Hendriks, L.E., Hermans, B.C., van den Beuken-van Everdingen, M.H., Hochstenbag, M.M., & Dingemans, A.M. (2016). Effect of bisphosphonates, denosumab, and radioisotopes on bone pain and quality of life in patients with non-small cell lung cancer and bone metastases: A systematic review. Journal of Thoracic, 11, 155–173. 

STUDY PURPOSE: To assess the evidence of effectiveness of these agents on bone pain and quality of life (QOL)

TYPE OF STUDY: Systematic review

• FINAL NUMBER STUDIES INCLUDED = 25 
• TOTAL PATIENTS INCLUDED IN REVIEW = 3,044 with bisphosphonates or denosumab, 762 with radioisotopes
• SAMPLE RANGE ACROSS STUDIES: 22–1,597 patients
• KEY SAMPLE CHARACTERISTICS: Multiple tumor types, including lung cancer

PHASE OF CARE: Late effects and survivorship
 
APPLICATIONS: Palliative care

Thirteen studies examined use of bisphosphonates and/or denosumab. Twelve studies used various radioisotopes. No randomized studies using bone-modifying agents were found. One randomized study compared zoledronic acid versus ibandronate. Most of these studies were examining effects to prevent skeletal events. Overall for those with NSCLC, a mean of 67% of patients had a decrease in pain score (3 studies, 225 patients). Of patients given samarium, 60%-95% experienced a decrease in pain. Overall radioisotopes appeared to reduce pain with rapid onset, lasting one to three months. Data were limited for individuals specifically with NSCLC. Most studies did not include QOL measurement; in the five studies that did, only two showed improvement.

Limited evidence exists that bisphosphonates or denosumab reduce or prevent pain from bone metastases or impact QOL in patients with NSCLC . Radioisotopes appear to have a palliative effect on pain, but no high-level evidence for this was found.

• No quality evaluation

Although some evidence exists that bone-modifying agents prescribed to prevent skeletal events may reduce associated pain, the evidence is limited, particularly for patients with NCSLC. Radioisotopes appear to reduce pain for a limited amount of time, and repeated use can have significant adverse effects on bone marrow. Authors of this report suggest that efficacy for pain relief may be tumor dependent, and that, due to potential bone marrow suppression, radioisotopes should be reserved for patients who are not receiving active anticancer therapy and pain that is not appropriate for palliative radiotherapy.