PRESENTING SYMPTOMS IN PATIENTS REFERRED TO A MULTIDISCIPLINARY CLINIC FOR BONE METASTASES

Symptom control is the goal of palliative irradiation. Approximately I month is required before symptomatic relief is accomplished with radi otherapy. However, many patients with cancer-related pain do not recei ve adequate analgesics, and opioids are often not prescribed until pat ients fail to respond to palliative irradiation. The presenting sympto ms of 108 patients who were referred to a multidisciplinary clinic for bone metastases were evaluated with the Wisconsin Brief Pain Inventor y (BPI). This validated instrument evaluates the severity of pain usin g a 0-10 scale; 10 represents the worst pain imaginable. The populatio n comprised GT men (60 %) and 43 women whose ages ranged from 33 years to 81 years; median age was 55 years, and 69% of patients were less t han GS years of age. Despite the presence of metastatic disease 21 % o f patients were working full-time outside the home, and 6% were employ ed part-time outside the home; 13 % were homemakers. Only 17 patients (16%) were unemployed. The time since diagnosis ranged from 2 weeks to 23 years; the median time since diagnosis was 22 months, and 30% of p atients had been diagnosed with the past 6 months. Pain was a presenti ng symptom in 74 % (N = 80) of patients at diagnosis. At its worst, th e pain was rated as severe (levels 7-10) by 78 % and intolerable (leve l 10) in 22 % of the patients in the 24 hr prior to the clinic appoint ment. On average, the pain was rated moderate to severe (levels 4-10) in 79% and severe in 23% of patients. Only 45% of patients experienced good relief from the prescribed analgesics, and 23 % of patients indi cated that the prescribed analgesics were ineffective. This survey dem onstrates that bone metastases incur significant pain that is often un dertreated with analgesics before antineoplastic therapy is administer ed. (C) Elsevier Science Inc. 1998.