Gender and age make no difference in the re-irradiation of painful bone metastases: A secondary analysis of the NCIC CTG SC.20 randomized trial.
*Age; *Bone metastases; *Gender; *Pain response; *Quality of life; *Radiotherapy; *Re-irradiation; Age Factors; Aged; Bone Neoplasms/physiopathology/*radiotherapy/*secondary; Cancer Pain/etiology/*radiotherapy; Female; Humans; Male; Middle Aged; Pain Measurement; Palliative Care/methods/statistics & numerical data; Patient Reported Outcome Measures; Physicians'/*statistics & numerical data; Practice Patterns; Quality of Life; Re-Irradiation; Sex Factors
BACKGROUND AND PURPOSE: Patient's gender and age may influence physicians in prescribing palliative radiotherapy. The purpose of this secondary analysis of the National Cancer Institute of Canada Clinical Trials Group Symptom Control Trial SC.20 was to explore the gender and age differences in pain and patient reported outcomes in cancer patients with bone metastases undergoing re-irradiation. MATERIALS AND METHODS: Response to radiation was evaluated using the International Bone Metastases Consensus Endpoint Definitions. Patients completed the Brief Pain Inventory (BPI) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (C30) before and 2months after re-irradiation. RESULTS: A total of 847 patients were analyzed. At baseline, men had more dyspnea, and mild pain. Older patients consumed less analgesic. More women reported clinically significant improvement in mood and enjoyment of life in the BPI after radiation. Similarly, younger patients reported better improvement in enjoyment of life. There were no significant gender or age differences in overall survival, response to radiation, or in C30 scores at 2months. CONCLUSION: Similar benefit in terms of pain relief was observed across all patient groups. Cancer patients with bone metastases should be offered palliative re-irradiation irrespective of gender or age. TRIAL REGISTRATION: NCT00080912; https://clinicaltrials.gov/ct2/show/NCT00080912.
Chow Ronald; Ding Keyue; Ganesh Vithusha; Meyer Ralph M; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Nabid Abdenour; van Acht Manouk; Wanders Rinus; Babington Scott; Demas William F; Wilson Carolyn F; Wong Rebecca K S; Brundage Michael; Zhu Liting; Chow Edward
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
2018
2018-03
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.radonc.2017.10.006" target="_blank" rel="noreferrer noopener">10.1016/j.radonc.2017.10.006</a>
Minimal clinically important differences in the EORTC QLQ-C30 and brief pain inventory in patients undergoing re-irradiation for painful bone metastases.
*Bone metastases; *Brief pain inventory; *EORTC QLQ-C30; *Minimal Clinically Important Difference; *Minimal clinically important differences; *Radiation; 80 and over; 80 and Over; Adolescence; Adolescent; Adult; Aged; Bone Metastases – Radiotherapy; BONE metastasis; BONE metastasis – Treatment; Bone Neoplasms/*complications/radiotherapy/secondary; Brief Pain Inventory; BRIEF Pain Inventory; Cancer Patients; CANCER patients; CANCER radiotherapy; Clinical Assessment Tools; Female; Funding Source; Human; Humans; Instrument Scaling; LONGITUDINAL method; Male; Middle Age; Middle Aged; Pain Management; PAIN management; Pain/*diagnosis; Prospective Studies; Quality of Life/*psychology; Questionnaires; QUESTIONNAIRES; RANDOMIZED controlled trials; Re-Irradiation/*adverse effects; REOPERATION; Repeat Procedures; RESEARCH funding; SCALING (Social sciences); Secondary Analysis; SECONDARY analysis; Surveys and Questionnaires; Young Adult
PURPOSE: The EORTC QLQ-C30 and the Brief Pain Inventory (BPI) are validated tools for measuring quality of life (QOL) and the impact of pain in patients with advanced cancer. Interpretation of these instrument scores can be challenging and it is difficult to know what numerical changes translate to clinically significant impact in patients' lives. To address this issue, our study sought to establish the minimal clinically important differences (MCID) for these two instruments in a prospective cohort of patients with advanced cancer and painful bone metastases. METHODS: Both anchor-based and distribution-based methods were used to estimate the MCID scores from patients enrolled in a randomized phase III trial evaluating two different re-irradiation treatment schedules. For the anchor-based method, the global QOL item from the QLQ-C30 was chosen as the anchor. Spearman correlation coefficients were calculated for all items and only those items with moderate or better correlation (\textbarr\textbar \textgreater/= 0.30) with the anchor were used for subsequent analysis. A 10-point difference in the global QOL score was used to classify improvement and deterioration, and the MCID scores were calculated for each of these categories. These results were compared with scores obtained by the distribution-method, which estimates the MCID purely from the statistical characteristics of the sample population. RESULTS: A total of 375 patients were included in this study with documented pain responses and completed QOL questionnaires at 2 months. 9/14 items in the QLQ-C30 and 6/10 items in the BPI were found to have moderate or better correlation with the anchor. For deterioration, statistically significant MCID scores were found in all items of the QLQ-C30 and BPI. For improvement, statistically significant MCID scores were found in 7/9 items of the QLQ-C30 and 2/6 items of the BPI. The MCID scores for deterioration were uniformly higher than the MCIDs for improvement. Using the distribution-based method, there was good agreement between the 0.5 standard deviation (SD) values and anchor-based scores for deterioration. For improvement, there was less agreement and the anchor-based scores were lower than the 0.5 SD values obtained from the distribution-based method. CONCLUSION: We present MCID scores for the QLQ-C30 and BPI instruments obtained from a large cohort of patients with advanced cancer undergoing re-irradiation for painful bone metastases. The results from this study were compared to other similar studies which showed larger MCID scores for improvement compared to deterioration. We hypothesize that disease trajectory and patient expectations are important factors in understanding the contrasting results. The results of this study can guide clinicians and researchers in the interpretation of these instruments.
Raman Srinivas; Ding Keyue; Chow Edward; Meyer Ralph M; van der Linden Yvette M; Roos Daniel; Hartsell William F; Hoskin Peter; Wu Jackson S Y; Nabid Abdenour; Haas Rick; Wiggenraad Ruud; Babington Scott; Demas William F; Wilson Carolyn F; Wong Rebecca K S; Zhu Liting; Brundage Michael
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation
2018
2018-04
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1007/s11136-017-1745-8" target="_blank" rel="noreferrer noopener">10.1007/s11136-017-1745-8</a>