Incorporating Lifestyle Data of Breast Cancer Patients to Assess Bone Health and Improve Treatment

Breast cancer patients are at increased risk of fractures due to osteoporosis resulting from estrogen reduction caused by treatments, which significantly lowers Bone Mineral Density (BMD). To counteract it, the integration of non-pharmacological measures such as weight-bearing exercises and calcium and vitamin D supplements are recommended. However, the lack of data on the effects of increasing BMD and generic lifestyle advice complicates the design of individualized strategies. More research is needed to optimize specific treatments for bone health, the choice of pharmacological agents, and treatment duration, considering lifestyle, age, and chronic cancer-related symptoms.

To address these challenges, the exploratory study REBECCA-OST (Cancer-related osteopathy induced treatment) has been launched in Spain, conducted by the research team of INCLIVA Biomedical Research Institute and led by Dr Cristina Hernando, to evaluate the functional and emotional characteristics of patients during the first year of adjuvant endocrine therapy based on aromatase inhibitors.

This oral hormonal treatment, administered after localized disease treatment, aims to reduce and prevent the risk of relapse and is indicated for use over 5 to 10 years. However, one of its side effects is its negative impact on bone health, as it accelerates the process of osteopenia (a lesser degree of bone loss) and osteoporosis (greater bone weakness and fracture risk).

The first phase of this exploratory study on bone health in breast cancer patients involved recruiting and training patients in the use of tools necessary for data collection. Recruitment began in January 2023 and concluded in December of the same year. During this period, 92 patients were recruited, of which 10 revoked their consent, and 2 dropped out, remaining 80 active patients.

Patients attended their first visit to the medical oncology service at the Clinical University Hospital of Valencia, where they received detailed information about the REBECCA project and what their participation entailed. Those who decided to join the study signed the informed consent form and received appointments for their clinical exams, including a gynaecological visit, a blood test, and a bone mineral density test. They were also appointed for a workshop related to the project and given quality of life questionnaires.

One week after their initial medical visit, patients attended the project workshop led by the research nurse. This workshop, conducted weekly in groups of 2 to 5 patients, had several key objectives:

· Patients downloaded, installed, and tested the REBECCA mobile application.

· They received training on how to use the platform for data collection.

· They were provided with a smartwatch and instructed on its use.

· They returned the completed quality of life questionnaires.

The collaboration between the medical team, research nurses, and patients has been crucial for the success of this first phase of the study REBECCA-OST. This level of commitment and cooperation promises significant results in understanding and improving the management of bone health in breast cancer patients.