Bone metastases: assessment, management and treatment options

Cancer cells from a primary tumour can spread to other parts of the body through the bloodstream or the lymphatic system. Bone metastases are common in multiple myeloma, where 70-80% of patients have bone metastases at diagnosis. They are also a common feature in solid tumours such as breast, lung, prostate, thyroid and renal carcinomas. The median survival in patients with bone metastases from breast cancer is 24 months; 20% of patients survive for 5 years or more. Pain is the most common symptom of bone metastases, which can often be severe and difficult to control. This article will discuss normal bone physiology and explain the changes that occur when cancer cells spread to bone. It will outline the signs and symptoms of bone metastases and discuss patient assessment, symptom management and treatment options, including different bisphosphonates. The physical and psychological impact of bone metastases should not be underestimated and nurses are well placed to improve the quality of life of patients.