Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

• Published in: Supportive care in cancer 2016-03, Vol.24 (3), p.1327-1337
• Main Authors: von Moos, Roger, Body, Jean-Jacques, Egerdie, Blair, Stopeck, Alison, Brown, Janet, Fallowfield, Lesley, Patrick, Donald L., Cleeland, Charles, Damyanov, Danail, Palazzo, Felipe Salvador, Marx, Gavin, Zhou, Ying, Braun, Ada, Balakumaran, Arun, Qian, Yi
• Format: Article
• Language: English
• Subjects: Algorithms; Analgesics; Analgesics - administration & dosage; Analgesics - therapeutic use; Analysis; Bone disorder agents; Bone Neoplasms - drug therapy; Bone Neoplasms - secondary; Bones; Cancer; Cancer metastasis; Cancer patients; Care and treatment; Denosumab - administration & dosage; Denosumab - therapeutic use; Diphosphonates - administration & dosage; Diphosphonates - therapeutic use; Double-Blind Method; Female; Fractures, Spontaneous - complications; Humans; Imidazoles - administration & dosage; Imidazoles - therapeutic use; Male; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Neoplasm Metastasis; Nursing; Nursing Research; Oncology; Original; Original Article; Pain - etiology; Pain management; Pain Medicine; Rehabilitation Medicine; Tumors; Zoledronic Acid
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-015-2908-1

Purpose Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients’ pain, analgesic use, and pain interference with daily functioning. Methods Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials ( N  = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. Results The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. Conclusions SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning.