Health professional awareness of treatment-related bone loss in prostate cancer.

Abstract

e15099 Background: Prostate cancer is the most common male cancer. Androgen deprivation therapy (ADT) is the mainstay of treatment for metastatic disease, and is increasingly used in radical therapy. Treatment with ADT causes bone mineral density (BMD) loss, and is a significant contributor to fracture risk. Therapy with bisphosphonates, raloxifen or denosumab can impact on BMD loss. Imaging with dual energy X-ray absorptiometry (DEXA) scanning is the gold standard for the quantification of BMD. Despite the growing body of evidence supporting BMD loss secondary to ADT a screening and management consensus has not been reached in the United Kingdom. Methods: A questionnaire based study was undertaken. The aims were to investigate current practice around bone health among health professionals treating men with ADT for prostate cancer. Results: Responses from 76 urologists, 49 clinical nurse specialists (CNS) and 48 medical oncologists (of which only 12 regularly treat prostate cancer) have been evaluated to date. Of all 137 treating clinicians 127 (93%) are treating at least 20% of their patients with ADT. In total 114 (83%) do not have local guidelines for the screening and management of BMD loss. Whilst 115 (84%) do have access to DEXA scanning, 95 (69%) have not ordered a DEXA scan in the past 6 months, and 95 (69%) are ‘not confident at all’ of interpreting DEXA scan results. When asked if responders would repeat an abnormal DEXA scan at a later date only 45 (33%) responded yes, 86 (63%) did not know. Understanding of the role of lifestyle advice and therapeutic intervention was poor. When asked whether national guidelines would benefit practice 119 (87%) responded yes. Conclusions: This study shows that understanding of the importance of screening for, and management of BMD loss was poor. Further education about this important complication of treatment is required.