Radiotherapy for bone metastases: A critical appraisal of outcome measures

Robin Dawson, David Currow, Graham Stevens, Graeme Morgan, Michael B. Barton

Research output: Contribution to journalReview articlepeer-review

20 Citations (Scopus)


Pain from bone metastases is a common problem in patients with advanced cancer, and radiotherapy plays an important role in its palliation. Single fraction treatments are often prescribed, but there is no clear consensus on this issue and clinical practice shows significant variability. This situation is unsatisfactory for all parties - the patient, the clinician, and the health care administrator. Randomized trials may use poor outcome measures and this contributes to practice variability. The credibility of outcome studies is often reduced due to poor study design, small sample sizes, and the use of endpoints that are both unreliable and unsuitable. The endpoints used have been narrowly defined, the patient's perspective has generally been overlooked, and quality of life has only once been used as an endpoint. A review of the current literature suggests that instruments specific to bone metastases are required. These must be based on patient experience, and rely on self-report. In addition, there is a need to understand the relative priority that patients attribute to treatment outcomes. The use of better instruments and methodologies in future trials will enhance the credibility of results and reduce practice variations.

Original languageEnglish
Pages (from-to)208-218
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number3
Publication statusPublished - Mar 1999
Externally publishedYes


  • Bone metastases
  • Measures of outcome
  • Palliative radiotherapy
  • Practice variations
  • Quality of life
  • Radiotherapy


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