A New Model for Bone Health Management in Postmenopausal Early Breast Cancer Patients Undergoing Adjuvant Endocrine...

Area of Science:

• Oncology
• Endocrinology
• Pharmacology

Background:

• Italian Drug Agency (AIFA) Determination n. 589 of 2015 (Note 79) mandates bisphosphonates or denosumab for primary fracture prevention in postmenopausal early breast cancer (EBC) patients on adjuvant endocrine therapy (ET).
• Adherence to the 2015 AIFA recommendation was notably low in 2019, necessitating a new bone health management strategy.
• The Predict & Prevent project aimed to address this gap by implementing a novel bone health management model.

Purpose of the Study:

• To increase the percentage of hormone receptor-positive (HR+) early breast cancer (EBC) patients receiving appropriate bone health management.
• To evaluate the effectiveness of a new bone health management model in improving adherence to bisphosphonate or denosumab treatment.
• To assess the impact of the model on key performance indicators (KPIs) related to bone health assessment and treatment initiation.

Main Methods:

• Implementation of a new bone health management model involving training for multidisciplinary teams and bone health specialists.
• Evaluation of two key performance indicators (KPIs): 1) rate of HR+ EBC patients assessed for bone health within 30 days of adjuvant ET start, and 2) rate of HR+ EBC patients receiving bisphosphonates or denosumab within 90 days of adjuvant ET start.
• Comparison of KPI rates at baseline (T0) and 12 months after project implementation (T3) across 10 participating Italian cancer centers.

Main Results:

• In 6 out of 9 reporting cancer centers, both KPI-1 and KPI-2 rates showed progressive increases from baseline (T0) to 12 months post-implementation (T3).
• In the remaining 3 cancer centers, where baseline rates for KPI-1 and KPI-2 were already high, these rates remained consistently high after 12 months.
• The observed improvements are attributed to the training of multidisciplinary teams and the implementation of the new bone health management model.

Conclusions:

• The new bone health management model demonstrated success in increasing the rates of bone health assessment and treatment with bisphosphonates or denosumab in HR+ EBC patients on adjuvant ET.
• The model led to improved adherence in six centers and maintained high adherence in three centers that already had robust baseline rates.
• Widespread adoption of this model is recommended to ensure adequate bone health management and reduce fracture rates in postmenopausal HR+ EBC patients undergoing adjuvant ET.