Exploratory Evaluation of the Functional/Emotional Life Characteristics During the First Year of Ongoing Endocrine Adjuvant Treatment With Aromatase Inhibitors in Breast Cancer Patients With Reduced Bone Mineral Density

Many breast cancer therapies cause decreases in bone mineral density (BMD), as a result of oestrogen deprivation, a well-established risk factor for osteopenia (OST), osteoporosis and bone fractures. That leads to breast cancer patients having reduced bone mass, leading to higher risk for bone osteoporosis-related fractures, compared with age-matched healthy women, necessitating routine bone health assessments after a diagnosis of breast cancer. Such treatments include adjuvant endocrine therapies (e.g., tamoxifen and aromatase inhibitors) commonly used for hormone receptor-positive breast cancers, the most common type of breast cancer.

Additionally, chemotherapy or ablation of ovarian function (either medically or surgically) can lead to premature menopause among younger women and further reduce BMD5. Despite the advances in the pharmacology managing cancer treatment-induced osteopenia, the long-term efficacy of drug effects is debatable6 and there are numerous concerns about rare (but significant) side-effects of anti-resorptive drugs, particularly bisphosphonates. Those challenges necessitate additional research for the optimal OST management as a chronic breast cancer comorbidity.

Thus, the elucidation of the precise onset and progress of OST in patients and its interaction with lifestyle and high risk behaviours are now receiving increased research attention, aiming at the identification of novel patient management strategies to alleviate the chronic effects of the condition.

In order to counter the important life-effects of OST in breast cancer patients, current disease management schemes propose the integration of non-pharmacologic measures to maintain (or improve) optimal bone health, such as weight-bearing exercises and calcium and vitamin D supplementation. However, the lack of objective RWD on the effects of increased BMD on lifestyle is a serious challenge for the design of pragmatic and individualized patient management strategies. Indeed, lifestyle advice for increased physical activity are usually generic, lacking disease-specific knowledge, probably affecting the efficacy of exercise interventions. Overall, further evidence is required to optimise antiresorptive treatments, the use and choice of pharmacological agents, the duration of treatment and the potential of interaction with ongoing endocrine treatment.

Thus, the study will conduct the longitudinal comparison of Functional and Emotional Life Indices in Breast Cancer patients exhibiting significant reduction of BMD up to 12 months of adjuvant treatment with aromatase inhibitors, compared against matched BCPs with mild reduction of BMD. The study will use RWD to assess the safety and the effectiveness of aromatase inhibitor adjuvant endocrine therapy, with regards to osteopenia symptomatology over time. The study will consider data from 3 routine clinical evaluations (study month 0, 6 and 12) for the objective evaluation of BMD loss, complemented with continuous REBECCA use for 12 months. The collected data will include: