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents

Patrick, D L, Cleeland, C S, von Moos, R, Fallowfield, L, Wei, R, Ohrling, K and Qian, Y (2014) Pain outcomes in patients with bone metastases from advanced cancer: assessment and management with bone-targeting agents. Supportive Care in Cancer, 23 (4). pp. 1157-68. ISSN 0941-4355

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Abstract

Bone metastases in advanced cancer frequently cause painful complications that impair patient physical activity and negatively affect quality of life. Pain is often underreported and poorly managed in these patients. The most commonly used pain assessment instruments are visual analogue scales, a single-item measure, and the Brief Pain Inventory Questionnaire-Short Form. The World Health Organization analgesic ladder and the Analgesic Quantification Algorithm are used to evaluate analgesic use. Bone-targeting agents, such as denosumab or bisphosphonates, prevent skeletal complications (i.e., radiation to bone, pathologic fractures, surgery to bone, and spinal cord compression) and can also improve pain outcomes in patients with metastatic bone disease. We have reviewed pain outcomes and analgesic use and reported pain data from an integrated analysis of randomized controlled studies of denosumab versus the bisphosphonate zoledronic acid (ZA) in patients with bone metastases from advanced solid tumors. Intravenous bisphosphonates improved pain outcomes in patients with bone metastases from solid tumors. Compared with ZA, denosumab further prevented pain worsening and delayed the need for treatment with strong opioids. In patients with no or mild pain at baseline, denosumab reduced the risk of increasing pain severity and delayed pain worsening along with the time to increased pain interference compared with ZA, suggesting that use of denosumab (with appropriate calcium and vitamin D supplementation) before patients develop bone pain may improve outcomes. These data also support the use of validated pain assessments to optimize treatment and reduce the burden of pain associated with metastatic bone disease.

Item Type: Article
Additional Information: Patrick, Donald L Cleeland, Charles S von Moos, Roger Fallowfield, Lesley Wei, Rachel Ohrling, Katarina Qian, Yi Review Germany Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Support Care Cancer. 2015 Apr;23(4):1157-68. doi: 10.1007/s00520-014-2525-4. Epub 2014 Dec 23.
Keywords: Adult Analgesics/*therapeutic use Analgesics, Opioid/*therapeutic use Bone Density Conservation Agents/*therapeutic use Bone Neoplasms/complications/*drug therapy/secondary Disease Progression Female Humans Male Pain/*drug therapy/etiology/prevention & control Pain Measurement Quality of Life/*psychology Treatment Outcome
Schools and Departments: Brighton and Sussex Medical School > Sussex Health Outcomes Research & Education in Cancer (SHORE-C)
Subjects: R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology Including cancer and carcinogens
R Medicine > RM Therapeutics. Pharmacology > RM0260 Chemotherapy
Depositing User: Kathryn Monson
Date Deposited: 22 Jul 2015 11:09
Last Modified: 06 Mar 2017 15:12
URI: http://sro.sussex.ac.uk/id/eprint/55664

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