OBJECTIVES: Since 2014, IRST Research Cancer Hospital (Meldola, Italy) has established the first outpatient clinic dedicated to bone health in the Romagna district. This service offers the best-tailored treatment to prevent cancer treatment-induced bone loss (CTIBL). A propensity-score matching (PSM) study was developed to assess the impact of the IRST organizational model on bone health.

METHODS: The nearest neighbor PSM method was used to match Emilia-Romagna region patients who underwent breast cancer surgery between 2014 and 2022 and were in oncological Follow-up in the Romagna district. The population was grouped into 1) patients under IRST care and 2) under other hospitals care (without a bone health dedicated clinic, i.e. the control group). The matching was based on age, in-situ/invasive cancer and type of early-stage treatment (endocrine treatment vs. chemotherapy). Logistic regression and Cox proportional-hazard models were used to identify the factors associated with bone care treatment initiation and relative timings, respectively.

RESULTS: A total of 8,021 patients were initially enrolled in the study. After the PSM, 3,112 patients were included in each of the two cohorts. Patients under IRST care resulted to be a 39% more likely to receive anti-osteoporotic therapies than the control group (OR: 1.39; 95%CI: 1.24-1.57). Among patients treated with anti-osteoporotic drugs, the initiation of treatment occurred one year earlier among IRST patients. We observed that patients with invasive tumors were 77% more likely to initiate bone therapy than those with in situ tumors (OR: 1.77; 95%CI: 1.24-2.58). As expected, the early beginning of bone health therapy was influenced by age (p<0.001) and neo-adjuvant chemotherapy treatment (p<0.001).

CONCLUSIONS: The IRST model demonstrates responsiveness to bone health needs in cancer patients. In the future, it would be desirable to extend the implementation of this organizational model in other contexts, also for establishing a CTIBL management integrated pathway in cancer patients.