Cancer is a significant global health burden, with metastatic disease accounting for most cancer-related deaths and posing complex challenges in management. Metastasis, characterized by the spread of cancer to distant organs, is often associated with debilitating symptoms, including pain, fatigue, and psychological distress, which significantly impair the quality of life (QoL) of affected individuals [1]. Palliative care, including radiotherapy (RT), aims to alleviate these symptoms, enhance functional status, and provide emotional support to patients and families [2].  

Palliative RT is a cornerstone in the management of metastatic cancer, especially for pain control, spinal cord compression, and symptomatic brain metastases. It is particularly effective in managing pain caused by bone metastases, with response rates ranging from 50% to 80%, and complete pain relief achieved in approximately one-third of patients [3][4]. Despite its effectiveness, the variability in individual patient responses and the potential for side effects necessitate a personalized approach to palliative RT, ensuring that treatment aligns with patients' preferences and clinical conditions [5].

In addition to addressing physical symptoms, palliative care involves evaluating and addressing patients' information needs. Studies show that cancer patients often experience high levels of uncertainty and distress due to inadequate information about their disease, treatment options, and prognosis [6]. Meeting these information needs is essential to fostering patient satisfaction, enhancing adherence to treatment, and improving their overall sense of control and well-being [7].

Furthermore, QoL assessment is a critical component of palliative care, as it provides insight into the multidimensional impact of the disease and its treatment on physical, emotional, and social well-being. Validated tools, such as the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), enable healthcare providers to measure QoL comprehensively and implement targeted interventions [8]. Similarly, pain assessment using validated scales, such as the Brief Pain Inventory (BPI), is essential for monitoring pain levels and evaluating the effectiveness of palliative interventions [9].

The aim of this study is to assess and evaluate the information needs, pain, and quality of life in patients with metastatic cancer receiving palliative radiotherapy. It seeks to identify and address patients' specific information requirements regarding their disease, treatment, and prognosis, while assessing the severity and impact of pain and evaluating the effectiveness of radiotherapy in alleviating it. Additionally, the study aims to analyze changes in the quality of life before and after radiotherapy, focusing on physical, emotional, and social well-being to provide comprehensive insights into the benefits of palliative care interventions

• Study Design    -    Prospective Study
• Study Period     -    2019-2020
• Target Population -    50 Patients with Metastatic Cancers receiving Palliative Radiotherapy
• Place Of Study -    MNJ Institute of Oncology And Regional Cancer Centre

Inclusion Criteria:

• Age 18-75
• Histologically Confirmed Metastatic Cancers
• Patients able to Comprehend and Understand The Questionnaires
• ECOG Performance Score 1-3

Exclusion Criteria:

• ECOG Performance Status 0,4
• No Histopathological Proof of Malignancy
• Pregnancy

Methodology:

Patients meeting the eligibility criteria will undergo a routine evaluation, including a detailed history, physical examination, assessment of symptom severity (pain and other symptoms), ECOG performance status, complete hemogram, and renal function tests. Demographic details will be recorded. Information needs will be assessed using Cassileth’s Information Needs Questionnaire before starting radiotherapy, while quality of life will be evaluated using the EORTC QLQ-C30 questionnaire prior to and one month after completing radiotherapy. Pain levels will be measured using the Numeric Pain Scale at baseline and one month post-radiotherapy. Data collected will be statistically analyzed using SPSS version 22.0 (Statistical Package for Social Sciences, IL, Chicago).

The study included patients aged between 25 and 80 years, with a median age of 53 years and a mean age of 54 years. All patients were married, except for one who was divorced and another who was widowed.

The ECOG performance status of the patients showed that 5% had a status of 0, 25% had a status of 2, and 70% had a status of 3, reflecting varying levels of physical functioning. Regarding educational status, 56% of the patients were illiterate, 22% had completed primary education, 14% had secondary school education, and 8% were graduates.

Comorbidities were absent in 75% of the patients. Among those with comorbidities, 10% had hypertension, 8% had diabetes mellitus, 2% had thyroid disease, and 5% presented with mixed comorbidities.

Socioeconomic status, assessed using the Modified Kuppuswamy Scale (2017), revealed that 86% of the patients belonged to the low socioeconomic class. The remaining patients were distributed among the upper-lower class (10%) and the lower-middle class (4%).

The primary cancer sites identified were predominantly lung (38%) and breast (36%), followed by the cervix (8%) and other sites (18%). The most common metastatic cancer sites were the bone (76%), followed by the brain (16%), the lung (8%), and the supraclavicular lymph nodes (2%).

The majority of patients (68%) presented with pain as their primary complaint. Other presenting complaints included headache and vomiting (12%), bleeding per vagina (6%), difficulty in swallowing (6%), and difficulty in respiration (8%).

Pain management strategies varied among the patients. NSAIDs were the primary treatment for 46% of patients, while 28% were managed with weak opioids, and 26% received strong opioids.

Cassileth’s Information Needs Questionnaire

The study revealed a strong need for information among patients regarding their illness and treatment. A significant proportion, 88% of patients, expressed the need to know if their illness was cancer. Only 4% (2 out of 50 patients) stated that they did not want to know if they had cancer, while 88% (44 patients) reported either an absolute need or a strong desire to be informed about their diagnosis.

