Identifying osteoporosis risk early, in patients undergoing chemotherapy for lymphoma
Project description:
Lymphoma is the most common blood cancer and 6th most common cause of cancer in Australians. The majority of patients require combination chemotherapy to control, and in many cases, cure lymphoma. Osteoporotic fractures are a substantial cause of morbidity, disability, and mortality and early identification of increased fracture risk and comprehensive risk management can reduce these outcomes.
In this project, our multidisciplinary expert team are working towards formally establishing the baseline osteoporsis (OP) risk in Australian patients undergoing lymphoma therapy, determining the impact of lymphoma therapy on bone health in a local population, and providing an opportunity for early intervention via rapid access to a dedicated Metabolic Bone Clinic for formal management of patients with high fracture risk, to reduce their risk of fracture and associated morbidity / mortality in the longer term.
This patient-focused study commenced recruitment as an initial pilot in June 2022, with 6 patients recruited thus far. There is very high interest within our lymphoma patient cohort; with 6/7 eligible patients recruited over the first 6-8 weeks. Of the patients who have commenced detailed screening thus far, there is a high burden of pre-existing osteoporotic risk factors, which would not otherwise have been addressed, and these patients will now have upfront rapid access to specialist endocrinological management, with the aims of reducing osteoporotic fracture, the risk of which is likely increased by lymphoma therapy.
We anticipate that comprehensively assessing osteoporotic risk and developing a risk assessment tool for a larger population receiving high-dose glucocorticoids early in their lymphoma journey will have a significant impact. We have created rapid intervention pathways for high-risk patients by a multidisciplinary team, currently not part of standard lymphoma care guidelines. If feasible, this will be easily integrated in haematology services across Australia and internationally, with guideline development and risk assessment tools implemented. Ultimately, this strategy is likely to prevent osteoporotic fractures, a very common cause of significant morbidity and hospitalisation in the lymphoma population and occurring most often at least 12 months after therapy is complete.
Outcomes
Identifying osteoporosis risk early, in patients undergoing chemotherapy for lymphoma can lead to:
Identifying pre-existing osteoporotic risk factors
Providing rapid access to specialist endocrinological management
Reduction in osteoporotic fracture
Improved quality of life
Impact on the healthcare professional
This project will allow further growth into new areas intersecting with haematology, including bone health and endocrinology through multidisciplinary teamwork. Embedding this program within the Austin Health lymphoma clinic, and with the help of a coordinating lymphoma nurse, can lead to improved supportive care and survivorship for people impacted by lymphoma.
Impact on the healthcare institution
This project will enable Austin health to further develop leadership in the field of haematology survivorship research, through the active participation within the broader survivorship research community, and development of institutional expertise survivorship in lymphoma. It will enable a unique collaboration between specialty units, bringing together nursing, nuclear medicine scientists and physicians, endocrinologists and haematologists for the first time. It will also be cost effective as the development of a risk assessment tool will allow rationalisation of referrals to the metabolic bone clinic. It will strengthen referral patterns and prevent lengthy inpatient stays as a result of osteoporotic fractures.
Proposer
Clinical Haematology Department, Austin Health
145 Studley Road
Heidelberg, Victoria
Project contact person:
Dr Genevieve Douglas , Haematologist & Research Fellow
genevieve.douglas2@austin.org.au
Project team members:
A/Prof Eliza Hawkes (Medical Oncologist, Austin Health)
Dr Cherie Chiang (Endocrinologist, Austin Health)
A/Prof Sze-Ting Lee (Nuclear Medicine Physician, Austin Health)
Dr Kathryn Hackman (Endocrinologist, Alfred Health)
Dr Geoffrey Chong (Medical Oncologist, Austin Health)
Tania Cushion (Clinical Nurse Consultant, Austin Health)