Background Patients with bone metastases can suffer from considerable pain and reduced quality of life, in addition to complications such as pathological fracture and spinal cord compression. Bisphosphonates can be used as an adjunct to treat pain in addition to conventional analgesia and radiotherapy.
Aims Our outpatient bisphosphonate infusion service at the hospice was set up in 2008, in conjunction with our local acute NHS trust oncology unit. The pilot service initially accepted patients with bone metastases from hormone refractory prostate cancer when pain was not controlled with conventional radiotherapy and analgesia.
Method Patients benefit from an outpatient appointment with a doctor and nurse to assess current symptoms using IPOS (Integrated Palliative care Outcome Scale), followed by bisphosphonate treatment on the same day. Referral into other services within the hospice, such as physiotherapy, occupational therapy, rehab services and our FAB (Fatigue, Anxiety and Breathlessness) clinic, can be made when needed.
Results Following review of the service we now accept patients earlier in their disease trajectory and treat patients with bone involvement from other diagnoses such as myeloma, sarcoma or renal cancer. Our referral numbers continue to increase on a yearly basis.
We have successfully treated patients with recurrent hypercalcaemia in the day case setting by monitoring levels closely and treating early with a bisphosphonate before they are symptomatic; thereby reducing morbidity, preventing the need for inpatient admission and reducing pressure on acute hospital services.
Conclusion Future expansion of this interventional outpatient clinic might include breast cancer patients who currently receive denosumab injections in the hospital. We could use this model of service to allow early integration of these patients into palliative care services and allow them to benefit from the diversity of therapies and services the hospice can offer at an earlier stage in their illness.
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