Bone metastases and skeletal-related events

Overview

• Lung cancer: NICE NG122 (1.17.1) says to offer single-fraction radiotherapy to people with bone metastasis who need palliation and for whom standard pain relief is inadequate, and points to its guideline on spinal metastases and metastatic spinal cord compression. NG234 lists the pain that should prompt a call within 24 hours (severe unremitting back pain, progressive back pain, pain aggravated by standing, sitting, moving, coughing, sneezing or straining, night-time pain disturbing sleep, localised tenderness) and the symptoms treated as an oncological emergency (bladder or bowel problems, difficulty walking, limb weakness, numbness or altered sensation, radicular pain).
• Prostate cancer: Prostate Cancer UK says about 4 in 100 people with prostate cancer develop metastatic spinal cord compression, that the risk is highest where the cancer has already spread to the spine, and that at its worst cord compression can cause nerve damage and paralysis, so treatment straight away lowers the risk of that being permanent. NICE NG234 (1.3.2) treats new symptoms or signs of cord compression in anyone with a past or current cancer diagnosis as an oncological emergency, and (1.5.2) asks for an MRI as soon as possible and always within 24 hours.
• Protecting the skeleton: NICE NG131 (1.5.19) says to consider zoledronic acid to prevent or reduce skeletal-related events in hormone-relapsed metastatic disease, and (1.5.20) oral or intravenous bisphosphonates for pain relief where analgesics and palliative radiotherapy have not been enough. NG131 (1.3.35) says not to offer bisphosphonates to prevent bone metastases in the first place, and (1.4.12) not to offer them routinely to prevent osteoporosis on hormone therapy, which are three different questions with three different answers.