Educational strategies including pamphlets and recommendations from family physicians and support from a specialist can improve bone care in men with prostate cancer undergoing androgen deprivation therapy (ADT), according to a new study.
“ADT, which is widely used to treat prostate cancer, is associated with significant skeletal side effects,” wrote study authors led by Shabbir M. H. Alibhai, MD, of Toronto General Hospital in Canada. The treatment is associated with bone loss and an elevated risk of fractures, but bone mineral density (BMD) testing and calcium, vitamin D, and bisphosphonates remain underused.
The investigators conducted a study of 119 men (112 analyzed) undergoing ADT to test whether educational interventions might improve bone care. Results were published online ahead of print last month in Cancer.
Patients were randomized to one of three groups: one group received a bone health pamphlet and brief recommendations from a family physician (BHP+FP, 40 patients); one received the pamphlet and support from a bone healthcare coordinator (BHP+BHCC, 36 patients); and the third received usual care (36 patients).
The interventions did improve bone care over usual care. A total of 23 men in the BHP+FP (57.5%) group, 29 men in the BHP+BHCC (80.6%) group, and 13 men in the usual care (36.1%) arm underwent a BMD test within 6 months of randomization. The odds ratio (OR) for undergoing a BMD test in the BHP+FP group, when compared to the usual care group, was 2.70 (90% CI, 1.19–6.15); for the BHP+BHCC group, the OR was 8.00 (90% CI, 3.11–20.6).
The improvement from baseline of patients meeting the guideline-appropriate calcium intake was 15.6% higher in the BHP+FP arm than in the usual care arm (P = .0386). The BHP+BHCC group was also better, but not significantly so, at 5.6% over the usual care arm (P = .24). Neither intervention showed significantly better improvements in vitamin D intake.
“These are relatively low-risk, low-cost interventions,” the authors wrote. “Clinical and cost-effectiveness will need to be demonstrated on multiple outcomes, ones that are ideally of clinical importance to men with prostate cancer.” A randomized trial that examines their effect on fractures may not be feasible due to the need for very large sample sizes, so future trials may need to focus on men at high fracture risk and focus on BMD use, among other outcomes.
“If either or both strategies is/are shown to be clinically effective and cost-effective in improving BMD use and the prescription of bisphosphonates in men at high fracture risk, then knowledge translation efforts will be needed to implement these new models of care.”