Relationship between incidence of fracture and health-related quality-of-life in metastatic breast cancer patients with bone metastases

Abstract

Objective

This retrospective observational study describes treatment patterns and longitudinal health-related quality-of-life (HRQoL) among metastatic breast cancer patients with bone metastasis from nine community oncology clinics.

Methods

For description of treatment patterns, patients were classified as treated if they started zoledronic acid within 60 days of diagnosis of bone metastasis, were considered untreated if they had not, and were considered unclassified if they died or experienced fracture before 60 days had elapsed. Medical record review provided demographic and disease characteristics as well as history of treatment. Patients completed Patient Care Monitor (PCM) assessments of patient reported outcomes during routine care for up to 2 years from the date of bone metastasis diagnosis.

Results

The overall rate of fracture in the sample was 17.4%. Of the 321 patients enrolled, 160 were treated as of 60 days after diagnosis of bone metastasis, 147 were untreated, and 14 were unclassified. Of the 147 untreated as of 60 days, 82 did eventually receive zoledronic acid. More than half of all patients treated with zoledronic acid delayed the start of treatment by more than 30 days after diagnosis of bone metastasis. Patients who had a fracture showed decreased mobility and increased pain and anxiety at fracture, with recovery taking ∼16 months.

Limitations:

Key limitations included: convenience sample with information limited to medical record content, low rate of observed fractures possibly due to limited 2-year follow-up, and exclusion of non-zoledronic acid bisphosphonate use.

Conclusions

Whereas the proportion of patients experiencing a fracture was small, the impact of fracture on HRQoL was significant and was more prominently seen to impact specific dimensions of HRQoL.

Keywords::

• Zoledronic acid
• Bisphosphonate
• Skeletal events
• Longitudinal quality-of-life
• Physical functioning
• Emotional functioning

Transparency

Declaration of funding

The study reported in this paper was funded by Novartis Pharmaceuticals Corporation. MSW contributed to study design, primary data review, and statistical analysis. PJEM contributed to statistical analysis and study design. MN contributed to study design and background research. ACH contributed to background research, conceptual analysis, and writing. EJS contributed to study design and background research. LSS contributed to clinical background, study design, and conceptual analysis. All authors read and approved the final manuscript.

Declaration of financial/other relationships

MN is employed by and owns stock in Novartis. LS is on the speakers’ bureau for Eisai, Genentech, and GSK, is a consultant for Eisai, and has received research funding from Eisai. The other authors report no conflicts of interest to disclose.

Acknowledgments

Special thanks to the participating community oncology practices, and their patients, for their contribution to this research. The nine participating community oncology practices were: Atlanta Cancer Care, Atlanta, GA; Cancer Care Associates, Royal Oak, MI; Columbus Hematology and Oncology, Columbus, MS; Frontier Cancer Center and Blood Institute, Billings, MT; Gaston Hematology & Oncology Associates, Gastonia, NC; Regional Hematology Oncology, PA, Newark, DE; Southeast Nebraska Cancer Center, Lincoln, NE; The West Clinic, Memphis, TN; and West Michigan Cancer Center, Kalamazoo, MI.