Improving Bone Health for Men with Prostate Cancer on Androgen Deprivation Therapy

Presentation Number: SUN 290
Date of Presentation: April 2nd, 2017

Ugis Gruntmanis*1, Jeong-hee Ku2 and Claus Roehrborn3
1UT Southwestern Medical Center, Dallas, TX, 2UCLA, Los Angeles, CA, 3University of Texas Southwestern, Dallas

Abstract

Overview:

Androgen deprivation therapy (ADT) for prostate cancer with Gonadotropin Releasing Hormone (GnRH) agonist, such as leuprolide, has been one of the mainstays of prostate cancer treatments. ADT is associated with accelerated bone loss and increased risk for fracture. Despite this, studies have shown that urologists often under-screen and under-treat prostate cancer patients on ADT for osteoporosis.

We initiated High Risk Osteoporosis Consult (HIROC) service to improve bone health among patients with at risk of developing osteoporosis.

Aim Statement:

To increase referral rate to HIROC clinic to 50% in order to improve early diagnosis and treatment of bone disease among patients with prostate cancer on ADT

Interventions

Two interventions were performed: implementation of EMR tool and provider education.

Best Practice Alert (BPA) in EPIC EMR system was created for leuprolide order that alerts provider to consider placing HIROC and/or adding ‘at risk for osteoporosis’ to patient’s problem list.

The BPA was launched and urology faculty and staff were educated about this BPA. A chart review done 9 months later revealed suboptimal HIROC referral rate (21%). This result was shared with urology department during subsequent meeting. Subsequently, RN staffs in urology clinic were educated about HIROC BPA.

Repeat chart review was performed 6 months after educational meeting.

Results

Referral rate to HIROC increased from 4% during pre-intervention period to 21% after BPA implementation alone, and to 44% after addition of inter-department meeting and further education of staff. More patients had bone density scan after these interventions (46%).

Data obtained from initial HIROC clinic visits shows high prevalence of vitamin D deficiency and bone disease in this population with more than 70% of patients having BMD suggesting osteopenia or osteoporosis at the time of referral. 60-70% of patients seen in HIROC clinic either were prescribed or had changes in types or dosages of calcium and/or vitamin D supplementations, and more than 50% of patients were either initiated or had plan to initiate antiresorptive medication in next clinic visit.

Revenue Enhancement /Cost Avoidance:

The estimated medical cost per closed hip fracture in males was between $22,601-$30,900. A study from California showed that implementing osteoporosis screening and treatment program for prostate cancer patient on ADT resulted in 70% reduction in hip fracture rate with absolute risk reduction of 2.3%. There will be estimated saving of $61,526 per 100 patients with prostate cancer on ADT who are recieving diagnosis and appropriate treatment.

Conclusions and Next Steps:

Our project confirms that prostate cancer patients on ADT are at high risk for osteoporosis. Simple interventions, such as medical staff education and best practice alerts, can be effective tools in improving osteoporosis screening and treatment.

 

Nothing to Disclose: UG, JHK, CR