Course of quality of life in short- and long-term survivors after radiotherapy for bone metastases

Background: Bone metastases often cause pain and interfere with quality of life (QoL). Survival of patients with bone metastases is increasing and there is a paucity of data about QoL in long-term survivors after external beam radiotherapy. Methods: Patients with bone metastases treated with radiotherapy were identified from the PRospective Evaluation of interventional StudiEs on boNe meTastases (PRESENT+) cohort. Patient and treatment characteristics were collected before radiotherapy. Patient-reported QoL scores were collected up to 5 years, and included global QoL, physical and emotional functioning, symptoms including pain (EORTC QLQ-C15 PAL) and functional interference and psychosocial aspects (EORTC QLQ-BM22). Dutch reference QoL data were used for comparison. Results: In total, 458 (23%) short-term (<3 months), 915 (46%) intermediate-term (≥3 months and <2 years), and 603 (31%) long-term (≥2 years) survivors were included. Median survival of the full cohort (n = 1,976) was 9.5 months (interquartile range, 3.3–30.5 months). Two third (n = 1,316, 67%) provided QoL scores. Long-term survivors reported a substantial increase in global QoL, emotional and physical functioning, and functional interference 4 weeks post radiotherapy; this improvement persisted over 5 years. Their QoL scores were substantially better than those of short-term and intermediate-term survivors, and somewhat lower than the reference population. Conclusion(s): Patients with bone metastases, referred for radiotherapy, represent a highly heterogeneous group. One third survives more than two years with QoL scores comparable to, or somewhat lower than the Dutch reference population. An individualized treatment approach is needed, addressing both short-term symptom palliation and, if applicable, long-term goals.