Patient reported change in pain outcome among stage IV cancer patients with bone metastases following palliative radiotherapy: A prospective study from Ethiopia.

BACKGROUND

Cancer is reported to be on the rise in low-income countries where most patients present in either locally advanced or metastatic stage of the disease. The standard treatment for cancer patients with metastatic bone disease includes radiotherapy, systemic agents and surgical intervention. Most cancer patients in Ethiopia present in advanced stage of the disease. Among these patients with advanced cancer are those with painful metastasis to the bone. Most commonly these patients are offered palliative single fraction 8 gy or fractionated 20 gy of radiotherapy to painful bone metastases. However, there is no data in Ethiopia regarding the effect of this palliative radiotherapy on pain arising from bone metastases.

OBJECTIVES

To determine the patient's reported change in pain status following palliative radiotherapy at two, four, and eight weeks (wks.), when compared to pretreatment pain status.

METHODS

A total of forty-four cancer patients with fifty sites of bone metastases were enrolled in the study. An observational cohort study was conducted to investigate the effectiveness of palliative RT towards alleviating pain due to bone metastases.

RESULT

Forty-four patients enrolled in this study with six of them having two sites of bone metastases which constituted fifty metastatic bone sites from February 10, 2020, to September 20, 2020. Half of patients initially presented with severe pain and the rest half had either moderate or mild pain. Patients who had severe pain were more likely to receive 8 Gy than 20 Gy. Following patients after administration of palliative radiotherapy at week 2, 4 and 8, complete pain response was 32.61 %, 45.24 %, and 51.28 % and overall response rate was 65 %, 67 %, 78 %, respectively. The radiotherapy cohorts receiving a single dose of 8 Gy and those receiving a fractionated dose of 20 Gy demonstrated comparable effectiveness in alleviating pain severity. Both treatment approaches showed similar efficacy in Ethiopian cancer care setting.

CONCLUSION

Palliative radiotherapy administered to stage IV cancer patients with painful bone metastases is effective in reducing pain severity in majority of patients in Ethiopia. Pain response in metastatic bone diseases to palliative radiotherapy is comparable between patients receiving a single dose of radiation therapy and those receiving a fractionated dose of 20 Gy in Ethiopian cancer care setting.