Insights on Bone Health Awareness and Education from Cancer Patients at Risk for Skeletal-Related Events: Findings from a Patient-Centric Survey

November 2020 Vol 11, No 11
Katherine B. Carlson, PhD
Amgen Inc.
Kimberly Lowe, PhD
Amgen Inc.
Basia Bachmann
Amgen Inc.
Benoit Cadieux, PhD
Amgen Inc.
Darcy R. Flora, PhD
GRYT Health, Inc.
David C. Fuehrer
GRYT Health, Inc.
Guy Boike, MD
Karmanos Cancer Institute

Background: Cancer patients with bone metastasis or multiple myeloma (MM) are at increased risk for painful and irreversible bone complications known as skeletal- related events (SREs), which include bone fractures, spinal cord compression, and radiation or surgery to the bone.1,2 Bone-targeting agents (BTAs) such as zoledronic acid and denosumab reduce the risk and delay time to SREs. However, despite the significant morbidity and poor prognosis associated with SREs, only 50% to 70% of eligible patients receive BTAs as protective therapy.3,4

Objectives: To better understand patient awareness about cancer bone health and SRE treatment options, we conducted a patient-centric survey designed to identify (1) the source, type, and extent of bone health education received as part of supportive care, and (2) potential opportunities for improvement of cancer bone health education to enhance appropriate BTA use.

Methods: The BonE HeAlth EduCatiOn Needs Assessment (BEACON) study was an online survey conducted by GRYT Health, Inc. through unique direct-to-patient outreach enrolling consenting US adult cancer patients with self-reported bone metastasis from breast cancer (BrC), prostate cancer (PrC), or lung cancer (LC), or with MM. Survey categories included demographics, primary cancer diagnosis and treatments, extent and overall satisfaction with bone health education received (amount, source, mode, and timing relative to diagnosis), and use of a BTA. Patients received a $50 gift card for participation.

Results: The 125 patients who participated in this study had the following types of cancer: 74 (59%) BrC, 8 (6%) PrC, 7 (6%) LC, and 36 (29%) MM. Patients ranged in age from 26 to 79 years (mean of 48 years); 99 (79%) were female. Seventy-one (57%) had experienced at least 1 SRE (fracture: 32%; spinal cord compression: 22%; radiation to the bone: 38%; surgery to the bone: 19%); 92 (74%) were currently receiving a BTA. Awareness of cancer bone health and protection was low to moderate; on average, patients reported knowledge of 50% of educational messages related to bone health included in the survey and 54% of messages related to bone health protection. Sources of information most commonly reported were oncologists (n = 118, 94%), followed by nurse practitioners (n = 66, 53%) and registered nurses (n = 65, 52%). The same number of patients reported that they received information through a discussion with a healthcare provider (HCP) (n = 110, 88%) and would like to receive information from an HCP (n = 110, 88%), but discrepancies were seen in other modes of information sharing. For example, 49% of patients reported wanting printed information (handout, pamphlet), but only 18% reported having received printed materials. Overall, patient-reported satisfaction with bone health education indicated an unmet need, with 39 (31%) patients responding “not satisfied” or “slightly satisfied.” Dissatisfaction was higher for patients not currently treated with a BTA (39% [13/33] not/slightly satisfied) than for treated patients (28% [26/92] not/slightly satisfied).

Conclusions: In this study largely comprised of BrC and MM patients, notable gaps in cancer patient awareness about the risk of SRE and BTA treatment options suggest there is an important need for improved communication and education strategies on this topic.


  1. Coleman RE. Skeletal complications of malignancy. Cancer. 1997;80(8 Suppl):1588-1594.
  2. Dimopoulos M, Spencer A, Attal M, et al. Lenalidomide plus dexamethasone for relapsed or refractory multiple myeloma. N Engl J Med. 2007;357:2123-2132.
  3. Hernandez RK, Adhia A, Wade SW, et al. Prevalence of bone metastases and bone-targeting agent use among solid tumor patients in the United States. Clin Epidemiol. 2015;7:335-345.
  4. McGrath LJ, Overman RA, Reams D, et al. Use of bone-modifying agents among breast cancer patients with bone metastasis: evidence from oncology practices in the US. Clin Epidemiol. 2018;10:1349-1358.
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