Standardized gynecologic consultation and bone surveillance in patients with breast cancer receiving hormone therapy

Long-term use of hormone therapy may increase the risks of endometrial cancer and osteoporosis in patients with breast cancer. To minimize these risks, breast surgeons should schedule early consultations with gynecologists and arrange bone mineral density (BMD) examinations. In this study, we used the plan-do-study-act (PDSA) methodology to enhance comprehensive care coordination with the gynecology department and promote early surveillance of bone loss in patients with breast cancer undergoing hormone therapy.

We conducted a workshop and implemented standardized interventions that included gynecologic consultations and BMD examinations. We tracked the rates of these interventions during sequential PDSA cycles in 2023 and compared them with baseline rates from 2020 to 2022. We also evaluated the adjustment rate of therapy in patients with osteoporosis after undergoing BMD examinations.

Before our interventions were implemented, the baseline 6-month rate of gynecologic consultations was 36%. This rate increased to 76.3% and 75% during PDSA cycles 1 and 2, respectively. Similarly, the rate of BMD examinations increased from 29.3 to 40% during PDSA cycle 1. Among patients who received a diagnosis of osteoporosis after a BMD examination, the rate of those who altered their hormone therapy increased from 11% before the PDSA cycles to 19% during the cycles.

Our standardized intervention successfully raises awareness among all practitioners and promotes comprehensive care for patients with breast cancer receiving hormone therapy. Future PDSA cycles should focus on developing implementation strategies aimed at enhancing electronic medical record systems to better identify patients at risk.