Edward Chow & Breanne Lechner 
Advanced Cancer 
Managing Symptoms and Quality of Life

Bone metastases are a common event for cancer patients. We have developed an innovative and unique clinical research program dedicated to palliative radiation oncology at the Odette Cancer Centre, Sunnybrook Health Sciences Centre and specifically a multidisciplinary clinic for bone metastases. The development of this program introduces an effective strategy to conduct research in palliative radiation oncology. Symptom control is very important for the quality of life for bone and brain metastases patients. This is an evolving active field of research as greater emphasis is being placed into understanding the goals of improving not only a patient’s survival, but the ability for therapies to improve the quality of a patient’s life. In this book we present the EORTC QLQ-C30 questionnaire, which was used in a multi-center study with patients recruited from Edmonton, Alberta, Canada; Kaohsiung, Taiwan; Kerala, India; Nicosia, Cyprus; Sao Paulo, Brazil; Taipei, Taiwan; Tanta, Egypt; and Toronto, Ontario, Canada, with brain and bone metastases. It was found that the difficulties bone and brain metastases patients experience are different in several ways. Patients with bone metastases have more pain and reduced physical functioning. However, patients with brain metastases have more severe role functioning deficits. With use of the QLQ-C30, it was also found that there is ambiguity regarding the root of patient issues. Future studies that require more comprehensive disease-specific findings should include disease-specific assessment modules such as the QLQ-BM22 and QLQ-BN20. Important domains such as the minimal clinically important difference should also be established in individual subgroups of patients to assist in clinical trial design.