Further, 82% (41 patients) indicated an absolute need to know the specific medical name of their illness. A majority, 86% (43 patients), expressed a strong desire to understand their week-by-week progress, and 70% (35 patients) wanted to know their chances of being cured. Information about all possible treatment options was important to 66% (33 patients), while 82% (41 patients) needed to know the potential side effects of their treatment. Additionally, 76% (38 patients) wanted information on how the treatment works to address their illness [Table 1].

It was observed that the desire for information was not influenced by the patients' educational or socioeconomic status.

Quality of life assessment

QOL data from base line to 1st month follow up was available for 50 patients. Base line 1st month follow up.

With Paired Sample T-test, there was a significant improvement in Global health score (GHS) (p=0.032), Physical functioning (p=0.00), Role functioning score (p=0.00), Emotional functioning score (p=0.016), Cognitive functioning score (p=0.008), Social functional scale shows improvement but statistically not significant (p=0.590) [Table 2, Figure 1].

Symptom scales Baseline to 1 month follow up

Symptom scales Pain (p=0.00), Fatigue (p=0.00), dyspnea (p= 0.034), appetite loss (p=0.047), diarrhoea (p= 0.009) and Insomnia (p=0.018) showed statistically significant improvement [Figure 2].

Nausea and vomiting (p=0.189), financial difficulties score (p=0.161) showed improvement but statistically not significant. Constipation showed worsening one month after RT (p=0.497) but statistically not significant [Table 3].

Pain assessment:

68% of patients presented with pain.  Pain score taken before starting radiotherapy and one month after completion of radiotherapy by using Numeric pain rating scale [Figure 3].

Mean pain scale score before RT 4.28, Mean pain scale score after one month RT 1.68, Showed statistically significant improvement in Pain reduction (p=0.000).

Table 1: Cassileth’s information needs questionnaire

Table 2:  Mean QOL C30 Score for Functional scales

Table 3: Mean QOL C30 Score for Symptom scales

Figure 1: Quality of life C-30 at baseline, 1-month post-RT

Figure 2: Quality of life C-30 at baseline, 1-month post-RT

Figure 3:  PS- pain score, BL – base line, 1m PS – 1 month after RT pain score

Cancer care focuses on more than just treating the disease; it also addresses the emotional, social, and daily needs of patients. In advanced stages, the goal is not only to extend life but also to improve its quality. Good communication between doctors and patients is essential to understand their concerns and provide the right information. Treatments like palliative radiotherapy help manage symptoms, reduce pain, and improve comfort, making life better for patients during their treatment journey. This approach ensures care is tailored to meet each patient’s unique needs.

Cancer patients' information needs and quality of life (QOL) are crucial aspects of care. Effective communication and tailored treatment approaches significantly influence patient satisfaction, adherence, and outcomes. Historically, physicians were hesitant to disclose full information to avoid distress, but evidence now supports the benefits of transparency. Informing patients enhances their physical and mental health, autonomy, and compliance with treatment protocols [10, 11]. However, balancing the level of detail provided to meet individual patient preferences remains essential.

Our study highlights that most patients have a strong need for information about their illness and treatment. About 92% of patients wanted to know their diagnosis, 90% sought information about their chances of cure, and 76% wanted to explore all available treatment options. This contrasts with earlier studies in India, which suggested a passive attitude toward decision-making [12, 13]. For instance, Elkin et al. reported that 52% of patients preferred a passive role in treatment decisions [14]. However, in our study, most patients sought detailed information, irrespective of their educational or socioeconomic status, although younger and more educated patients were slightly more inclined to actively participate.

Despite the desire for knowledge, 94% of patients in our cohort ultimately preferred physician-driven decisions. Factors contributing to this included low confidence, limited consultation time, and social inhibitions [13]. Proper communication training for physicians, as suggested by Back and Arnold, could improve information delivery and address patients' emotional and informational needs [10]. Failing to provide adequate information may result in dissatisfaction, non-compliance, and poor outcomes [11].

In advanced cancer, improving QOL takes precedence over traditional survival endpoints. Palliative radiotherapy effectively manages pain, reduces analgesic use, and mitigates associated side effects, contributing to better overall QOL [15]. Our study demonstrated significant improvements in pain (p = 0.00), fatigue (p = 0.00), physical functioning (p = 0.00), and role functioning (p = 0.00) after palliative radiotherapy. Similar findings by Zeng et al. corroborate that radiotherapy improves both pain symptoms and QOL in patients with bone metastases [15].

Validated tools, such as the European Organization for Research and Treatment of Cancer questionnaire, facilitate reliable QOL assessments. Patients experiencing pain relief from palliative radiotherapy report better outcomes in symptom and functional domains, reaffirming its role as a standard of care for symptomatic relief. Our findings emphasize the importance of integrating symptom management into routine cancer care to improve patient QOL.

Patients diagnosed with cancer expressed a strong desire to be fully informed about their diagnosis, including the type of cancer and the various treatment options available to them. This need for information was consistent across all groups, regardless of age, educational background, socioeconomic status, or prognosis.  Among patients with metastatic cancers, pain was the most common presenting symptom. Palliative radiotherapy not only provided significant pain relief but also resulted in a marked improvement in their overall quality of life, highlighting its vital role in symptom management and enhancing patient comfort.

Ethical Clearance: Ethical Clearance Certificate was obtained from the Institutional Ethics Committee (IEC) prior to commencement of study

Conflict of Interest: Nil - No conflict of interest

Source of funding: Self

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