Aromatase Inhibitors (AIs) are an important component of endocrine therapy in hormone receptor positive low-grade serous ovarian carcinoma and recurrent, metastatic, or high-risk uterine cancers. The risk of osteoporosis or fracture at 2 years on AI therapy ranges up to 15%.NCCN Task Force on bone health in cancer care has specific guidelines on recommended counseling and monitoring for patients on AI therapy.Despite these recommendations, compliance to bone health guidelines within the oncological community is questionable. A quality improvement (QI) project was designed to educate providers on current guidelines. The aim of this QI project was to assess provider compliance with the NCCN recommendations for AI therapy in the gynecologic oncology clinics, as well as patient-related outcomes before and after implementation of the QI initiative.

Patients 18 years or older initiated or continued on aromatase inhibitor therapy for the treatment of ovarian or endometrial cancer in the gynecologic oncology clinic at Stephenson Cancer Center were included. A pre-intervention retrospective chart review of patients who met inclusion criteria was performed from July 2023 through December 2023. A QI initiative was implemented to educate providers on current guidelines via an in-person didactic presentation and assist with guideline compliance via posting of checklists and electronic medical record documentation dot phrases. A post-intervention retrospective chart review was then performed beginning February 2024. Descriptive statistics to summarize the demographic and clinical characteristics of subjects. Chi-square and t-tests to make comparisons between groups.

From July 2023 through December 2023, 58 patients were included in the pre-interventional group. The median age was 60 and median duration of AI therapy was 20 months. From February 2024 through April 2024, 18 patients were included in the preliminary post-interventional group (planned analysis is 6 months). The median age was 61 and median duration of AI therapy was 22 months. Following the QI initiative implementation, preliminary data showed that documentation of recommended bone-health screening counseling increased from 46% to 61%. Provider compliance with ensuring baseline bone-density scans and labs were updated increased from 41% to 66% and 24% to 55%, respectively. More patients were noted to have normal vitamin D levels in the post-intervention group (44%) as compared to the pre-intervention group (22%).

While post-intervention sample size limits ability to perform statistical analysis, preliminary data shows a trend towards improvement in recommended counseling, ordering of baseline and interval bone density labs and imaging, and patient outcomes with implementation of our QI initiative.