Introduction Insufficient quality evidence exists to support or refute the use of non-steroidal anti-inflammatory drugs (NSAIDs) in the management of cancer pain.¹ Palliative physicians support a placebo-controlled trial of NSAIDs as strong opioid adjuncts for cancer-induced bone pain (CIBP) as the most pragmatic design to benefit clinical practice.² We aimed to determine the number, demographics and co-morbidities of palliative patients receiving radiotherapy for CIBP, guiding the feasibility of a future trial.

Method Five years of retrospective radiotherapy data from the regional Leeds Cancer Centre was filtered (94% sensitive, 90% specific) to achieve a palliative cohort with CIBP. Demographics and survival were linked to available serology and co-morbidity data. Linear regression and descriptive statistics were used.

Results Over five years, 2411 patients received palliative radiotherapy for CIBP in Leeds (mean 478 patients/year). Median age (IQR) was 70 (62–77); negatively skewed (-0.69). More were male (58%). 61.8% died within 1 year of radiotherapy; 46.6% within 6 months. Age did not correlate with survival duration, r(1878) 0.015,p=0.51. A large minority (30.1%) underwent further radiotherapy on subsequent dates. During the 6 months prior to radiotherapy, serology from 1063 (44.2%) patients were available; eGFR was ≥90 mL/min/1.73m2 in 47.0% and ≥60 mL/min/1.73m2 in 83.0%. Similarly, a minority had markers of impaired synthetic liver function (platelets<150 109/L in 7.9%; bilirubin ≥21 in 3.4%; INR ≥1.2 in 20.5%), excluding hypoalbuminaemia (54.1%). From available data (51.6% of sample), 20.2% had a coded co-morbidity contra-indicating NSAID prescription. Combining serological (eGFR>60 mL/min/1.73m2) and contra-indicated co-morbidity data, 68.5% of this population could be considered for NSAID prescription.

Conclusions Patient numbers at a single regional radiotherapy centre support the feasibility of trial recruitment. Available serology and co-morbidity data suggest two thirds may be suitable for NSAID prescription. This may be an underestimate, considering data limitations. Concerning survival post radiotherapy, NSAIDs could provide sustained benefit for this population if proven efficacious.

References

1. Derry S, Wiffen PJ, Moore RA, McNicol ED, Bell RF, Carr DB, McIntyre M, Wee B. 2017. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) for cancer pain in adults. Cochrane Database of Systematic Reviews 2017. Issue 7.

2. Page AJ, Mulvey MR, Bennett MI. 2020. Designing a clinical trial of non-steroidal anti-inflammatory drugs for cancer pain: a survey of UK palliative care physicians. BMJ Support Palliat Care. Published Online First: 02 December 2020.