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  • Original Article
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Clinical Research

Impact of symptomatic skeletal events on health-care resource utilization and quality of life among patients with castration-resistant prostate cancer and bone metastases




Data regarding the impact of symptomatic skeletal events (SSEs) on health economics and patient-reported outcomes in men with castration-resistant prostate cancer (CRPC) and bone metastases from a clinical setting are lacking. Hence, this study aimed to quantify the effects of SSEs on health-care resource utilization (HRU), health-related quality of life (HRQoL) and pain in men with CRPC metastasized to bone.


This cohort study included men with CRPC and bone metastasis treated at a tertiary center during December 1996–July 2015. SSEs, including pathological fracture, radiation to bone, spinal cord compression and bone surgery, as well as HRU were identified retrospectively through medical records and clinical database. A subset of surviving patients completed Functional Assessment of Cancer Therapy-Prostate (FACT-P) and Brief Pain Inventory-Short Form (BPI-SF) questionnaires. The incremental effect of SSEs on HRU was evaluated using multivariable generalized linear regression. Questionnaire scores were compared using effect sizes (ES); ES0.33 indicated meaningful differences between SSE and non-SSE cohorts. Lower scores suggest lower HRQoL and pain.


Of the 832 patients, 207 developed 1 SSE (mean 1.5±0.8) during follow-up (median 2.1 years). Radiation to bone was the most common SSE (84.1%). SSE cohort had significantly higher emergency room (incidence rate ratio (IRR)=1.48; P=0.006), outpatient (IRR=1.17; P=0.005) and inpatient (IRR=1.74; P<0.001) visits. Of the 107 eligible survey patients, 103 (96.3%) responded. SSE cohort had lower mean FACT-P functional well-being (17.5 vs 19.8; P=0.158; ES=0.36), higher mean pain severity (2.5 vs 1.6; P=0.048; ES=0.47) and worst pain scores (3.6 vs 2.3; P=0.033; ES=0.50) compared with the non-SSE cohort, indicating meaningful differences between cohorts.


This study demonstrated high economic and HRQoL burden of SSEs. The findings underscore the need for better supportive and disease-modifying treatments for these patients.

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We thank David Kinrich of Analysis Group for his support during the analysis of data. This study was supported by Bayer Healthcare Pharmaceuticals (Bayer).

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Correspondence to R McKay.

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Competing interests

RM, MN and MF were employed by the Dana-Farber Cancer Institute (DFCI) at the time of the study. RM is currently employed by Moores Cancer Center and University of California. PK, currently employed by Memorial Sloan Kettering Cancer Center, was an employee of the DFCI at the time of the study. PK has served as a consultant to Astellas, Bayer, Janssen, Millennium/Prometrika, Pfizer and Sanofi. RM has received institutional research funding from Bayer and Pfizer. MSD and BH are employees of Analysis Group, a consulting company that has received research grants from Bayer, including one for the current study. LR was an employee of the Analysis Group at the time of the study. AV and LW are employees of Bayer Healthcare, and LW owns Bayer stock. The remaining authors declare no conflict of interest.

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McKay, R., Haider, B., Duh, M. et al. Impact of symptomatic skeletal events on health-care resource utilization and quality of life among patients with castration-resistant prostate cancer and bone metastases. Prostate Cancer Prostatic Dis 20, 276–282 (2017).

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