Abstract
e17588 Background: Radiotherapy attenuates pain in patients with spinal metastases. A newer technology is stereotactic body radiotherapy (SBRT) that allows for high dose radiation to be accurately given to a target while sparing nearby tissues. Although a previous study reported improvement in pain, fatigue, disturbed sleep, drowsiness, sadness, fatigue, distress, lack of appetite, nausea, and difficulty remembering after SBRT, it did not examined the quantitative relationship of pain reduction with improvement in symptom burden. Methods: Cancer patients (n=149) with mechanically stable, non–cord-compressing, spinal metastases (n=166) were treated by SBRT in a phase I/II study. Patients received a total dose of 27–30 Gy, typically in three fractions. Symptoms were measured repeatedly using the M. D. Anderson Symptom Inventory (MDASI). Linear mixed model was fitted with pain as the dependent variable and other symptoms as predictor variables to determine the effect of other symptoms on pain throughout the treatment trajectory. Opioid use was a covariate in the analysis. Results: As reported previously, there were significant reduction in pain (p=0·00003) disturbed sleep, drowsiness, sadness (all p<0·0001), fatigue, distress, lack of appetite, nausea, and difficulty remembering (all p<0·05) during the six months post-SBR. Based on our linear mixed models, a 1-point reduction in fatigue (p<.001) is associated with 0.26 reduction in pain. Similarly, a 1-point reduction in in sleep disturbance (p<.001), numbness (p<.001), distress (p<.005), lack of appetite (p<.01) and dry mouth (p<.03) were associated with reductions of 0.25, 0.22, 0.16, 0.15, and 0.14 in pain, respectively. Opioid use was significantly reduced after SBRT. Conclusions: Significant reduction in pain from SBRT is associated with improvement in symptom burden. These findings may provide insights into how symptoms are interrelated during cancer treatment.
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