• Paulien G Westhoff, Verdam Mathilde G E MGE Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Frans J Oort, Jan J Jobsen, Marco van Vulpen, Leer Jan Willem H JWH Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands., Marijnen Corrie A M CAM Department of Radiotherapy, Leiden University Medical Center, Leiden, the Netherlands., Alexander de Graeff, Yvette M van der Linden, and Dutch Bone Metastasis Study Group.
• Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Radiotherapy, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: p.g.westhoff@umcutrecht.nl.
• Int. J. Radiat. Oncol. Biol. Phys. 2016 Aug 1; 95 (5): 1391-1398.

PurposeTo study the course of quality of life (QoL) after radiation therapy for painful bone metastases.Patients And MethodsThe Dutch Bone Metastasis Study randomized 1157 patients with painful bone metastases between a single fraction of 8 Gy and 6 fractions of 4 Gy between 1996 and 1998. The study showed a comparable pain response of 74%. Patients filled out weekly questionnaires for 13 weeks, then monthly for 2 years. In these analyses, physical, psychosocial, and functional QoL domain scores and a score of general health were studied. Mixed modeling was used to model the course of QoL and to study the influence of several characteristics.ResultsIn general, QoL stabilized after 1 month. Psychosocial QoL improved after treatment. The level of QoL remained stable, steeply deteriorating at the end of life. For most QoL domains, a high pain score and intake of opioids were associated with worse QoL, with small effect sizes (-0.11 to -0.27). A poor performance score was associated with worse functional QoL, with a medium effect size (0.41). There is no difference in QoL between patients receiving a single fraction of 8 Gy and 6 fractions of 4 Gy, except for a temporary worsening of physical QoL after 6 fractions.ConclusionAlthough radiation therapy for painful bone metastases leads to a meaningful pain response, most domains of QoL do not improve after treatment. Only psychosocial QoL improves slightly after treatment. The level of QoL is related to the actual survival, with a rather stable course of QoL for most of the remaining survival time and afterward a sharp decrease, starting only a few weeks before the end of life. Six fractions of 4 Gy lead to a temporary worse physical QoL compared with a single fraction of 8 Gy.Copyright © 2016. Published by Elsevier Inc.

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