Current management of treatment-induced bone loss in women with breast cancer treated in the United Kingdom

Abstract

New therapeutic options in breast cancer have improved survival but consequently increase the relevance of late complications. Ovarian suppression/ablation and aromatase inhibitors (AI) in the adjuvant setting have improved outcome, but have clinically important adverse effects on bone health. However, investigation and management of cancer treatment-induced bone loss (CTIBL) is poorly defined with no national guidance. In 2004, a questionnaire was sent to over 500 breast surgeons and oncologists who treat breast cancer within the United Kingdom. The questionnaire evaluated access to bone densitometry and specialist expertise as well as attitudes to investigation of CTIBL and anticipated changes in the use of AI for postmenopausal early breast cancer. A total of 354 completed questionnaires were received, 47 from clinicians not currently treating breast cancer. Of the 307 evaluable questionnaires, 164 (53%) were from breast surgeons, 112 (36%) from clinical oncologists and 31 (10%) from medical oncologists. Although most respondents recognised that CTIBL was the responsibility of the treating breast team, investigations for CTIBL are limited even though most had adequate access to bone densitometry; 98 (32%) had not requested a DXA scan in the last 6 months and 224 (73%) had requested fewer than five scans. In all, 235 (76%) were not routinely investigating patients on AI for bone loss. A total of 277 (90%) felt that their practice would benefit from national guidelines to manage these patients, and the majority (59%) had little or no confidence in interpreting DXA results and advising on treatment. This questionnaire has highlighted clear deficiencies in management of CTIBL in early breast cancer. The development of national guidelines for the management of these patients and educational initiatives for breast teams are urgently required.

Skeletal Manifestations of Treatment of Breast Cancer

“…About two-thirds of the oncologists did not address bone health in patients on an AI. Although, more than half of the oncologists agreed that it was their responsibility for treating bone health issues [89]. While goals of breast cancer therapy need to be acutely addressed, the long-term implication of cancer treatment, including bone health, must be taken into consideration in order to mitigate treatment toxicities.…”

Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial

“…For example, secondary osteopenia and osteoporosis, ie, bone loss that is not a direct result of aging but arises from cancer treatment, are major health problems for many breast cancer survivors. 3 However, no clinical guidelines for the management of cancer treatment-induced bone loss exist. 4 …”

Optimizing Bone Health and Minimizing Skeletal Morbidity in Men with Prostate Cancer

“…[86] In a global, phase III, double-blinded, placebo-controlled trial, 1,199 men with advanced prostate cancer previously treated with docetaxel were randomized to enzalutamide versus placebo in a 2:1 ratio. [87] The primary endpoint was OS. The study was stopped after a planned interim analysis at the time of 520 deaths.…”