S901
Clinical - Mixed sites & palliation
ESTRO 2026
Soliman 1 , Henry CY Wong 3 , Agata Rembielak 4,5 , Adrian W Chan 6 , Balamurugan A Vellayappan 7,8 , Dirk Rades 9 , Ali Alkan 10 , Pierluigi Bonomo 11 , Michele Aquilano 12 , Gustavo N Marta 13,14 , Daniel de Sousa Miragaia de Oliveira 13 , Vassilios Vassiliou 15 , Morfo Georgiou 15 , Vassilis Kouloulias 16 , Zoi Liakouli 17 , Edward Chow 1,18 , Shing Fung Lee 7,19 1 Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 2 Department of Medicine, University of Toronto, Toronto, Canada. 3 Department of Oncology, Princess Margaret Hospital, Kowloon West Cluster, Hong Kong, Hong Kong. 4 Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom. 5 Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom. 6 Department of Radiation Oncology, BC Cancer - Vancouver, Vancouver, Canada. 7 Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore. 8 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 9 Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. 10 Department of Medical Oncology, Mu ğ la Sıtkı Koçman University School of Medicine, Turkey, Mu ğ la Sıtkı Koçman University School of Medicine, Mu ğ la, Turkey. 11 Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. 12 Centro di Radiochirurgia Cyberknife IFCA, Casa di Cura Villa Ulivella e Glicini, Florence, Italy. 13 Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil. 14 Postgraduate Program, Department of Radiology and Oncology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. 15 Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus. 16 Department of Clinical Radiation Oncology, Medical School, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece. 17 Radiotherapy Unit, Medical School, 2nd Department of Radiology, National and Kapodistrian University of Athens, ATTIKON University Hospital, Athens, Greece. 18 Department of Radiation Oncology, University of Toronto, Toronto, Canada. 19 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Toronto, Canada Purpose/Objective: Bone metastasis (BM) is among the most common and clinically significant complications of advanced cancer and significantly impacts health-related quality of life (HRQoL). The European Organisation for Research and
Treatment of Cancer (EORTC) Quality of Life Questionnaire–Bone Metastases 22 (QLQ-BM22) was developed to assess BM-specific concerns; however, advances in treatment and changing patient priorities over the past 15 years necessitate an updated module. This Phase I study aimed to identify contemporary BM- relevant HRQoL issues to support the development of an updated EORTC BM module. Material/Methods: Following EORTC Quality of Life Group guidelines, a systematic literature review identified candidate HRQoL issues relevant to BM. These were evaluated by healthcare professionals (HCPs) and patients through semi-structured interviews, with participants rating relevance on a 4-point Likert scale, voting for inclusion/exclusion, and ranking their top ten priorities. For each issue, mean relevance, prevalence, priority votes, and top ten rankings were calculated. Issues meeting at least three of four predefined patient-based thresholds were advanced; those meeting two were reviewed using HCP criteria. All issues were further assessed by the research team based on clinical judgment. Results: The literature review identified 28 potential HRQoL issues across six domains: site of pain, nature of pain, other physical symptoms, functional interference, psychosocial, and treatment related. Sixty-one HCPs across seven countries participated, with mean relevance scores ranging from 2.6–3.6, prevalence 90.2–100%, and priority votes 59–96.7%. HCPs represented diverse professions, including physicians (59%), radiation therapists (23%), nurses (11.5%), and allied health workers (6.5%). Based on HCP input, one additional issue (“worried about fall/bone fracture”) was added, yielding 29 issues for patient evaluation. Ninety patients from six countries were subsequently recruited, with mean relevance scores ranging from 1.8–3.0, prevalence 35.6–90%, and priority votes 64.4– 96.7%. Across both groups, pain-related issues, physical symptoms, and functional limitations were consistently prioritised. Patients further emphasised interference with recreational activities, weight changes, and lack of motivation, while HCPs highlighted cranial nerve symptoms. After applying inclusion thresholds and expert review, ten issues were retained for Phase II development (Table 1).
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