title: Taking the lead: sharing best practice in intravenous bisphosphonate use in urological cancers.
abstract: OBJECTIVE
  Bisphosphonates relieve metastatic bone pain, prevent, reduce and delay skeletal morbidity in metastatic bone disease and are recommended in European guidelines but safety concerns, specifically renal dysfunction and osteonecrosis of the jaw, necessitate specific precautions when administered intravenously. Pan-European guidance for nurses at the forefront of patient-focussed cancer care is required to minimise patient risk.
  
  
  METHODS
  A panel of urology and oncology nurses from seven European countries collaborated to decide what constituted best practice for bisphosphonate administration when indicated for prevention of skeletal-related events in patients with advanced urological malignancies.
  
  
  RESULTS
  The panel agreed that urology, oncology, and home-care nurses who are at the forefront of patient-focussed care are well placed to ensure best practice is followed but across Europe nurses have insufficient training on bisphosphonate administration for urological cancers. Based on extensive clinical experience in administering bisphosphonates the panel propose best practice for identifying those patients who could benefit, for example those with bone pain or at risk of fracture, and for minimising risk of adverse events by checking renal function, adjusting dosing, ensuring adequate hydration, and regularly assessing dental health, as well as providing information and support.
  
  
  CONCLUSIONS
  Sharing this best practice across Europe could assist nurses who care for patients with urological cancers and bone metastases or indeed those caring for cancer patients in general, to take the lead, or at least be aware of what is the best practice that helps to ensure effective and safe IV bisphosphonates administration to patients under their care.
authors.affiliation: Aarhus University Hospital, Urology Department K, Denmark. benjense@skejby.rm.dk
authors.forename: Bente Thoft
authors.initials: BT
authors.lastname: Jensen
authors.forename: Pascale
authors.initials: P
authors.lastname: Dielenseger
authors.forename: Lawrence
authors.initials: L
authors.lastname: Drudge-Coates
authors.forename: Karen
authors.initials: K
authors.lastname: Flynn
authors.forename: Susanne
authors.initials: S
authors.lastname: Hieronymi
authors.forename: H A M
authors.initials: HA
authors.lastname: Erik van Muilekom
authors.forename: Ronny
authors.initials: R
authors.lastname: Pieters
authors.forename: Lisbeth Bjerregaard
authors.initials: LB
authors.lastname: Voss
mesh_terms: D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001859:Bone Neoplasms / Q000188:drug therapy / Q000451:nursing* / Q000556:secondary; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000451:nursing; D008297:Male; D017410:Practice Guidelines as Topic; D014571:Urologic Neoplasms / Q000451:nursing* / Q000473:pathology
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates