Pain and quality of life in patients with metastatic bone disease treated with palliative radiotherapy at Ocean Road Cancer Institute, Tanzania

Abstract

Introduction: Palliative radiotherapy is a frequently prescribed treatment for pain control in advanced cancer patients presenting with painful bone metastasis. Treatment using a single fraction of radiotherapy is widely recommended since it is as effective in pain control as multiple fraction treatments but also reduces cost and travel burdens. Studies have documented the late adoption of single fraction schedules globally despite the known advantages of this treatment option.
Objectives: This study aimed to evaluate the effectiveness of palliative radiotherapy in controlling pain in patients presenting with metastatic bone disease at Ocean Road Cancer Institute (ORCI) and assess the role of fractionation in pain control and quality of life. This understanding can provide insight into current practices and recommendations on possible practice changes in prescribing palliative radiotherapy.
Methods: A prospective study was conducted involving patients presenting with metastatic bone disease due to various primary cancers who were scheduled for palliative radiotherapy. Consenting patients were evaluated for pain intensity before and 4 weeks after treatment. Clinical data on diagnosis, metastatic site, and prescribed treatments were recorded. Quality of life before and after treatment was assessed using the Short Form Survey (SF-36).
Results: Forty-eight patients with complete follow-up results were included in the final analysis. The mean age was 56.7 years, and 52.1% were females. Prostate cancer was the most frequent primary diagnosis (31.3%), followed by breast and cervix (18.8% each). The spine was the most affected metastatic site (90%). Only 27% of patients received single-fraction radiotherapy treatments, with a 5-fraction treatment being the most prescribed schedule. More than 80% of patients had improvement in pain after treatment, and there was no difference in pain improvement across the different treatment schedules. Quality of life improved in 6 out of 8 dimensions after treatment.
Conclusion: Cancer patients receiving palliative radiotherapy for bone metastasis at ORCI have similar clinical features as those in other parts of the world. Radiotherapy is an effective treatment for pain relief, with similar analgesic effects regardless of the fractionation schedule, and contributes to improving quality of life. There is a preference for prescribing multiple fraction regimens for radiotherapy; this has implications for educating clinicians to change practice to single fraction schedules, which are equally effective and can reduce patient cost and burden.