Radiotherapy for bone metastases: A critical appraisal of outcome measures

Pain from bone metastases is a common problem in patients with advanced can cer and radiotherapy plays an important role in its palliation. Single frac tion treatments are often prescribed, but there is no clear consensus on th is issue and clinical practice shows significant variability. This situatio n is unsatisfactory for all parties-the patient, the clinician, and the hea lth care administrator randomized trials may use poor outcome measures and this contributes to practice variability. The credibility of outcome studie s is often reduced due to poor. study design, small sample sizes, and the u se of endpoints that are both unreliable and unsuitable. The endpoints used have been narrowly defined, the patient's perspective has generally been o verlooked, and quality of life has only once been used as an endpoint. A re view of the current literature suggests that instruments specific to bone m etastases are required. These must be based on patient experience, and rely on self-report. In addition, there is a need to understand the relative pr iority that patients attribute to treatment outcomes. The use of better ins truments and methodologies in future trials will enhance the credibility of results and reduce practice variations. J Pain Symptom Manage 1999;17:208- 218. (C) U.S. Cancer Pain Relief Committee, 1999.