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01-08-2018 | Original Article

Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?—a before/after study

Authors: Derek S. Tsang, Jennifer M. Jones, Osai Samadi, Suhayb Shah, Nicholas Mitsakakis, Charles N. Catton, William Jeon, Joshua To, Henriette Breunis, Shabbir M. H. Alibhai

Published in: Supportive Care in Cancer | Issue 8/2018

Abstract

Purpose

To evaluate the ability of a multimodal patient education initiative to improve adherence to healthy bone behaviors (HBBs) in men with prostate cancer receiving androgen deprivation therapy (ADT).

Methods

This was a pilot prospective, single-site, before-and-after clinical trial. The control arm (n = 51) received routine care. The intervention arm (n = 52) received multimodal HBB education which included a healthy bones prescription (BoneRx), focused face-to-face education with an oncology nurse or physician, and customized educational materials. The primary endpoints were feasibility of study methods and self-reported adherence to HBBs (vitamin D intake ≥ 1000 IU/day, calcium intake 1000–1500 mg/day, and exercise ≥ 150 min/week) at 3-month follow-up. Secondary endpoints included receipt of bone mineral density (BMD) testing.

Results

Patients were satisfied with the study intervention, found educational materials easy to understand, and felt that it increased their knowledge about osteoporosis. Although the intervention appeared to be associated with trends toward improved levels of vitamin D intake (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 0.74–4.5), calcium intake (OR 1.5, 95% CI 0.63–3.4), and exercise (OR 1.7, 0.75–3.9) as compared to the control arm, none of these were statistically significant. Patients who received the study intervention were more likely to receive BMD testing (OR 3.3, 95% CI 1.3–8.8).

Conclusions

Although a brief, tailored educational intervention was feasible to implement and improve BMD test utilization, it did not increase HBB participation. Larger, well-designed trials are needed to clarify the effect of patient education interventions on HBB adherence.

Trial registration

ClinicalTrials.gov (NCT01973673)

Available only for authorised users

Mohler JL, Armstrong AJ, Bahnson RR, Boston B, Busby JE, D'Amico AV, Eastham JA (2012) NCCN clinical practice guidelines in oncology: prostate cancer. vol Book, Whole. National Comprehensive Cancer Network,

Schulman CC, Irani J, Morote J, Schalken JA, Montorsi F, Chlosta PL, Heidenreich A (2010) Androgen-deprivation therapy in prostate cancer: a European expert panel review. Eur Urol Suppl 9(7):675–691CrossRef

Lattouf JB, Saad F (2010) Bone complications of androgen deprivation therapy: screening, prevention, and treatment. Curr Opin Urol 20(3):247–252. https://doi.org/10.1097/MOU.0b013e32833835be CrossRefPubMed

Ross RW, Small EJ (2002) Osteoporosis in men treated with androgen deprivation therapy for prostate cancer. J Urol 167(5):1952–1956CrossRefPubMed

Tsang DS, Alibhai SM (2014) Bone health care for patients with prostate cancer receiving androgen deprivation therapy. Hosp Pract (1995) 42(2):89–102. https://doi.org/10.3810/hp.2014.04.1107 CrossRef

Alibhai SM, Mohamedali HZ, Gulamhusein H, Panju AH, Breunis H, Timilshina N, Fleshner N, Krahn MD, Naglie G, Tannock IF, Tomlinson G, Warde P, Duff Canning S, Cheung AM (2013) Changes in bone mineral density in men starting androgen deprivation therapy and the protective role of vitamin D. Osteoporos Int 24(10):2571–2579. https://doi.org/10.1007/s00198-013-2343-4 CrossRefPubMed

Shahinian VB, Kuo YF, Freeman JL, Goodwin JS (2005) Risk of fracture after androgen deprivation for prostate cancer. N Engl J Med 352(2):154–164. https://doi.org/10.1056/NEJMoa041943 CrossRefPubMed

Krupski TL, Foley KA, Baser O, Long S, Macarios D, Litwin MS (2007) Health care cost associated with prostate cancer, androgen deprivation therapy and bone complications. J Urol 178(4 Pt 1):1423–1428. https://doi.org/10.1016/j.juro.2007.05.135 CrossRefPubMed

Oefelein MG, Ricchiuti V, Conrad W, Resnick MI (2002) Skeletal fractures negatively correlate with overall survival in men with prostate cancer. J Urol 168(3):1005–1007. https://doi.org/10.1097/01.ju.0000024395.86788.cc CrossRefPubMed

10.

