Transcript Lymphedema
Cancer, Exercise & Bone Health Beyond the Break Web Module Kate Smith, BKin. (Hons), R.Kin. Program Manager Wellspring Cancer Support Foundation (GTA) • • • • What is Osteoporosis and Osteopenia? Cancer types that have a higher risk of affecting bone health Cancers types that have hormone involvement Cancer treatments that affect bone health • HOW EXERCISE CAN HELP! • • • • • brittle porous weak easily damaged subject to fracture calcium mineralization bone density strength T-score = bone weakness and skeletal deformation • • • • • Less than normal peak density Not low enough to be osteoporosis Precursor to osteoporosis T-score between -1.0 and -2.5 SD Like osteoporosis, treatable not curable Osteopenia • • • • • Lower peak bone density than normal Not as low as osteoporosis Can develop into osteoporosis Bone fragility Risk of fracture • • • • Hips Spine Wrist Shoulder • Asymptomatic Osteoporosis • • • • • Low bone mass Deterioration of bone tissue Range in severity Bone fragility Risk of fracture • • • • Hips Spine Wrist Shoulder • Asymptomatic Cancer patients can experience side effects of diagnosis and treatment referred to as Secondary Osteoporosis or Secondary Osteopenia Bone Impacting Cancers • • • • • • • • • Osteosarcoma Chondrosarcoma Ewing Sarcoma Breast Cancer Lung Cancer Thyroid Cancer Kidney Cancer Prostate Cancer Multiple Myeloma Hormone Involved Cancers • Breast Cancer • Endocrine receptor positive • HER2 positive • Triple positive Bone Cancers Metastasizes to bone • • • • • Prostate Cancer Endometrial Cancer Uterine Cancer Ovarian Cancer Testicular Cancer • Osteosarcoma • most common bone cancer • develops in long bones • young adults <30 years • Chondrosarcoma • rare bone cancer • young adults • Ewing Sarcoma • develops in long bones • young adults and children AFFECT BONE INTEGRITY AND CELL PRODUCTION • Spread from primary site, not ‘bone cancer’ • To any bone in the body • Most common locations: • Spine • Pelvis • Ribs • Upper leg (femur) • Upper arm (humerus) • Skull • • • • Breast Cancer Estrogen protective effect on bone Decrease estrogen promotes bone loss Treatment modalities effect ovarian function = low estrogen levels Elicit early menopause in premenopausal women • • • • Prostate Cancer Testosterone protective effect on bone Hormone deprivation therapy = increased risk Treatment modalities effect testosterone production Early and late stage to stop or decrease risk of spread Surgery • Surgical resection of cancer tumour or hormone producing organ Radiation Therapy • Intense energy beams concentrated on location to kill cancer cells Chemotherapy • The treatment of disease by the use of cytotoxic chemicals and other drugs. Hormone Therapy • Hormone deprivation to impair cancer growth • Bone cancer • Limb salvaging or limb amputation • Removal of hormone producing organs • Orchiectomy • Ovarectomy • Hysterectomy • Calcium levels drop • Impair gonadal function • Lead to loss of serum estrogen • Effect bone turnover • Suppress bone marrow • Steroids • Anti-nauseants • Destroys bone tissue • Especially pelvic region • Damage to osteoblasts • Irradiation = increased osteoblasts • Deterioration bone quality and quantity • • • • Suppression of hormones Tamoxifen (breast) Arimidex (breast) Aromatase inhibitor (breast) • LHRH (prostate) • Anti-nauseates • Steroids • Bisphosphonates • • • • • • Increases muscle strength Increase core strength Fall prevention training Balance training Weight-bearing exercise Safe and Progressive stress on muscle to pull on bone to induce bone rebuild HOW IS CANCER DIFFERENT? • Fatigue • Falls & Fractures • Oxygen Saturation • Blood pressure/Heart Rate • Spinal Compression Fractures • Malignant Spinal Cord Compression • Hypercalcamia • Dowanger’s hump + breast cancer posture • • • • • • • • 30 week exercise program Individual assessment Specially trained health professional Experience in oncology Group environment Individualized program Program for cancer patients No cost to patient https://www.youtube.com/watch?v=f-d8Y6fbrQA http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/bone_mass_measure.asp http://www.naturalhealthadvisory.com/daily/osteoporosis-prevention-and-treatment/bone-density-chart-understandyour-bone-density-scores/ http://www.webmd.com/osteoporosis/tc/osteopenia-overview https://dianecasey56.wordpress.com/2013/10/28/what-exactly-is-osteoporosis-what-is-osteopenia/ http://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=34&ContentID=26578-1 http://www.womens-health-advice.com/osteoporosis/osteopenia.html http://www-rohan.sdsu.edu/~pcipart6/Bone/osteosarcoma.html http://www.emedicinehealth.com/bone_cancer/article_em.htm http://www.aboutcancer.com/hosp6.htm http://www.aboutcancer.com/hosp6.htm http://www.cancer.org/treatment/understandingyourdiagnosis/bonemetastasis/bone-metastasis-detailed-guide-toc http://www.webmd.com/breast-cancer/breast-cancer-and-osteoporosis?page=3 http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/Conditions_Behaviors/osteoporosis_prostate_cancer.as p#b http://www2.mdanderson.org/depts/oncolog/articles/10/3-mar/3-10-2.html http://yaletownnaturopathic.com/fasting-before-chemotherapy/ http://www.telegraph.co.uk/news/health/news/7985399/Thousands-of-cancer-patients-missing-out-onradiotherapy.html http://onlinelibrary.wiley.com/doi/10.1002/9781118453926.ch88/summary http://www.diseasesanddrugs.com/2014/07/hormonal-treatment-for-prostate-cancer.html http://www.medscape.org/viewarticle/444817_3 http://umm.edu/health/medical/reports/articles/osteoporosis https://nigelwayne.wordpress.com/ https://rickolddoc.wordpress.com/2013/12/13/treatment-of-osteoporosis-and-fragility-fractures/ http://www.cancerresearchuk.org/about-cancer/coping-with-cancer/coping-physically/spinal/what-spinal-cordcompression-is http://www.massagetherapy.com/articles/index.php/article_id/1260/Osteoporosis-and-Hyperkyphosis%3A-WhatDoes-Calcium-Have-to-Do-With-It Steele, J. CancerSmart Rehab Techniques in Oncology Course Notes Steele, J. CancerSmart Rehab Advanced Techniques in Oncology Course Notes Newcastle University ONC8002: Cancer Pathology Course Notes