Oncology nurse specialists participating in a survey study identified a number of barriers to optimal management of bone health in their patients with cancer. The findings from this study were published in Supportive Care in Cancer.

Bone metastases are common in patients with advanced cancers of the breast and prostate, and also occur in the setting of some other solid tumors. Furthermore, bone lesions are present in most patients with multiple myeloma. In addition, cancer treatment-induced bone loss (eg, bone loss due to aromatase inhibitor therapy) also occurs frequently. Hence, the incidence of skeletal-related events is high in patients with cancer, and have been associated with quality of life and survival detriments. 

“With continuing improvements in cancer survival, the management of bone metastases and cancer treatment–induced bone loss is becoming increasingly important to improve outcomes and to reduce the burden on patients and healthcare provision,” the study authors noted.

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This cross-sectional observational survey study of oncology specialist nurses was conducted with the aim of providing a quantitative assessment of their awareness and knowledge of, and confidence and involvement in the management of bone health for their patients with cancer, as well as their perceptions of barriers to its optimal implementation. No remuneration was offered for study participation.

Links to the online survey were provided on the websites of numerous European oncology nursing associations, as well as nursing societies in Australia and New Zealand. The online survey was available in multiple languages and consisted of 39 multiple choice questions. The responses of those answering at least 1 survey question were included in the study.

Of the 283 nurse participants, approximately three-quarters identified increased calcium intake as an approach to bone loss prevention, although only approximately one-fourth correctly selected a reduction in alcohol intake as another measure to prevent bone loss. Approximately half of survey respondents acknowledged use of clinical practice guidelines for managing bone health in their patients with cancer, although more than 40% did not respond to questions regarding their use of these guidelines either in the setting of bone metastases or cancer treatment-induced bone loss. With respect to approaches to the latter, responses from less than half of participants were consistent with guideline recommendations from the European Society of Medical Oncology on the prevention of skeletal-related events.

Furthermore, only 40.0% of survey participants reported a high level of confidence in managing the bone health of their patients with bone metastases, 38.2% reported a high level of confidence in identifying patients at risk of fracture, and 36.3% reported a high level of confidence in their ability to prevent and manage adverse effects of bisphosphonates and denosumab, respectively.

Some of the barriers to optimal bone health management identified by oncology nurse participants included training, time, funding, and knowledge deficits.

The study authors noted that their results indicate “the need for new nursing education initiatives with a focus on bone health management.”


Drudge-Coates L, van Muilekom E, de la Torre-Montero JC, et al. Management of bone health in patients with cancer: a survey of specialist nurses [published online June 15, 2019]. Support Care Cancer. doi: 10.1007/s00520-019-04858-2