Evaluation of Patient Reported Outcome Differences by Radiotherapy Technique for Bone Metastases in a Non-Incentivized Health Care System

Abstract

<h3>Purpose/Objective(s)</h3> We previously demonstrated a low utilization, but mild increase over time, of advanced radiotherapy (RT) techniques (3D conformal RT [3DCRT], intensity modulated radiotherapy [IMRT] and stereotactic ablative radiotherapy [SABR] from 2009-2016) for bone metastases. Patient reported outcome (PRO) data was not yet available in our previous publication. This analysis therefore compares PROs by RT technique in a public, salary-funded, non-incentivized health care system, to assess if patient reported pain and impact on quality of life (QoL) is superior with advanced techniques. <h3>Materials/Methods</h3> From 2017-2021 inclusive, patients with bone metastases who completed the brief pain inventory (BPI) PRO questionnaire at one of five BC Cancer centers before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3DCRT, IMRT, or SABR). Pain response was compared using chi-square tests. Patient reported interference on QoL to pain was compared with t-tests. Multivariable analyses of pain response and pain impact on QoL was compared with logistic and linear regression, respectively. <h3>Results</h3> 1712 patients completed the BPI, with an average age of 64 (SD 12.4). From 2017 – 2021 the rate of advanced RT technique use increased significantly (p<0.001; 2.4%, 2.5%, 9.6%, 4.7%, 7.9%), with most advanced techniques consisting of 3DCRT (26%) or IMRT (67%) versus SABR (7%). Comparing simple vs advanced techniques, neither the complete response (12.2% vs 11.9%; p=0.93) nor the partial response (50.1% vs 50.6%; p=0.92) were significantly different. There was no significant patient reported difference in pain interfering with general activity (p=0.70), mood (p=0.26), walking ability (p=0.89), normal work (p=0.37), relationships (p=0.63), sleep (p=0.94), or enjoyment of life (p=0.31). Controlling for age, gender, primary histology, and treatment region, there was no significant association between advanced RT (vs simple RT) and a partial (OR 1.04; 95% CI: 0.66-1.64) or complete (OR 0.97; 0.48-1.93) pain response. <h3>Conclusion</h3> In this publicly funded, non-incentivized health care system, there was no patient reported difference in pain or impact of pain on quality of life between simple vs advanced RT techniques. Given there is increasing utilization of advanced RT techniques in our cohort and other jurisdictions internationally, there is further need for randomized trials to assess the benefits of advanced techniques given their increased cost and inconvenience to patients.