Skip to main content
SpringerLink
Log in

The investigation of symptoms burden and treatment status in patients with bone metastasis

  • Published:
The Chinese-German Journal of Clinical Oncology

Abstract

Objective

This survey was a non-intervention study, which aimed to investigate symptom burden and treatment status in cancer patient with bone metastasis, and to make out whether patients received the normative treatment.

Methods

We designed a questionnaire, the main items of which include patient’s symptom burden, previous and ongoing treatment. We used it to investigate 120 patients from six different medical agencies. We examined the association between symptoms using Spearman’s rank correlation. SPSS software was used to analyze data.

Results

The data of one hundred one questionnaires were completed and fitted for analysis. The five most prevalent symptoms were fatigue (84.2%), unhappiness (83.2%), pain (77.2%), dry mouth (77.2%) and lack of appetite (73.3%). Three symptom clusters were identified. Cluster 1 included anxiety and unhappiness and accounted for 61.4% in all patients. Cluster 2 included pain, fatigue and constipation and accounted for 39.6% in all patients. Cluster 3 included nausea, vomiting, lack of appetite and accounted for 27.7% in all patients. Cronbach’s alpha coefficient demonstrated high internal reliability in the clusters, with a coefficient ranging from 0.65 to 0.84. The proportion of patients receiving analgesic therapy, bisphosphates therapy, palliative chemotherapy and radiotherapy were 70.3%, 63.4%, 58.4% and 36.6% respectively. Pain in various degree was obviously alleviated (P < 0.01) after analgesic therapy. Among the surveyed patients, 64 patients received bisphosphates therapy, while the administration of zoledronic acid accounted for the most large proportion. The average duration of bisphosphates administration was 5.79 months (SD = 7.43). Patients who received radiotherapy adopted multiple fractions treating mode.

Conclusion

Symptom burden was common and severe in patients with bone metastasis, which often appeared as symptom cluster, and significantly affected their quality of life (QOL). The normative treatment should be strengthened to manage and control patients’ symptoms and improve their QOL. The analgesic therapy was normative in patients with bone metastasis. Reasons impeding patients to receive bisphosphates were in varieties. More propaganda should be done to generalized bisphosphates therapy for patients with bone metastasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Burkett VS, Cleeland CS. Symptom burden in cancer survivorship. J Cancer Surviv, 2007, 1: 167–175.

    Article  PubMed  Google Scholar 

  2. Cleeland CS, Bennett GJ, Dantzer R, et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer, 2003, 97: 2919–2925.

    Article  PubMed  Google Scholar 

  3. Walsh D, Rybicki L. Symptom clustering in advanced cancer. Support Care Cancer, 2006, 14: 831–836.

    Article  PubMed  Google Scholar 

  4. Chen ML, Tseng HC. Symptom clusters in cancer patients. Support Care Cancer, 2006, 14: 825–830.

    Article  PubMed  Google Scholar 

  5. Chow E, Fan G, Hadi S, et al. Symptom clusters in cancer patients with bone metastases. Support Care Cancer, 2007, 15: 1035–1043.

    Article  PubMed  Google Scholar 

  6. Lipton A, Jun S. RANKL inhibition in the treatment of bone metastases. Curr Opin Support Palliat Care, 2008, 2: 197–203.

    Article  PubMed  Google Scholar 

  7. Sabino MA, Mantyh PW. Pathophysiology of bone cancer pain. J Support Oncol, 2005, 3: 15–24.

    CAS  PubMed  Google Scholar 

  8. Hofman M, Morrow GR, Roscoe JA, et al. Cancer patients’ expectations of experiencing treatment-related side effects: A University of Rochester Cancer Center — Community Clinical Oncology Program study of 938 patients from community practices. Cancer, 2004, 101: 851–857.

    Article  PubMed  Google Scholar 

  9. Schwartz AL, Nail LM, Chen S, et al. Fatigue patterns observed in patients receiving chemotherapy and radiotherapy. Cancer Invest, 2000, 18: 11–19.

    Article  CAS  PubMed  Google Scholar 

  10. Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull, 2008, 134: 700–741.

    Article  PubMed  Google Scholar 

  11. Lloyd-Williams M, Reeve J, Kissane D. Distress in palliative care patients: developing patient-centred approaches to clinical management. Eur J Cancer, 2008, 44: 1133–1138.

