Clinical & Experimental Metastasis

, Volume 36, Issue 5, pp 441–448 | Cite as

Factors related to the quality of life in patients with bone metastases

  • Yusuke ShinodaEmail author
  • Ryoko Sawada
  • Futaba Yoshikawa
  • Takahiro Oki
  • Toshihide Hirai
  • Hiroshi Kobayashi
  • Ko Matsudaira
  • Hiroyuki Oka
  • Sakae Tanaka
  • Hirotaka Kawano
  • Nobuhiko Haga
Research Paper


Treatment for bone metastases aims to preserve patients’ quality of life (QOL). Therefore, assessment of patients’ reported QOL is important, especially in this field. This cross-sectional study sought to investigate the clinical factors of QOL in patients with bone metastasis in different cancer settings, at any treatment status, and examined the effect of these factors on systemic symptoms and psychological disorders. This study was conducted by a multidisciplinary team for bone metastases at a university hospital in Japan. One-hundred seventy-four patients who could complete the self-report questionnaires were selected. The questionnaire included the EQ-5D, EORTC QLQ-C15-PAL, BM22, and K6 distress scale. We obtained clinical data on tumor progression, bone metastasis, pain, and ECOG-PS. The mean (SD) EQ-5D score was 0.58 (0.24), which was lower than that of the general Japanese and US population (0.85). Skeletal-related events (SREs), pain, and ECOG-PS were significantly related to lower EQ-5D scores in the multivariable analysis (p < 0.01), whereas primary lesion or expected prognosis at the first examination was not. These three factors were also related to systemic symptoms and emotional functioning. Radiologically lytic bone metastasis and lower limb/acetabular metastases were related to SREs and ECOG-PS, respectively. In conclusion, for improving the QOL of patients with bone metastases, we should focus on SRE prevention, treatment for pain, and modifying ADL, and a multidisciplinary team might be useful.


Bone metastasis Quality of life Skeletal-related events Pain Performance status Multidisciplinary approach 



Quality of life




The European Organization for Research and Treatment of Cancer


QOL Questionnaire Core-15 Palliative


QOL Questionnaire Bone Metastases module 22

K6 distress scale

The Kessler Psychological Distress Scale 6


The Eastern Cooperative Oncology Group


Performance Status


Skeletal related events


Activities of daily living


Computed tomography


Body mass index








Total bilirubin


Alkaline phosphatase


C reactive protein


Numerical rating scale


Bone-modifying agents



This work was supported by a Grant from Japan Orthopaedics and Traumatology Foundation, Inc. No 318 and KAKENHI (Grants-in-Aid for Scientific Research©) Grant Number 15K10388. We would like to thank Editage ( for English language editing. The study was approved by the University of Tokyo Medical Research Center Ethics Committee (approval number: 2373).

Compliance with ethical standards

Ethical approval

The study was approved by the University of Tokyo Medical Research Center Ethics Committee (approval number: 2373).

Conflict of interest

The authors declare no conflicts of interest regarding the publication of this paper.

Supplementary material

10585_2019_9983_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 18 kb)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Yusuke Shinoda
    • 1
    Email author
  • Ryoko Sawada
    • 1
    • 2
  • Futaba Yoshikawa
    • 1
    • 2
  • Takahiro Oki
    • 1
    • 2
  • Toshihide Hirai
    • 2
  • Hiroshi Kobayashi
    • 2
  • Ko Matsudaira
    • 3
  • Hiroyuki Oka
    • 3
  • Sakae Tanaka
    • 2
  • Hirotaka Kawano
    • 4
  • Nobuhiko Haga
    • 1
  1. 1.Department of Rehabilitation MedicineThe University of Tokyo HospitalTokyoJapan
  2. 2.Department of Orthopaedic Surgery, Faculty of MedicineThe University of TokyoTokyoJapan
  3. 3.Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of MedicineThe University of TokyoTokyoJapan
  4. 4.Department of Orthopaedic Surgery, School of MedicineTeikyo UniversityTokyoJapan

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