973 Managing Primary Endocrine Treatment (PET) in Breast Cancer Patients: An Audit of Resource Utilisation and Risks

Aim Primary endocrine treatment (PET) is considered in patients with oestrogen receptor (ER) positive breast cancer who decline or are deemed unfit for surgery. This treatment can affect bone density resulting in osteoporosis and risk of fractures. With increasing demand on resources, our aim was to examine clinical practices in this vulnerable patient group, balancing risks whilst ensuring good patient selection for treatments. Method We reviewed patients who had PET for ER positive breast cancer from a single consultant database in a district general hospital in South Wales between May 2018 and March 2023. We examined use of bone density (DEXA) scans, bone protection medications, outcomes, and complications. Results 48 patients were included, aged 50-95 years (median 80) and male: female (1:47). All were ER positive, excepting 2 with limited prognosis empirically started on treatment. Reasons for PET included patient choice (15%), palliative treatment (8%), co-morbidities (65%), late stage (4%) and other (8%). There were 27 deaths (54%), with mean time from diagnosis to death 14 months (range 1-50 months). 5 patients (10%) had DEXA scan and 16 (33%) were on bone protection. 3 patients had fractures whilst on PET, likely due to pre-existing conditions. Conclusions The frail breast cancer patient population has limited life expectancy and should not be over-investigated unnecessarily. It could be debated as to how much benefit bone protection provides, given the low fracture rate. Further studies are required to determine benefits of empirical bone protection in PET patients.