Chahin R, Gulamhusein H, Breunis H, Alibhai SM (2016) Quality of care provided to prostate cancer (PC) patients for prevention and treatment of osteoporosis induced by androgen deprivation therapy (ADT). Support Care Cancer 24(11):4713–4720. https://doi.org/10.1007/s00520-016-3320-1 CrossRefPubMed

11.

Nadler M, Alibhai S, Catton P, Catton C, To MJ, Jones JM (2013) Osteoporosis knowledge, health beliefs, and healthy bone behaviours in patients on androgen-deprivation therapy (ADT) for prostate cancer. BJU Int 111(8):1301–1309. https://doi.org/10.1111/j.1464-410X.2012.11777.x CrossRefPubMed

12.

Panju AH, Breunis H, Cheung AM, Leach M, Fleshner N, Warde P, Duff-Canning S, Krahn M, Naglie G, Tannock I, Tomlinson G, Alibhai SM (2009) Management of decreased bone mineral density in men starting androgen-deprivation therapy for prostate cancer. BJU Int 103(6):753–757. https://doi.org/10.1111/j.1464-410X.2008.08156.x CrossRefPubMed

13.

Satia JA, Walsh JF, Pruthi RS (2009) Health behavior changes in white and African American prostate cancer survivors. Cancer Nurs 32(2):107–117. https://doi.org/10.1097/NCC.0b013e3181982d4c CrossRefPubMedPubMedCentral

14.

Yee EF, White RE, Murata GH, Handanos C, Hoffman RM (2007) Osteoporosis management in prostate cancer patients treated with androgen deprivation therapy. J Gen Intern Med 22(9):1305–1310. https://doi.org/10.1007/s11606-007-0291-4 CrossRefPubMedPubMedCentral

15.

Alibhai SM, Yun L, Cheung AM, Paszat L (2012) Screening for osteoporosis in men receiving androgen deprivation therapy. JAMA 307(3):255–256. https://doi.org/10.1001/jama.2011.2022 CrossRefPubMed

16.

Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E (2000) Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 88(3):674–684CrossRefPubMed

17.

Demark-Wahnefried W, Pinto BM, Gritz ER (2006) Promoting health and physical function among cancer survivors: potential for prevention and questions that remain. J Clin Oncol 24(32):5125–5131. https://doi.org/10.1200/JCO.2006.06.6175 CrossRefPubMed

18.

Hillen MA, de Haes HC, Smets EM (2011) Cancer patients’ trust in their physician—a review. Psycho-Oncology 20(3):227–241. https://doi.org/10.1002/pon.1745 CrossRefPubMed

19.

Sapir R, Catane R, Kaufman B, Isacson R, Segal A, Wein S, Cherny NI (2000) Cancer patient expectations of and communication with oncologists and oncology nurses: the experience of an integrated oncology and palliative care service. Support Care Cancer 8(6):458–463CrossRefPubMed

20.

Hung A, Hamidi M, Riazantseva E, Thompson L, Tile L, Tomlinson G, Stewart B, Cheung AM (2011) Validation of a calcium assessment tool in postmenopausal Canadian women. Maturitas 69(2):168–172. https://doi.org/10.1016/j.maturitas.2011.02.016 CrossRefPubMed

21.

Godin G, Shephard RJ (1997) Godin Leisure-Time Exercise Questionnaire. Med Sci Sports Exerc 29(6):S36–S38

22.

Amireault S, Godin G, Lacombe J, Sabiston CM (2015) The use of the Godin-Shephard Leisure-Time Physical Activity Questionnaire in oncology research: a systematic review. BMC Med Res Methodol 15:60. https://doi.org/10.1186/s12874-015-0045-7 CrossRefPubMedPubMedCentral

23.

Ailinger RL, Lasus H, Braun MA (2003) Revision of the facts on osteoporosis quiz. Nurs Res 52(3):198–201CrossRefPubMed

24.

Gaines JM, Marx KA, Narrett M, Caudill J, Landsman J, Parrish JM (2011) Validation of the male osteoporosis knowledge quiz. Am J Mens Health 5(1):78–83. https://doi.org/10.1177/1557988310363816 CrossRefPubMed

25.

