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Association of Performance Status and Pain in Metastatic Bone Pain Management in the Spanish Clinical Setting



Bone metastasis is the most common cause of cancer-related pain, and metastatic bone pain (MBP) is not only severe but also progressive in many patients. The aim of this study was to investigate the association between pain management and performance status in patients with metastatic bone cancer in the Spanish clinical setting.


A 3-month follow-up prospective, epidemiologic, multicenter study was conducted in 579 patients to assess the evolution of their performance, the impact of pain control on sleep and functionality, and the degree of pain control according to analgesic treatment.


In patients with MBP, Eastern Cooperative Oncology Group (ECOG) status (1.5 ± 0.7–1.3 ± 0.7 and 1.3 ± 0.8; p < 0.001) and pain (6.5 ± 1.4–2.8 ± 1.9 and 2.1 ± 1.9; p < 0.001) improved significantly from baseline to months 1 and 3, as did functionality and sleep, after a treatment change consisting of increasing the administration of opioids. Evolution of ECOG and pain were closely related. ECOG and pain outcomes were significantly more favorable in patients treated with opioids versus non-opioid treatment, and in patients who did not need rescue medication versus those who did.


MBP is currently poorly managed in Spain. ECOG improvement is closely and directly related to pain management in MBP. Opioid treatment and a lack of requirements for rescue medication are associated with better ECOG and pain outcomes in MBP patients.


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Sponsorship and article processing charges were funded by Mundipharma Pharmaceuticals S.L. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. We would like to thank the following investigators that participated in the Bone Metastatic Pain Study: Eva María Ciruelos, Hospital 12 de Octubre, Madrid; Mónica Corral, Hospital Alcañiz, Alcañiz, Teruel; Purificación Martínez del Prado, Hospital Basurto, Bilbao, Vizcaya; Francisco J. Carabantes, Hospital Carlos Haya, Málaga; Manuel Cobo, Hospital Carlos Haya, Málaga; Luis Olay, Hospital Central de Asturias, Oviedo, Asturias; Diego Soto, Hospital Clínico de Valladolid, Valladolid; Isabel Blancas, Hospital Clínico San Cecilio, Granada; Javier Puente, Hospital Clínico San Carlos, Madrid; José Miguel, Hospital Clínico San Cecilio, Granada; Dolores Isla, Hospital Clínico Lozano Blesa, Zaragoza; Julio José Lambea, Hospital Clínico Lozano Blesa, Zaragoza; Yolanda López, C. A. de Zamora, Zamora; Irma Muruzabal, Hospital de Cruces, Barakaldo, Vizcaya; José Miguel Martín, Hospital de Getafe, Getafe, Madrid; Salvador Garcerá, Hospital de la Ribera, Alzira, Valencia; Natalia Lupión, Hospital de Mérida, Mérida, Badajoz; Enrique Martínez, Hospital de Navarra, Pamplona, Navarra; Núria Calvo, Hospital de Sant Pau, Barcelona; Sonia Maciá, Hospital General de Elda-Virgen de la Salud, Alicante; Ana Blasco, Hospital General de Valencia, Valencia; José María García, Hospital General de Albacete, Albacete; Enric Carcereny, Hospital Germans Trias i Pujol, Badalona, Barcelona; Esperanza Blanco, Hospital Infanta Cristina, Badajoz; Ana Belén Custodio, Hospital La Paz, Madrid; Juan Bayo, Clínica Los Naranjos, Huelva; Carmen Velilla, Hospital Lozano Blesa, Zaragoza; Almudena García, Hospital Marqués de Valdecilla, Santander; Miguel Méndez, Hospital de Móstoles, Móstoles, Madrid; Román Bastus, Hospital Mutua de Terrassa, Terrassa, Barcelona; Ana María Tortorella, Hospital Naval de Cartagena, Cartagena, Murcia; Yolanda García, Hospital Parc Taulí, Sabadell, Barcelona; José María Puerto, Hospital Perpetuo Socorro, Badajoz; Cristina López, Hospital Povisa, Vigo, Pontevedra; Fátima Navarro, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid; Javier Munárriz, Hospital Provincial, Castellón; Ramón de las Peñas, Hospital Provincial, Castellón; Miguel Ruiz, Hospital Punta de Europa, Algeciras, Cádiz; María Fernández, Hospital Ramón y Cajal, Madrid; Laura Murillo, Hospital Reina Sofía, Tudela, Navarra; Isabel Palomo, Hospital Río Hortega, Valladolid; Christian Rolfo, Clínica Rotger, Palma de Mallorca; Antonia Perello, Hospital Son Dureta, Palma de Mallorca; Aránzazu González del Alba, Hospital Son Dureta, Palma de Mallorca; José Manuel Pérez, Hospital Vall d’Hebron, Barcelona; Miguel Marín, Hospital Virgen de la Arrixaca, Murcia; Javier Medina, Hospital Virgen de la Salud, Toledo; Ruth Álvarez, Hospital Virgen de la Salud, Toledo; Francisco de Asís, Hospital Virgen de los Lirios, Alcoy, Alicante; David Vicente, Hospital Virgen Macarena, Sevilla; Manuel Codes, Hospital Virgen Macarena, Sevilla; Guillermo Quintero, Complexo Hospitalario Xeral-Calde, Lugo; Sergio Vázquez, Complejo Hospitalario Xeral-Calde, Lugo; Silvia Antolín, CHUAC, A Coruña; Rafael López, CHUS, Santiago de Compostela, A Coruña; Bernardo Queralt, ICO-Girona, Girona. We would like to thank Mayte Martín Fuentes from Mundipharma Pharmaceuticals S.L. for managing the study, and Almudena Pardo and Luis Santamaría, both independent medical writers, for helping in the medical writing of the manuscript. This medical writing assistance was funded by Mundipharma Pharmaceuticals S.L. The authors would also like to thank Simone Boniface of Springer Healthcare Communications, who edited the manuscript for English and styled for submission, and Nishad Parkar, PhD, of Springer Healthcare Communications who edited the manuscript post-submission. This medical writing assistance was funded by Mundipharma Pharmaceuticals S.L.


Susana Traseira Lugilde is a Medical Director at Mundipharma Pharmaceuticals S.L., sponsor of this study. Manuel Dómine Gómez, Nieves Díaz Fernández, Blanca Cantos Sánchez de Ibargüen, Luis Zugazabeitia Olabarría, Joaquina Martínez Lozano, Raúl Poza de Celis, Rafael Trujillo Vílchez, Ignacio Peláez Fernández, Jaume Capdevila Castillón and Emilio Esteban González have nothing to disclose.

Compliance with Ethics Guidelines

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013. Informed consent was obtained from all patients for being included in the study.

Data Availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Manuel Dómine Gómez.

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Dómine Gómez, M., Díaz Fernández, N., Cantos Sánchez de Ibargüen, B. et al. Association of Performance Status and Pain in Metastatic Bone Pain Management in the Spanish Clinical Setting. Adv Ther 34, 136–147 (2017).

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  • Bone metastasis
  • Cancer
  • ECOG
  • Pain