Promoting bone health management in women diagnosed with breast cancer: a pilot randomized controlled trial
This study investigates, in women diagnosed with breast cancer, the feasibility of evaluating the effects of educational material and its delivery method, on bone health management. The study results suggest educational material may improve rates of bone mineral density testing.
Educational materials improve bone mineral density (BMD) testing rates in high-risk patients, but the effect is unknown in women diagnosed with breast cancer. Methods of delivering educational materials may also affect testing rates. The purposes of this study were to determine the feasibility of the protocol and to pilot-test the effects of educational material and its delivery methods on BMD testing rates.
Pilot randomized controlled trial with block randomization. Fifty-four women (aged 65–75 and diagnosed with breast cancer ≥ 3 years ago (2010–2012) and not taking osteoporosis medication) were recruited from February to May 2016 and randomized to three groups: control without educational material, educational material delivered by postal mail, and educational material delivered by patient choice of postal mail, email, or text messaging. Outcome measures were primarily evaluated using self-report questionnaires.
The participation rate, defined as the proportion of eligible participants who consented to participate, was 39.1%. Primary outcome measure was obtained for 98% of the recruited women. During the 6-month follow-up period, BMD testing rates were significantly higher in the groups receiving educational materials by mail (26%, 95%CI = 10 to 49) and by patient choice (18%, 95%CI = 5 to 41), when compared with the control group (6%, 95%CI = 0.3 to 25). Educational material was associated with a 17% higher BMD testing rate.
The study protocol is feasible for a large-scale study. The educational material intervention is broadly accepted by the study participants with a promising positive effect on BMD testing rates.
KeywordsEducational material BMD testing rates Lifestyle Breast cancer Exercise Vitamin D Calcium Patient choice
Bone Mineral Density
Calcium Assessment Tool
Dual energy X-ray absorptiometry
Fracture risk assessment tool
Godin Leisure-Time Exercise Questionnaire
Randomized Controlled Trial
Vitamin D & Sun
The authors thank pharmacist Jin Qing Pan for reviewing medication dispensing records and the Centre of Excellence in Cancer Prevention, a partnership between the Canadian Cancer Society and the University of British Columbia’s School of Population and Public Health, for facilitating development of the educational material. The first author, Dr. Olivia L. Tseng, was financially supported by a Clinician Scholarship through the Department of Family Practice of University of British Columbia and a Roman M. Babicki Fellowship in Medical Research through the University of British Columbia.
This study was supported by Janus research Award from the College of Family Physicians Canada.
Compliance with ethical standards
This study has been approved by the University of British Columbia/BC Cancer Agency Ethics Board (H15-00849).
Conflicts of interest
- 1.Kanis JA on behave of the World Health Organizaiton Scientific Group (2007) Assessment of osteoporosis at the primary health care level. Technical Report. University of Sheffield, UKGoogle Scholar
- 12.Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, Hanley DA, Hodsman A, Jamal SA, Kaiser SM, Kvern B, Siminoski K, Leslie WD, for the Scientific Advisory Council of Osteoporosis Canada (2010) 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182:1864–1873CrossRefGoogle Scholar
- 14.Little EA, Eccles MP (2010) A systematic review of the effectiveness of interventions to improve post-fracture investigation and management of patients at risk of osteoporosis. Implement Sci 5Google Scholar
- 17.(2015) BC Cancer Agency Registry Data and Breast Cancer Outcomes Unit Data. In Agency BC (ed). British Columbia Cancer Agency [Publisher], Vancouver, BCGoogle Scholar
- 19.Godin G, Shephard R (1997) Godin leisure-time exercise questionnaire. Med Sci Sports Exerc 29:36–38Google Scholar
- 23.Levy Milne R, Forster-Coull L, Barr SI, British Columbia, Ministry of Health Services, Canada Health Canada, University of British Columbia, British Columbia Government EBook Collection (2004) British Columbia nutrition survey report on seniors' nutritional health. Ministry of Health services,, Victoria, B.C., pp 1 online resource (viii, 51 p)Google Scholar