Clinical Orthopaedics and Related Research®

, Volume 475, Issue 2, pp 498–507

What Factors are Associated With Quality Of Life, Pain Interference, Anxiety, and Depression in Patients With Metastatic Bone Disease?

  • Q. M. J. van der Vliet
  • N. R. Paulino Pereira
  • S. J. Janssen
  • F. J. Hornicek
  • M. L. Ferrone
  • J. A. M. Bramer
  • C. N. van Dijk
  • J. H. Schwab
Clinical Research

DOI: 10.1007/s11999-016-5118-3

Cite this article as:
van der Vliet, Q.M.J., Paulino Pereira, N.R., Janssen, S.J. et al. Clin Orthop Relat Res (2017) 475: 498. doi:10.1007/s11999-016-5118-3

Abstract

Background

It would be helpful for the decision-making process of patients with metastatic bone disease to understand which patients are at risk for worse quality of life (QOL), pain, anxiety, and depression. Normative data, and where these stand compared with general population scores, can be useful to compare and interpret results of similar patients or patient groups, but to our knowledge, there are no such robust data.

Questions/Purposes

We wished (1) to assess what factors are independently associated with QOL, pain interference, anxiety, and depression in patients with metastatic bone disease, and (2) to compare these outcomes with general US population values.

Methods

Between November 2011 and February 2015, 859 patients with metastatic bone disease presented to our orthopaedic oncology clinic; 202 (24%) were included as they completed the EuroQOL-5 Dimension (EQ-5DTM), PROMIS® Pain Interference, PROMIS® Anxiety, and PROMIS® Depression questionnaires as part of a quality improvement program. We did not record reasons for not responding and found no differences between survey respondents and nonrespondents in terms of age (63 versus 64 years; p = 0.916), gender (51% men versus 47% men; p = 0.228), and race (91% white versus 88% white; p = 0.306), but survey responders were more likely to be married or living with a partner (72%, versus 62%; p = 0.001). We assessed risk factors for QOL, pain interference, anxiety, and depression using multivariable linear regression analysis. We used the one-sample signed rank test to assess whether scores differed from US population averages drawn from earlier large epidemiologic studies.

Results

Younger age (β regression coefficient [β], < 0.01; 95% CI, 0.00–0.01; p = 0.041), smoking (β, −0.12; 95% CI, −0.22 to −0.01; p = 0.026), pathologic fracture (β, −0.10; 95% CI, −0.18 to −0.02; p = 0.012), and being unemployed (β, −0.09; 95% CI, −0.17 to −0.02; p = 0.017) were associated with worse QOL. Current smoking status was associated with more pain interference (β, 6.0; 95% CI, 1.6–11; p = 0.008). Poor-prognosis cancers (β, 3.8; 95% CI, 0.37–7.2; p = 0.030), and pathologic fracture (β, 6.3; 95% CI, 2.5–7.2; p = 0.001) were associated with more anxiety. Being single (β, 5.9; 95% CI, 0.83–11; p = 0.023), and pathologic fracture (β, 4.4; 95% CI, 0.8–8.0; p = 0.017) were associated with depression. QOL scores (0.68 versus 0.85; p < 0.001), pain interference scores (65 versus 50; p < 0.001), and anxiety scores (53 versus 50; p = 0.011) were worse for patients with bone metastases compared with general US population values, whereas depression scores were comparable (48 versus 50; p = 0.171).

Conclusions

Impending pathologic fractures should be treated promptly to prevent deterioration in QOL, anxiety, and depression. Our normative data can be used to compare and interpret results of similar patients or patient groups. Future studies could focus on specific cancers metastasizing to the bone, to further understand which patients are at risk for worse patient-reported outcomes.

Level of evidence

Level III, prognostic study.

Supplementary material

11999_2016_5118_MOESM1_ESM.doc (34 kb)
Supplementary material 1 (DOC 33 kb)

Copyright information

© The Association of Bone and Joint Surgeons® 2016

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Department of Orthopaedic Surgery, Orthopaedic Oncology Service, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA
  3. 3.Department of Orthopaedic Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  4. 4.Massachusetts General HospitalBostonUSA