Background: Pain due to bone metastases represents a common source of cancer-related morbidity. Not all patients who develop bone metastases develop pain. It is a subjective experience unique to each patient. We conducted a quality assessment project at the Providence VA Medical Center (PVAMC) to characterize the problem of pain due to bone metastases.
Methods: All veterans with bone metastases seen by the oncology service during 2011 to 2013 at the PVAMC were included. Pain scores were assessed from each outpatient visit. Scores ranged from 0 to10 with 0 to 3 considered mild pain, 4 to 6 moderate pain, and 7 to 10 severe pain. If veterans were found to have severe pain, then their charts were reviewed for the interventions undertaken and whether pain was brought to a more acceptable score.
Results: Sixty-nine veterans with bone metastases were included. Fifty-one percent experienced severe pain. Of those experiencing severe pain, 46% had lung cancer and 37% had prostate cancer. Ninety-four percent of veterans with lung cancer and bone metastases experienced severe pain. Of those veterans with severe pain, 94% were prescribed narcotics, 83% enrolled in hospice, 66% received palliative care, and 63% received radiation therapy. Eleven veterans in total were admitted to the hospital for pain control. It took a median of 25 days to reduce pain to a score of 3. Overall the median time from onset of severe pain to death was 80 days. For veterans with lung cancer, the median time to death was 63 days compared with 371 days in veterans with prostate cancer.
Conclusions: Many veterans with bone metastases experince severe pain. This project demonstrated that the majority of lung cancer patients reported extreme pain from their bone metastases, and the median time from severe pain onset to death was about 2 months. Early and aggressive pain control and palliative or hospice care may be particularly beneficial for these patients. In the future, we will seek to shorten the duration of time to adequate pain control through a quality improvement project.