Fig. 1

Patient 1 : A 57-year old woman who was diagnosed with breast cancer and developed bone metastases along with 2cm mediastinal and supraclavicular adenopathy 3 years after her initial diagnosis. She initially received treatment with docetaxel and cyclophosphamide adjuvant chemotherapy. The tumour is oestrogen receptor/progesterone receptor positive and HER-2 negative. She was on an adjuvant aromatase inhibitor at the time of her relapse. Her recurrence was noted by examination identifying the supraclavicular adenopathy. On further questioning, she admits to increasing mid-back (thoracic area) pain, which she rates as a 4 on a scale of 0 to 10*. The patient’s health is otherwise good (high performance status†) with no history of kidney disease and no significant comorbidities. Patient 2 : A 71-year-old man who was initially diagnosed with Gleason 8-10 prostate cancer 3 years ago. He is now castration-resistant and has developed bone metastases. His PSA level is ≥10. He is complaining of left hip pain when he walks and low back pain if he sits too long, which he rates as a 4 on a scale from 0–10*. The patient’s health is otherwise good (high performance status†) with no history of kidney disease and no significant comorbidities.

*Where 0 is no pain and 10 is worst pain imaginable; †Karnofsky performance status.

BPI, Brief Pain Inventory; HER-2, human epidermal growth factor-2; ONJ, osteonecrosis of the jaw; PSA prostate-specific antigen; SRE, skeletal-related event