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ACS Panel on Prostate Cancer: Painful Skeletal Mets Require Special Management

ACS Panel on Prostate Cancer: Painful Skeletal Mets Require Special Management

PHILADELPHIA--Pain from skeletal metastasis has a major impact
on quality of life in patients with prostate cancer, Mary Layman-Goldstein,
RN, OCN, said at the American Cancer Society's National Conference
on Prostate Cancer. Ms. Layman-Goldstein, a clinical nurse specialist
at Memorial Sloan-Kettering Cancer Center, served on a panel discussion
on how to manage complications of prostate cancer.

In addition to general principles of pain assessment and management,
the clinician who treats patients with prostate cancer should
be familiar with adjuvant analgesic drugs used to treat bone pain,
Ms. Layman-Goldstein said.

Short-term corticosteroid administration can be helpful in controlling
severe pain if there is difficulty establishing an effective opioid
dose, she said.

By administering dexamethasone as an initial high-dose intravenous
bolus, followed by tapered IV/PO doses every 6 hours, "the
clinician can buy some time, break the pain cycle, and give the
patient a chance to become more tolerant to the effect of opioids."
She cautioned, however, that long-term use of corticosteroids
can cause problems, which should be weighed against their potential
benefits in relieving pain.

The bisphosphonates, etidronate (Didonrel) and pamidronate (Aredia),
can reduce pain from skeletal metastases by inhibiting the activity
of osteoclasts and decreasing bone resorption. These agents have
been used successfully to reduce bone pain in patients with some
kinds of cancer.

Calcitonin works in a similar fashion, by inhibiting osteoclasts,
and also has a central antinociceptive effect. Before administering
calcitonin, it is advisable to give a small trial dose to assess
for anaphylactic response. If there is no untoward reaction, calcitonin
can be started at a dose of 25 IU and increased as necessary,
she said. Many patients' pain can be relieved at doses of 100
units three times a week, but some patients may need higher doses.

Radiopharmaceuticals are promising agents whose optimal role in
pain management remains to be fully explored, Ms. Layman-Goldstein
said. Strontium-89 (Metastron), a bone-seeking radioisotope, has
been demonstrated to reduce opioid requirements in patients with
bone metastases.

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