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Variation in Oncologic Opinion Regarding Management of Metastatic Bone Pain with Systemic Radionuclide Therapy

Advanced Medical Technology Assessment and Policy Program, Division of Nuclear Medicine and Radiation Oncology, Department of Radiology, University of California at San Diego
The Cancer Center, University of California, San Diego, California

Correspondence: For correspondence or reprints contact: Frank J. Papatheofanis, MD, PhD, UCSD Medical Center, Department of Radiology, Division of Nuclear Medicine and Radiation Oncology, 200 W. Arbor Dr., San Diego, CA 92103-8758.

ABSTRACT

The objective of this study was to determine whether there is consistency of opinion regarding the management of metastatic bone disease pain among medical oncologists who are given the option of using systemic radionuclide therapy (⁸⁹Sr, ¹⁵³Sm). Methods: One hundred board-certified medical oncologists were given a brief clinical summary of three patients with metastatic cancer. Management options included oral, parenteral and transdermal delivery forms of opioid analgesics; external beam irradiation; and systemic radionuclide therapy. The oncologists rated, in whole numbers from 1 (most appropriate) to 10 (least appropriate), their opinions on the appropriateness of each proposed intervention for each patient. Results: Systemic radionuclide therapy was perceived consistently as having low appropriateness for palliation of metastatic bony pain compared with opioid analgesics. A slight increase in appropriateness for systemic therapy was indicated for the patient with widespread metastatic disease, who, on the basis of literature reports, was unlikely to benefit from such therapy. The oncologists rated the appropriateness of systemic therapy as low in the patient with limited early disease, in which the literature indicates the greatest benefit will be derived from such intervention. Conclusion: Referring oncologists perceive the appropriateness of systemic radionuclide therapy as low. Their perception of its appropriateness increases with extent of disease. As a result, this palliative option is underutilized or used in less-than-optimal disease settings.

Key Words: cancer • oncology • ⁸⁹Sr

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