Perceptions around bone-modifying agent use in patients with bone metastases from breast and castration resistant prostate cancer: a patient survey

Abstract

Background Optimal use of bone-modifying agent (BMA) therapy in patients with bone metastases from breast and castrateresistant prostate cancer (CRPC) is evolving. Methods Patients receiving BMA for bone metastases from breast or CRPC were surveyed. Information was collected on patient and disease characteristics, BMA treatments and perceptions regarding BMA benefits and side effects. Interest in participation in trials of de-escalated BMA therapy was also gauged. Results Of 220 patients contacted, 172 eligible patients responded (response rate 78%). Median age was 67 (range: 21-91); 137 (80%) had breast cancer and 35 (20%) CRPC. Symptomatic skeletal events (SSEs) occurred prior to starting BMAs in 61% (84/137) of breast and 48% (17/35) of CRPC patients. Among breast cancer patients, 47, 33 and 13% received zoledronate, pamidronate and denosumab, respectively. Eighty-five percent (30/35) of CRPC patients received denosumab. De-escalation of therapy was more common among breast cancer patients. Although most patients correctly reported the goals of BMA therapy were to "help stop fractures" (62%) and "[improve] quality of life" (63%), 46.5% felt it prolonged survival and 54% felt it reduced bone progression. Most respondents (102/129, 79%) were comfortable with de-escalating to 6-monthly treatment after 2 years of BMA therapy. Patients considered the most important endpoints of de-escalation studies to be "stability of bone metastases" (45%), "quality of life" (22%) and "SSE rates" (14%). Conclusion Twelve weekly BMA was more common in breast than in prostate cancer. There remain misconceptions about the benefits of BMAs, highlighting potential gaps in patient education. Patients were interested in further BMA de-escalation after 2 years of prior BMA and provided study endpoints that were most important to them.

Treatment of bone metastases from solid tumors with bone-modifying agents: a web survey of Italian oncologists investigating patterns of practice drug prescription and prevention of side effects

“…The drug choice may depend on many criteria: direct and indirect costs, real or supposed risk of SREs or SSEs, risk of early disease progression and/or worsening of performance status or quality of life (QoL), comorbidities, risk of side effects, patient’s preferences, and life expectancy [ 10 , 16 , 17 , 19 , 20 , 23 – 25 , 27 , 30 – 32 ].…”

How has the field of metastatic breast cancer in bones evolved over the past 22 years?

“…Denosumab is a classic drug that targets the receptor activator of the NF-κβ ligand (RANKL) [57] . A retrospective study of 84 patients with MBCB found that most patients treated with denosumab benefited from fracture arrest, improved quality of life, and prolonged survival [58] . Others have mentioned that the use of denosumab is effective in reducing the probability of skeletal-related events, including disability and bone pain [52] , [53] .…”

The Rethinking Clinical Trials (REaCT) Program. A Canadian-Led Pragmatic Trials Program: Strategies for Integrating Knowledge Users into Trial Design

“…All of these surveys involved patients with breast cancer. Two surveys included patients with bone metastases, evaluating the use of bone-modifying agents (BMAs) accrued patients with breast cancer and castration resistant prostate cancer (CRPC) [61,68].…”

“…This occurred because of the increasing recognition that not all surveys required written consent and indeed the requirement for written consent could reduce the validity of study findings to reflect as broad a patient population as possible. Potential patients for surveys were often identified in the clinic (11/15), however in more recent surveys patients have also been identified and approached through their involvement in other studies [29,32] and pharmacy lists [50,68]. With the introduction of the MyChart function within the EPIC EMR patients are also now able to consent to being contacted about other studies [29,32].…”

“…With the introduction of the MyChart function within the EPIC EMR patients are also now able to consent to being contacted about other studies [29,32]. Previously while most studies would accrue patients through the physician at a clinic visit it is evident that more recent studies launched since March 2021 and COVID-19 restrictions on in-person visits to the clinic have used a combination of approaches including cold calling by study CRAs [29,32,68]. However, all eligible patients were approached and presented the survey by someone in their circle of care.…”