Use of bisphosphonates for the treatment of metastatic bone pain. A survey of palliative physicians in the UK.

A postal survey of palliative physicians in the UK conducted in 1999 demonstrated widespread use of bisphosphonates for treatment of bone metastases from a variety of tumour types. In the absence of clear guidelines, however, there was found to be wide variation in treatment regimes, and opinions about efficacy varied greatly between respondents. Pamidronate was the most popular choice of drug, but a number of respondents chose to use clodronate, often on the basis of cost saving. A high level of uncertainty about how to monitor side-effects and efficacy was revealed. As well as acute treatment of severe pain, a significant number of respondents reported treating patients prophylactically, and the majority thought that their use of bisphosphonates would increase over the next 2 years. The potential financial consequences of this are considered.