Research Article| Volume 45, ISSUE 7, P1146-1152, May 2009

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The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for patients with Bone Metastases: The EORTC QLQ-BM22

Published:December 19, 2008DOI:



      The aim of this study was to develop a bone metastases module to supplement the European Organisation for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) or the EORTC QLQ-C15-PAL for patients with bone metastases.


      Phases 1–2 of module development were conducted in Canada, Australia and Germany according to EORTC QOL group guidelines. Phase 3 was conducted in nine countries in seven languages.


      Sixty-one health-related quality of life (HRQOL) issues were generated from health care professionals (n = 152) and patients (n = 413). This resulted in a 22-item provisional module. Further testing in 170 patients from nine countries resulted in the EORTC QLQ-BM22 module, containing 22 items, conceptualised into both symptom scales, with five painful sites and three pain characteristics, and also functional scales, with eight functional interference and six psychosocial aspects.


      This study provides a provisional comprehensive HRQOL measurement tool for future trials, which will continue to undergo further validation.


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      1. Pain palliation of bone metastases – overview. InSightec Image Guided Treatment Ltd. 1st April 2005 <>.

        • Heider U.
        • Fleissner C.
        • Zavrski I.
        • et al.
        Bone markers in multiple myeloma.
        Eur J Cancer. 2006; 42: 1544-1553
        • Body J.
        • Diel I.J.
        • Bell R.
        • et al.
        Oral ibandronate improves bone pain and preserves quality of life in patients with skeletal metastases due to breast cancer.
        Pain. 2004; 111: 306-312
        • Cresswell S.M.
        • English P.J.
        • Hall R.R.
        • Roberts J.T.
        • Marsh M.M.
        Pain relief and quality-of-life assessment following intravenous and oral clodronate in hormone-escaped metastatic prostate cancer.
        Brit J Urol. 1995; 76: 360-365
        • Diel I.J.
        • Body J.J.
        • Lichinitser M.R.
        • et al.
        Improved quality of life after long-term treatment with the bisphosphonate ibandronate in patients with metastatic bone disease due to breast cancer.
        Eur J Cancer. 2004; 40: 1704-1712
        • Ernst D.S.
        • Tannock I.F.
        • Winquist E.W.
        • et al.
        Randomized, double-blind, controlled trial of mitoxantrone/prednisone and clodronate versus mitoxantrone/prednisone and placebo in patients with hormone-refractory prostate cancer and pain.
        J Clin Oncol. 2003; 21: 3335-3342
        • Fernandez-Conde M.
        • Alcover J.
        • Aaron J.E.
        • Ordi J.
        • Carretero P.
        Skeletal response to clodronate in prostate cancer with bone metastases.
        Am J Clin Oncol. 1997; 20: 471-476
        • Kristensen B.
        • Ejlertsen B.
        • Groenvold M.
        • Hein S.
        • Loft H.
        • Mouridsen H.T.
        Oral clodronate in breast cancer patients with bone metastases: a randomized study.
        J Intern Med. 1999; 246: 67-74
        • Lipton A.
        • Theriault R.L.
        • Hortobagyi G.N.
        • et al.
        Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases.
        Cancer. 2000; 88: 1082-1090
        • Mancini I.
        • Dumon J.C.
        • Body J.J.
        Efficacy and safety of ibandronate in the treatment of opioid-resistant bone pain associated with metastatic bone disease: a pilot study.
        J Clin Oncol. 2004; 22: 3587-3592
        • Purohit O.P.
        • Anthony C.
        • Radstone C.R.
        • Owen J.
        • Coleman R.E.
        High-dose intravenous pamidronate for metastatic bone pain.
        Brit J Cancer. 1994; 70: 554-558
        • Saad F.
        • Gleason D.M.
        • Murray R.
        • et al.
        • Zoledronic Acid Prostate Cancer Study Group
        A randomized, placebo-controlled trial of zoledronic acid in patients with hormone-refractory metastatic prostate carcinoma.
        J Natl Cancer Inst. 2002; 94: 1458-1468
        • Van Holten-Verzantvoort A.T.
        • Hermans J.
        • Beex L.V.
        • et al.
        Does supportive pamidronate treatment prevent or delay the first manifestation of bone metastases in breast cancer patients?.
        Eur J Cancer. 1996; 32A: 450-454
        • Van Holten-Verzantvoort A.T.
        • Kroon H.M.
        • Bijvoet O.L.M.
        • et al.
        Palliative pamidronate treatment in patients with bone metastases from breast cancer.
        J Clin Oncol. 1993; 11: 491-498
        • Van Holten-Verzantvoort A.T.
        • Zwinderman A.H.
        • Aaronson N.K.
        • et al.
        The effect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer.
        Eur J Cancer. 1991; 27: 544-549
        • Wardley A.
        • Davidson N.
        • Barrett-Lee P.
        • et al.
        Zoledronic acid significantly improves pain scores and quality of life in breast cancer patients with bone metastases: a randomized, crossover study of community vs. hospital bisphosphonate administration.
        Brit J Cancer. 2005; 92: 1869-1876
        • World Health Organization
        WHO Basic Documents, Geneva, Switzerland1948
        • Soni M.K.
        • Cella D.
        Quality of life and symptom measures in oncology: an overview.
        Am J Manage Care. 2002; 8: S560-S573
        • Harrington K.D.
        Prophylactic management of impending fractures.
        in: Harrington K.D. Orthopedic management of metastatic bone disease. CV Mosby, 1988: 283-307
        • Aaronson N.K.
        • Ahmedzai S.
        • Bergman B.
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993; 85: 365-376
        • Sprangers M.A.
        • Cull A.
        • Bjordal K.
        • Groenvold M.
        • Aaronson N.K.
        The European Organization for Research and Treatment of Cancer. Approach to quality of life assessment: guidelines for developing questionnaire modules. EORTC Study Group on Quality of Life.
        Qual Life Res. 1993; 2: 287-295
      2. Blazeby J, Sprangers M, Cull A, et al. EORTC Quality of Life Group: guidelines for developing questionnaire modules. 3rd ed. revised. August 2002. <>.

        • Bottomley A.
        • Vachalec S.
        • Bjordal K.
        • et al.
        The development and utilization of the European Organisation for research and treatment of cancer quality of life group item bank.
        Eur J Cancer. 2002; 38: 1611-1614
        • Velikova G.
        • Weisb J.
        • Hjermstadc M.J.
        • et al.
        • On behalf of the EORTC Quality of Life Group
        The EORTC QLQ-HDC29: a supplementary module assessing the quality of life during and after high-dose chemotherapy and stem cell transplantation.
        Eur J Cancer. 2007; 43: 87-94