Kim KK, Horan ML, Gendler P, Patel MK (1991) Development and evaluation of the Osteoporosis Health Belief Scale. Res Nurs Health 14(2):155–163CrossRefPubMed

26.

Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, D'Angelo ME, Wells GA (2003) Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21(9):1653–1659. https://doi.org/10.1200/JCO.2003.09.534 CrossRefPubMed

27.

Santa Mina D, Ritvo P, Segal R, Culos-Reed N, Alibhai SMH (2010) Exercise after prostate cancer diagnosis. In: Saxton J, Daley A (eds) Exercise and cancer survivorship. Springer New York, New York, pp 113–139. https://doi.org/10.1007/978-1-4419-1173-5_7 CrossRef

28.

Baumann FT, Zopf EM, Bloch W (2012) Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials. Support Care Cancer 20(2):221–233. https://doi.org/10.1007/s00520-011-1271-0 CrossRefPubMed

29.

Demark-Wahnefried W, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, Cohen HJ (2006) Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. J Clin Oncol 24(21):3465–3473. https://doi.org/10.1200/JCO.2006.05.7224 CrossRefPubMedPubMedCentral

30.

Demark-Wahnefried W, Clipp EC, Lipkus IM, Lobach D, Snyder DC, Sloane R, Peterson B, Macri JM, Rock CL, McBride CM, Kraus WE (2007) Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. J Clin Oncol 25(19):2709–2718. https://doi.org/10.1200/JCO.2007.10.7094 CrossRefPubMed

31.

Bauer DC (2013) Clinical practice. Calcium supplements and fracture prevention. N Engl J Med 369(16):1537–1543. https://doi.org/10.1056/NEJMcp1210380 CrossRefPubMedPubMedCentral

32.

Nadler M, Alibhai S, Catton P, Catton C, Jones J (2014) The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study. Support Care Cancer 22(9):2409–2415. https://doi.org/10.1007/s00520-014-2183-6 CrossRefPubMed

33.

Lebret T, Coloby P, Descotes JL, Droupy S, Geraud M, Tombal B (2010) Educational tool-kit on diet and exercise: survey of prostate cancer patients about to receive androgen deprivation therapy. Urology 76(6):1434–1439. https://doi.org/10.1016/j.urology.2010.07.483 CrossRefPubMed

34.

Soeyonggo T, Warde P, Fleshner N, Timilshina N, Alibhai SM (2012) Information needs of men on androgen deprivation therapy. BJU Int 109(10):1503–1509. https://doi.org/10.1111/j.1464-410X.2011.10475.x CrossRefPubMed

35.

Davison BJ, Wiens K, Cushing M (2012) Promoting calcium and vitamin D intake to reduce the risk of osteoporosis in men on androgen deprivation therapy for recurrent prostate cancer. Support Care Cancer 20(10):2287–2294. https://doi.org/10.1007/s00520-011-1331-5 CrossRefPubMed

36.

Lassemillante AM, Skinner TL, Hooper JD, Prins JB, Wright OR (2015) Osteoporosis-related health behaviors in men with prostate cancer and survivors: exploring osteoporosis knowledge, health beliefs, and self-efficacy. Am J Men’s Health

37.

Morfeld J-C, Vennedey V, Müller D, Pieper D, Stock S (2017) Patient education in osteoporosis prevention: a systematic review focusing on methodological quality of randomised controlled trials. Osteoporos Int 28:1–25. https://doi.org/10.1007/s00198-017-3946-y CrossRef

38.

O'Neill RF, Haseen F, Murray LJ, O'Sullivan JM, Cantwell MM (2015) A randomised controlled trial to evaluate the efficacy of a 6-month dietary and physical activity intervention for patients receiving androgen deprivation therapy for prostate cancer. J Cancer Surviv 9(3):431–440. https://doi.org/10.1007/s11764-014-0417-8 CrossRefPubMed

Title: Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?—a before/after study
Authors: Derek S. Tsang
Jennifer M. Jones
Osai Samadi
Suhayb Shah
Nicholas Mitsakakis
Charles N. Catton
William Jeon
Joshua To
Henriette Breunis
Shabbir M. H. Alibhai
Publication date: 01-08-2018
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 8/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4150-0

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Results

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