PROs

Metastatic bone disease (MBD) affects roughly 280,000 individuals each year resulting in nearly 12,000 number of pathologic fractures [1, 2]. This leads to a significant source of pain and functional impairment in this patient population. Risk assessment scoring systems and surgical advancements have reduced impending fractures and likely improved the functional outcomes and pain in these patients over that period. However, there are questions as to which outcome measurement is valid, reliable, and responsive to use in this patient population and what measures are appropriate to use for research, clinical care, or both. MBD as a condition covers a wide range of symptoms not only focused on the orthopedic perspective of pain and function but also includes symptoms related to the progression of cancer, such as fatigue, sleep, anxiety, depression, cognitive decline, and many other physical, mental, and social declines [3, 4]. Outcomes measurement tools assessing these subjective reported symptoms and outcomes of patients with MBD have continued to evolve over the past number of decades [5–8]. This chapter will discuss how these assessment techniques have changed over time, provide education to the current tools available, and make recommendations for future studies and clinical implementations. We will also provide a discussion about the role of patient preference studies and how outcomes and preferences have become a driver for decision-making in clinical trials.