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

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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)

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Acknowledgements

The authors thank Alya Mohmood (ELLICSR) for the administrative support to the study.

Funding

This work was supported by an ACURA (AbbVie – CARO Uro-Oncologic Radiation Award) grant and the Canadian Cancer Society Research Institute.

Author information

Authors and Affiliations

  1. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada

    Derek S. Tsang & Charles N. Catton

  2. Cancer Survivorship Program (ELLICSR), Princess Margaret Cancer Centre, University Health Network, 585 University Avenue, Toronto, Ontario, M5G 2C4, Canada

    Jennifer M. Jones, Suhayb Shah, William Jeon & Joshua To

  3. Department of Medicine, University Health Network and University of Toronto, 200 Elizabeth St., Toronto, Ontario, M5G 2C4, Canada

    Osai Samadi, Henriette Breunis & Shabbir M. H. Alibhai

  4. Biostatistics Research Unit, University Health Network; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada

    Nicholas Mitsakakis

  5. Toronto General Hospital, 14th Floor, Room EN14-214, 200 Elizabeth St., Toronto, ON, M5G 2C4, Canada

    Shabbir M. H. Alibhai

Authors
  1. Derek S. Tsang
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  10. Shabbir M. H. Alibhai
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Corresponding author

Correspondence to Shabbir M. H. Alibhai.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

DST and SMHA received an AbbVie – CARO Uro-Oncologic Radiation Award (ACURA) from the Canadian Association of Radiation Oncology (CARO) in support of this study. The funding organization was not involved in the study design; in the collection, analysis, or interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The other authors (JMJ, OS, SS, NM, CNC, WJ, JT, HB) have nothing to disclose.

Data-related statement

DST and SMHA have full control of all primary data and agreed to allow the journal to review the data if requested.

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Tsang, D.S., Jones, J.M., Samadi, O. et al. Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?—a before/after study. Support Care Cancer 26, 2861–2869 (2018). https://doi.org/10.1007/s00520-018-4150-0

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