EVALUATING THE EFFECTS OF BONE METASTASES

Men with advanced prostate cancer are often considerably burdened with symptoms, which may cause significant changes in health-related quality of life (HRQOL). Disease burden is inversely related to HRQOL in men with prostate cancer. Men with poor-prognosis metastatic disease and hormone-resistant disease reported significantly worse physical functioning scores, role functioning scores, pain scores, and global health status than men with locoregional disease.

Bone Metastases Have Multiple Symptoms

Most men with mCRPC experience mental and physical morbidity and a decreased HRQOL. Multiple symptoms are associated with bone metastases (

Figure 6

), yet a recent Prostate Cancer Symptoms Survey revealed that nearly 7 of 10 patients (68%) ignore their symptoms. Therefore, a complete review/discussion of patient history is critical to reveal symptoms associated with bone metastatic disease in advanced prostate cancer. In a US survey of men with advanced prostate cancer, the most common symptoms reported by men with bone metastases include:

Fatigue: 85%
All over body pain or aches: 55%
Numbness or weakness: 55%
Difficulty sleeping as a result of pain: 42%
Difficulty doing normal activities: 40%
Anxiety or distress as a result of pain: 40%
Vomiting: 25%
Loss of appetite: 20%

68% of patients ignore their symptoms.

Figure 6. Multiple Symptoms Are Associated With Bone Metastases

Fatigue is the most stressful symptom of which patients complain. They report that fatigue influences their daily functioning more so than any other symptom. Fatigue can be attributed to mCRPC, the adverse effects of mCRPC treatments, decreased activity, poor nutrition, depression, and comorbid conditions. Pain and discomfort can vary in nature and severity and is often accompanied by fatigue.

Fatigue is the most stressful symptom of which patients complain.

Bone metastases in the spine, pelvis, and femur may affect mobility.Patients with bone metastases in these locations may have problems sitting, walking, or being able to lie in a comfortable position. Bone metastases located in the cervical spine, humerus, or shoulder can impact range of movement, and may compromise activities of daily living. A decrease in mobility also raises the risk of respiratory infections and thromboembolism.

Weakness or numbness in the legs, and problems with the bladder and bowel could be caused by the pressure of bone metastases on the spinal cord. Spinal cord compression represents an oncological emergency, and early diagnosis and treatment is necessary for successful rehabilitation. If left untreated, neurological damage can occur, ranging from mild sensory impairment to complete paraplegia, with loss of bowel and bladder function. Neurological recovery is unlikely if spinal cord compression is not relieved within 24-48 hours.

Anemia, neutropenia, and thrombocytopenia may also be caused by bone marrow involvement, which can increase fatigue, general weakness, and dyspnea. Abnormal bleeding or bruising can occur if platelets are low. Men with advanced prostate cancer may also have hypercalcemia (a serum calcium of more than 2.6 mmol/L), which develops due to the increased release of calcium from bone and kidney dysregulation. Common symptoms of hypercalcemia include nausea, reduced appetite, increased thirst, and fatigue and confusion. If left untreated, hypercalcemia can result in arrhythmias, coma, and death.

Bone Metastatic Disease: A Significant Economic Burden

The costs of healthcare resource use (HRU) related to metastatic bone disease for Canadian patients with CRPC are high. A retrospective chart review of 393 patients was conducted at Centre Hospitalier de l'Université de Montréal (CHUM, n=130), Princess Margaret Cancer Centre (PMCC, n=154), and Vancouver General Hospital (VGH, n=109). The metastatic bone disease (MBD)-related HRU costs were estimated between MBD onset and death for patients who were dying from or palliated for mCRPC between Jan 1, 2006 and Jan 31, 2013.

Skeletal complications caused by prostate cancer metastases to bone are an important public health concern due to their association with increased health care costs (Figure 7).

Figure 7. Bone Metastatic Disease: A Significant Economic Burden

^{Adapted from Saad}^{et al.}²⁰¹⁸

A total of 275 (70%) patients experienced 833 SSEs (85 events/100 patient-years). Mean MBD-related HRU costs ranged from $22,101 to $34,670 for patients with one or more SSE and $9,550 for patients with no SSEs.

A second retrospective, population-based cohort study was conducted with men with a prostate cancer diagnosis and one or more health care claims in the RAMQ database (Province of Quebec). Adjusted mean all-cause healthcare costs were found to be $11,820 higher among the 626 men with MBD than among the 1,671 control subjects without MBD. MBD-related costs^† were $3,091 higher in patients with MBD than in controls.

Footnotes
† Resources considered to be indicative of MBD could also have been consumed by some control patients, e.g., for prevention or diagnosis.

PP-PF-ONC-CA-0118-1

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