Introduction Several types of cancers including those

Introduction Several types of cancers, including those originating in the breast, prostate, and lung, have a propensity to metastasize to the bones [1,2]. Bone metastases severely impair skeletal metabolism, and result in important clinical sequelae, such as excruciating chronic bone pain and the so-called skeletal-related events (SREs), such as pathologic fracture, spinal-cord compression, surgery to bone, radiotherapy to bone, hypercalcemia with a dramatic order ctap in quality of life and increased risk of death of the affected patients [2]. Moreover, different systemic oncologic treatments, including chemotherapy and endocrine therapy, further accelerate the natural process of bone loss, a phenomenon known as cancer treatment-induced bone loss (CITBL) [3,4]. This event, which is associated with an increased risk of fractures and worsening of prognosis, is observed for instance in breast cancer patients undergoing treatment with aromatase inhibitors, or in men with prostate cancer on androgen deprivation therapy [3,4]. Bone health, which includes the management of bone metastases and the treatment of CITBL, is a major concern in cancer patients. Several international guidelines/recommendations of major scientific societies (e.g. the American Society of Clinical Oncology [ASCO] and the National Comprehensive Cancer Network [NCCN]) have emphasized the importance of the maintenance of bone health, as an important component of comprehensive cancer care [5–10]. In particular, the use of bisphosphonates (BPs), potent inhibitors of bone resorption, to prevent, reduce, and delay cancer-related SREs and CITBL in cancer patients is supported by a general consensus [5–12], even if BP treatment is potentially associated with the onset of osteonecrosis of the jaw (ONJ) [5–10]. Although several guidelines for the treatment and management of cancer patients are now available, there is the perception of a wide gap between recommendations and actual clinical practice in Western Countries, including Italy [13–15]. However, to our knowledge, no survey of the oncologists\' approach to bone metastasis care in cancer patients has been conducted to date, while it appears highly advocated. In addition, it has been suggested that further education of healthcare professionals is necessary to improve the awareness of the importance of bone health management in cancer patients, and to optimize specific medical therapy in this setting [16,17]. The introduction of new therapies, such as BP treatment, and the publication of new evidence in this field may result in measures to increase the level of education and training of oncologists and therefore improve the standard of care. This goal can be achieved, in our opinion, only if a clear picture of real clinical practice becomes available.
Methods The recruitment of the oncologists was conducted by GfK Eurisko, the leading market research organization operating in Italy (http://www.gfk.com/gfk-eurisko/index.en.html).
Results
Discussion The results of this large survey, conducted in 170 oncology centers representative of all regions and clinical institutions in Italy, suggest that the current management of bone metastasis in cancer patients is still suboptimal. The recommendations from current clinical guidelines issued by Italian (AIOM) [8] and international (NCCN, ASCO, ESMO) [5,9,10] scientific societies are not completely followed by all specialists. It must be recognized that, like all observational surveys, the results of this study are likely to be an overestimation of actual clinical practice, and it cannot be ruled out that the understanding of each question may be different among participating clinicians. However, the questionnaire was tested by a group of experts before initiating the study, in order to limit this potential bias. In addition, the number of participating oncologists was high (approximately 10–15% of all Italian oncologists) and the participating clinicians had several years of experience in oncology practice; in our opinion, these factors could strengthen the validity of the results in reflecting current clinical practice.