    Article  PubMed  Google Scholar 

  12. Roth AJ, Massie MJ. Anxiety and its management in advanced cancer. Curr Opin Support Palliat Care, 2007, 1: 50–56.

    Article  PubMed  Google Scholar 

  13. Roscoe JA, Kaufman ME, Matteson-Rusby SE, et al. Cancer-related fatigue and sleep disorders. Oncologist, 2007, 1: 35–42.

    Article  Google Scholar 

  14. McMillan SC, Tofthagen C, Morgan MA. et al. Relationships among pain, sleep disturbances, and depressive symptoms in outpatients from a comprehensive cancer center. Oncol Nurs Forum, 2008, 35:603–611.

    Article  PubMed  Google Scholar 

  15. Sateia MJ, Lang BJ. Sleep and cancer: recent developments. Curr Oncol Rep, 2008, 10: 309–318.

    Article  PubMed  Google Scholar 

  16. Theobald DE. Cancer pain, fatigue, distress, and insomnia in cancer patients. Clin Cornerstone, 2004, 6Suppl 1D: S15–21.

    Article  PubMed  Google Scholar 

  17. Cleeland CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr, 2007, 37:16–21.

    Article  PubMed  Google Scholar 

  18. Hadi S, Fan G, Hird AE, et al. Symptom clusters in patients with cancer with metastatic bone pain. J Palliat Med, 2008, 11: 591–600.

    Article  PubMed  Google Scholar 

  19. Kirkova J, Walsh D. Cancer symptom clusters — a dynamic construct. Support Care Cancer, 2007, 15: 1011–1013.

    Article  PubMed  Google Scholar 

  20. World Health Organization. Achieving balance in national opioids control policy-Guidelines for assessment. Geneva: WHO pubulication, 2000: 3–4.

    Google Scholar 

  21. Pavlakis N, Schmidt RL, Stockler M. Bisphosphonates for breast cancer. Cochrane Database Syst Rev, 2005, 3: 1–38.

    Google Scholar 

  22. Hatoum HT, Lin SJ, Smith MR, et al. Zoledronic acid and skeletal complications in patients with solid tumors and bone metastases: analysis of a national medical claims database. Cancer, 2008, 113: 1438–445.

    Article  CAS  PubMed  Google Scholar 

  23. Olson K, Van Poznak C. Significance and impact of bisphosphonateinduced acute phase responses. J Oncol Pharm Pract, 2007, 13: 223–229.

    Article  CAS  PubMed  Google Scholar 

  24. Kimmel DB. Mechanism of action, pharmacokinetic and pharmacodynamic profile, and clinical applications of nitrogen-containing bisphosphonates. J Dent Res, 2007, 86: 1022–1033.

    Article  CAS  PubMed  Google Scholar 

  25. Aapro M, Abrahamsson PA, Body JJ, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of aninternational expert panel. Ann Oncol, 2008, 19: 420–432.

    Article  CAS  PubMed  Google Scholar 

  26. Chow E. Update on radiation treatment for cancer pain. Curr Opin Support Palliat Care, 2007, 1: 11–15.

    Article  PubMed  Google Scholar 

  27. Chow E, Harris K, Fan G, et al. Palliative radiotherapy trials for bone metastases: a systematic review. J Clin Oncol, 2007, 25: 1423–1436.

    Article  PubMed  Google Scholar 

  28. Roos DE, Turner SL, O’Brien PC, et al. Trans-Tasman Radiation Oncology Group, TROG 96.05. Randomized trial of 8 Gy in 1 versus 20 Gy in 5 fractions of radiotherapy for neuropathic pain due to bone metastases (Trans-Tasman Radiation Oncology Group, TROG 96.05). Radiather Oncol, 2005, 75: 54–63.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cancer Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430030, China

    Zhiyong Shi, Hong Qiu & Shiying Yu

Authors
  1. Zhiyong Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hong Qiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shiying Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shiying Yu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shi, Z., Qiu, H. & Yu, S. The investigation of symptoms burden and treatment status in patients with bone metastasis. Chin. -Ger. J. Clin. Oncol. 9, 63–67 (2010). https://doi.org/10.1007/s10330-010-0009-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10330-010-0009-7

Key words

Search

Navigation