Healthcare and QoL burden of symptomatic skeletal events in CRPC with bone mets

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Published: 8 Jan 2016
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Dr Rana McKay - Dana-Farber Cancer Institute, Boston, USA

Dr McKay talks to ecancertv at ASCO GU 2016 about her research in to the impact of symptomatic skeletal events (SSE) in castration resistant prostate cancer (CRPC) patients.

Prostate cancer patients frequently develop bone metastases, leading to symptomatic skeletal events.

The study evaluated the impact of SSE on healthcare resource utilization, health-related quality of life, and pain.

The economic and quality of life burden of SSE amongst CRPC patients with bone metastases is high, underscoring the need for preventive treatments for SSE in this population.

Bone metastases are the most common site of metastases in patients with metastatic prostate cancer and bone metastases can cause significant morbidity for patients, pain, deterioration of quality of life and also skeletal related events which manifest as fractures to the bone, radiation to the bone, cord compression. The purpose of this abstract was really to assess the role of skeletal related events with regards to outcomes in patients with metastatic prostate cancer and also specifically how skeletal related events affect quality of life measures, as demonstrated through a patient survey, and also health resource utilisation – how much ED time, ER time, in-patient hospitalisations does a patient with a skeletal related event actually encounter.

What did you ask patients?

Patients were actually given two kinds of questionnaires, one questionnaire was a functional domain questionnaire which basically assesses a patient’s function – are they able to do their activities of daily living, how is their wellbeing – and these are standardised questionnaires that have been validated. A second questionnaire that they were given was a brief pain inventory where they can actually assess their worst degree of pain, where is their pain, how bad their pain is and patients were given both questionnaires to complete.

What did you look into regarding healthcare systems?

We were specifically looking at ED admissions or ED visits, in-patient hospitalisations, length of stay during an admission, also out-patient clinic visits, surgeries, procedures, biopsies and we compared outcomes in the patients who had skeletal related events versus the patients who did not have skeletal related events.

What did you find?

We found that the patients who actually had skeletal related events used a significant amount of resources, medical resources. They had a lot more ED visits, they had a lot more admissions to the hospital, a lot more outpatient visits and more procedures and surgeries done, as you would expect for somebody who is having more pain to the bone, fractures to the bone, cord compression and things like that. In addition, with regards to the patient aspect and the questionnaires, we found that patients also had significantly more pain, worse degree of pain, worse amount of pain, in the SSE cohort versus not.

What should this tell us?

I think this tells us that this is an unmet need for patients with prostate cancer. How better can we implement therapies that are going to mitigate their pain, prevent skeletal related events? I think it also speaks to the fact that these skeletal related events happen at a time when a patient’s disease is not being well controlled by their systemic therapy and speaks to us actually having better systemic therapies for these patients.

What is the take home message?

Listen to your patients with regards to the symptoms that they’re having. Act early with regards to detection of these events and optimise the patients’ systemic therapy to help prevent these events from occurring.