Manging bone pain in cancer

Bone is the most common site of tumour metastases in patients with advanced cancer. Approximately 80-900/0 of men dying from prostate cancer and 50-800% of patients dying from breast cancer will have skeletal metastases and the majority of these patients will suffer severe pain and impaired mobility as a result. As well as suffering pain these patients are at risk of hypercalcaemia, bone marrow failure, pathological fracture and spinal cord compression.

The aetiology of the pain is multifactorial and includes stretching and destruction of the periosteum, micro and macro fractures, infiltration and compression of nerve roots, muscle spasm and local cytokine release. Therapy should address symptom management, treatment of the cancer and prevention of complications such as fracture.

Palliation represents a large component of cancer treatment. The goal is to effectively and efficiently relieve symptoms and maintain maximum quality of life. Radiotherapy is one of the many treatment options and is usually delivered as external beam therapy. A short course of treatment can provide very effective symptom relief without major toxicity. Radionucleides (eg Sr 89) are used occasionally.