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. 2016 Aug;24(8):3557-65.
doi: 10.1007/s00520-016-3154-x. Epub 2016 Mar 29.

Burden of symptoms associated with development of metastatic bone disease in patients with breast cancer

Charles Cleeland  1 , Roger von Moos  2 , Mark S Walker  3 , Yuanyuan Wang  4 , Jianqing Gao  4 , Mariana Chavez-MacGregor  5 , Alexander Liede  6 , Jorge Arellano  7 , Arun Balakumaran  7 , Yi Qian  7
Affiliations

Burden of symptoms associated with development of metastatic bone disease in patients with breast cancer

Charles Cleeland et al. Support Care Cancer. 2016 Aug.

Abstract

Purpose: Women with breast cancer frequently develop painful bone metastases. This retrospective study was designed to longitudinally characterize patterns of patient-reported symptoms among patients with breast cancer relative to the diagnosis of bone metastases.

Methods: Patient records were identified from the Oncology Services Comprehensive Electronic Records (OSCER) database which includes outpatient oncology practices across the USA. Symptom burden was assessed by Patient Care Monitor (PCM) assessments, which are administered as part of routine care in a subset of these practices. Eligible patients were women diagnosed with breast cancer (ICD-9-CM 174.xx) who developed bone metastases (ICD-9-CM 198.5) and had ≥1 PCM assessment between January 2007 and December 2012. The pre-specified endpoint was the occurrence of moderate to severe symptom burden, defined as PCM score ≥4 (0-10 scale).

Results: One thousand one hundred five women (median age, 61) met the eligibility criteria. Worsening of symptoms, particularly fatigue and pain, occurred in the months leading up to the diagnosis of bone metastases. After bone metastases diagnosis, the rate of increase in the proportion of patients experiencing moderate/severe symptoms slowed, but continued to climb during follow-up. Median time to moderate/severe symptoms was 0.9 month for fatigue, 1 month for pain, 2.9 months for trouble sleeping, and 7.7 months for numbness/tingling. Half of the patients received bone-targeted agents after diagnosis of bone metastases.

Conclusions: Symptom burden, especially pain and fatigue, increased both before and after the diagnosis of bone metastases, highlighting the need for proactive monitoring and management of symptoms in breast cancer patients.

Keywords: Bone metastases; Bone-targeting agents; Metastatic breast cancer; Pain; Symptom burden.

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Figures

Fig. 1
Fig. 1
Symptom burden over time relative to the diagnosis of bone metastases. a Mean PCM score over time. b Proportion of patients with moderate or severe symptoms (PCM score ≥4). The number of patients assessed at each time point and for each PCM item is shown in Supplemental Table S1
Fig. 2
Fig. 2
Kaplan-Meier estimated proportion of patients with moderate to severe symptoms over time. a Fatigue. b Physical pain. c Trouble sleeping. d Numbness/tingling. e Anxious. f Loss of interest in others
See this image and copyright information in PMC

References

    1. Coleman RE. Clinical features of metastatic bone disease and risk of skeletal morbidity. Clinical Can Res. 2006;12:6243s–6249s. doi: 10.1158/1078-0432.CCR-06-0931. - DOI - PubMed
    1. Body JJ, Diel IJ, Bell R, Pecherstorfer M, Lichinitser MR, Lazarev AF, Tripathy D, Bergstrom B. Oral ibandronate improves bone pain and preserves quality of life in patients with skeletal metastases due to breast cancer. Pain. 2004;111:306–312. doi: 10.1016/j.pain.2004.07.011. - DOI - PubMed
    1. von Moos R, Body JJ, Egerdie B, Stopeck A, Brown JE, Damyanov D, Fallowfield LJ, Marx G, Cleeland CS, Patrick DL, Palazzo FG, Qian Y, Braun A, Chung K. Pain and health-related quality of life in patients with advanced solid tumours and bone metastases: integrated results from three randomized, double-blind studies of denosumab and zoledronic acid. Support Care Cancer. 2013;21:3497–3507. doi: 10.1007/s00520-013-1932-2. - DOI - PubMed
    1. Wardley A, Davidson N, Barrett-Lee P, Hong A, Mansi J, Dodwell D, Murphy R, Mason T, Cameron D. Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomised, crossover study of community vs hospital bisphosphonate administration. Br J Cancer. 2005;92:1869–1876. doi: 10.1038/sj.bjc.6602551. - DOI - PMC - PubMed
    1. Chow E, Hruby G, Davis L, Holden L, Schueller T, Wong R, Hayter C, Szumacher E, Loblaw A, Danjoux C. Quality of life after local external beam radiation therapy for symptomatic bone metastases: a prospective evaluation. Support Cancer Ther. 2004;1:179–184. doi: 10.3816/SCT.2004.n.010. - DOI - PubMed