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Classification of painful bone metastases as mild, moderate, or severe using both EORTC QLQ-C15-PAL and EORTC QLQ-BM22

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Abstract

Purpose

Previous studies have determined optimal cut points (CPs) for the classification of pain severity as mild, moderate, or severe using only the Brief Pain Inventory (BPI) or the BPI in conjunction with a quality of life (QOL) tool. The purpose of our study was to determine the optimal CPs based on correlation with only QOL outcomes.

Methods

We conducted an analysis of 298 patients treated with radiation therapy for painful bone metastases on a phase III randomized trial. Prior to treatment, patients provided their worst pain score on a scale of 0 (no pain) to 10 (worst possible pain), as well as completed the European Organization of Cancer Research and Treatment (EORTC) QOL Questionnaire Bone Metastases module (QLQ-BM22) and the EORTC QOL Questionnaire Core-15 Palliative (QLQ-C15-PAL). Optimal CPs were determined to be those that yielded the largest F ratio for the between category effect on each subscale of the QLQ-BM22 and QLQ-C15-PAL using the multivariate analysis of variance (MANOVA).

Results

The two largest F ratios for Wilk’s λ, Pillai’s Trace, and Hotelling’s Trace were for CPs 5,6 and 5,7. Combining both, the optimal CPs to differentiate between mild, moderate, and severe pain were 5 and 7. Pain scores of 1–5, 6, and 7–10 were classified as mild, moderate, and severe, respectively. Patients with severe pain experienced greater functional interference and poorer QOL when compared to those with mild pain.

Conclusion

Our results suggest that, based on the impact of pain on QOL measures, pain scores should be classified as follows: 1–5 as mild pain, 6 as moderate pain, and 7–10 as severe pain. Optimal CPs vary depending on the type of outcome measurement used.

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Acknowledgments

This study was supported by the NCIC CTG’s programmatic grants from the Canadian Cancer Society Research Institute. We thank the participation of all the patients and the research teams.

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Authors and Affiliations

  1. Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada

    Rachel McDonald, Edward Chow & Carlo DeAngelis

  2. Canadian Clinical Trials Group, Cancer Research Institute, Queen’s University, Kingston, ON, Canada

    Keyue Ding, Carolyn F. Wilson & Liting Zhu

  3. Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, ON, Canada

    Ralph M. Meyer

  4. Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada

    Abdenour Nabid

  5. Hopital Maisonneuve-Rosemont, Montreal, QC, Canada

    Pierre Chabot

  6. CHUM-Hopital Notre-Dame, Montreal, QC, Canada

    Genevieve Coulombe

  7. CancerCare Manitoba, Winnipeg, MB, Canada

    Shahida Ahmed

  8. Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, ON, Canada

    Joda Kuk

  9. London Regional Cancer Program, London, ON, Canada

    Rashid Dar

  10. Cancer Centre of Southeastern Ontario, Kingston General Hospital, Kingston, ON, Canada

    Aamer Mahmud

  11. Cross Cancer Institute, Edmonton, AB, Canada

    Alysa Fairchild

  12. Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada

    Jackson S. Y. Wu

  13. University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Kristopher Dennis

  14. Princess Margaret Hospital, Radiation Medicine Program, Ontario Cancer Institute, University of Toronto, Toronto, ON, Canada

    Rebecca K. S. Wong

  15. Queen’s University, Kingston, ON, Canada

    Michael Brundage

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  1. Rachel McDonald
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  2. Keyue Ding
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  3. Edward Chow
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  4. Ralph M. Meyer
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  5. Abdenour Nabid
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  7. Genevieve Coulombe
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  8. Shahida Ahmed
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  9. Joda Kuk
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  10. Rashid Dar
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  11. Aamer Mahmud
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  12. Alysa Fairchild
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  13. Carolyn F. Wilson
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  14. Jackson S. Y. Wu
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  15. Kristopher Dennis
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  16. Carlo DeAngelis
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  17. Rebecca K. S. Wong
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  18. Liting Zhu
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  19. Michael Brundage
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Corresponding author

Correspondence to Edward Chow.

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McDonald, R., Ding, K., Chow, E. et al. Classification of painful bone metastases as mild, moderate, or severe using both EORTC QLQ-C15-PAL and EORTC QLQ-BM22. Support Care Cancer 24, 4871–4878 (2016). https://doi.org/10.1007/s00520-016-3341-9

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  • DOI: https://doi.org/10.1007/s00520-016-3341-9

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