Reducing the burden of bone metastases

Abstract

Recent progress may help to reshape evidence-based guidelines to improve patient care and reduce the economic burden of bone metastases.

NGF Blockade at Early Times during Bone Cancer Development Attenuates Bone Destruction and Increases Limb Use

“…In the clinic, commonly-measured endpoints for bone cancer disease progression and functional status include radiological assessment of bone destruction and time-to-fracture (5), weight loss (45), evaluation of gait and weight-bearing (46, 47), and pain (48-50). As illustrated in Fig.…”

“…However, advances in cancer treatments continue to dramatically increase survival rates, thus patients with metastatic disease and suffering with malignant skeletal pain are living years to decades beyond their initial cancer diagnosis. Maintenance of the functional status of patients with CMB requires proactive management as CMB can cause excruciating bone pain, pathologic fractures, spinal cord and nerve compression syndromes, weight loss, derangements of calcium and phosphate homeostasis and decline in the ability to load and use tumor-bearing bones cannot be viewed individually but rather as interactive events ultimately contributing to increased morbidity, mortality, and diminished quality of life (2, 5). …”

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

“…Other solid tumors that commonly affect bone are cancers of the lung, thyroid, kidney, and bladder [ 1 , 2 ]. Advances in cancer treatments and earlier diagnosis have extended survival; patients with breast and prostate cancers live an average of 2 to 3 years after a diagnosis of bone metastasis [ 3 ]. However, extending survival also prolongs the course of the disease and its associated sequelae.…”

“…Pain is among the most common symptoms of bone metastasis in patients with advanced disease [ 11 , 12 ]. Pain has a substantial psychological and physical impact on patients and is one of the most feared cancer symptoms [ 13 , 14 ], with worsening pain often interpreted as disease progression [ 3 ]. The need for opioid analgesics increases as pain worsens, but some patients are reluctant to take opioids due to concerns about side effects (constipation, nausea, decreased alertness), tolerance, and addiction [ 3 , 15 ].…”

“…Pain associated with bone metastases has been well described [ 3 , 12 , 17 ], and the effects of bone-targeted agents on pain, analgesic use, and quality of life in patients with bone metastases have been reported previously [ 18 , 19 ]. However, the precise impact of SREs exclusively, in addition to the pain of bone metastases and regardless of treatment received, has not yet been defined in a large patient population with a wide variety of tumor types.…”