Supportive Care in Cancer

, Volume 21, Issue 11, pp 3021–3030 | Cite as

Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment

  • Kinsey Lam
  • Edward ChowEmail author
  • Liying Zhang
  • Erin Wong
  • Gillian Bedard
  • Alysa Fairchild
  • Vassilios Vassiliou
  • Mohamed Alm El-Din
  • Reynaldo Jesus-Garcia
  • Aswin Kumar
  • Fabien Forges
  • Ling-Ming Tseng
  • Ming-Feng Hou
  • Wei-Chu Chie
  • Andrew Bottomley
Original Article



Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.

Methods and materials

Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.


Karnofsky Performance Status (KPS) was correlated with better physical (p = 0.0002), role (p < 0.0001), emotional (p < 0.0001), and social (p < 0.0001) functioning, and global health scores (p = 0.0015) and predicted lower symptom scores for fatigue (p < 0.0001), pain (p < 0.0001), appetite loss (p < 0.0001), and constipation (p < 0.0001). Increased age was predictive of better social functioning (p < 0.0001) and less insomnia (p = 0.0036), higher education correlated with better global health status (p = 0.0043), and patients who were employed or retired had improved physical functioning (p = 0.0004 and p = 0.0030, respectively) and less financial challenges compared to patients who were unemployed (p = 0.0005).


Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.


Quality of life Social determinants Baseline factors EORTC QLQ-C30 Bone metastases Advanced cancer 



We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kinsey Lam
    • 1
  • Edward Chow
    • 1
    Email author
  • Liying Zhang
    • 1
  • Erin Wong
    • 1
  • Gillian Bedard
    • 1
  • Alysa Fairchild
    • 2
  • Vassilios Vassiliou
    • 3
  • Mohamed Alm El-Din
    • 4
  • Reynaldo Jesus-Garcia
    • 5
  • Aswin Kumar
    • 6
  • Fabien Forges
    • 7
  • Ling-Ming Tseng
    • 8
  • Ming-Feng Hou
    • 9
  • Wei-Chu Chie
    • 10
  • Andrew Bottomley
    • 11
  1. 1.Department of Radiation Oncology, Odette Cancer CentreUniversity of Toronto, Sunnybrook Health Sciences CentreTorontoCanada
  2. 2.Department of Radiation Oncology, Cross Cancer InstituteUniversity of AlbertaEdmontonCanada
  3. 3.Department of Radiation OncologyBank of Cyprus Oncology CentreNicosiaCyprus
  4. 4.Department of Clinical OncologyTanta University Hospital, Tanta Faculty of MedicineTantaEgypt
  5. 5.Department of Orthopedic OncologyFederal University of São PauloSão PauloBrazil
  6. 6.Division of Gynaecology and Genitourinary Oncology, Department of Radiation OncologyRegional Cancer CenterTrivandrumIndia
  7. 7.Inserm CIE3 and Unit of Clinical Research, Innovation, and PharmacologySaint Etienne University HospitalSaint-EtienneFrance
  8. 8.Department of Surgery, Taipei Veterans General HospitalNational Yang-Ming UniversityTaipeiTaiwan
  9. 9.Department of Gastroenterologic SurgeryKaohsiung Medical University HospitalKaohsiungTaiwan
  10. 10.Department of Public Health and Institute of Epidemiology and Preventative MedicineNational Taiwan UniversityTaipeiTaiwan
  11. 11.European Organisation for Research and Treatment of CancerBrusselsBelgium

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