Cancer, Exercise & Bone Health Beyond the Break Web Module Kate Smith, BKin. (Hons), R.Kin. Program Manager Wellspring Cancer Support Foundation (GTA)

Osteoporosis, Cancer and Exercise 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!

Bone Density

Osteoporosis the ‘silent disease’ brittle porous weak easily damaged subject to fracture calcium mineralization bone density strength T-score = bone weakness and skeletal deformation

Osteopenia the ‘in between’ 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 vs. Osteoporosis 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 Low bone mass Deterioration of bone tissue Range in severity Bone fragility Risk of fracture Hips Spine Wrist Shoulder Asymptomatic

Cancer Type and Risk of Osteoporosis Cancer patients can experience side effects of diagnosis and treatment referred to as Secondary Osteoporosis or Secondary Osteopenia Hormone Involved Cancers Bone Impacting Cancers Osteosarcoma Chondrosarcoma Ewing Sarcoma Breast Cancer Lung Cancer Thyroid Cancer Kidney Cancer Prostate Cancer Multiple Myeloma Breast Cancer Endocrine receptor positive HER2 positive Triple positive Prostate Cancer Endometrial Cancer Uterine Cancer Ovarian Cancer Testicular Cancer Bone Cancers Metastasizes to bone

Bone Cancers (Osteosarcoma, Chondrosarcoma, Ewing Sarcoma) most common bone cancer develops in long bones young adults <30 years Chondrosarcoma rare bone cancer young adults Ewing Sarcoma young adults and children AFFECT BONE INTEGRITY AND CELL PRODUCTION

Bone Metastasis 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

Hormone Involved Cancers Breast Cancer Prostate 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 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

Cancer Treatment Effects on Osteoporosis Surgery Chemotherapy Surgical resection of cancer tumour or hormone producing organ The treatment of disease by the use of cytotoxic chemicals and other drugs. Radiation Therapy Hormone Therapy Intense energy beams concentrated on location to kill cancer cells Hormone deprivation to impair cancer growth

Surgery Bone cancer Removal of hormone producing organs Limb salvaging or limb amputation Removal of hormone producing organs Orchiectomy Ovarectomy Hysterectomy

Chemotherapy Calcium levels drop Impair gonadal function Lead to loss of serum estrogen Effect bone turnover Suppress bone marrow Steroids Anti-nauseants

Radiation Therapy Destroys bone tissue Damage to osteoblasts Especially pelvic region Damage to osteoblasts Irradiation = increased osteoblasts Deterioration bone quality and quantity

Hormone Therapy Suppression of hormones Tamoxifen (breast) Arimidex (breast) Aromatase inhibitor (breast) LHRH (prostate)

Medications Anti-nauseates Steroids Bisphosphonates

How Exercise Helps 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

Physical Concerns & Oncological Emergencies 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

Wellspring Cancer Exercise Program 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

Wellspring Cancer Exercise Program https://www.youtube.com/watch?v=f-d8Y6fbrQA

Questions?

References 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-understand-your-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.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.asp#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-on-radiotherapy.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-cord-compression-is http://www.massagetherapy.com/articles/index.php/article_id/1260/Osteoporosis-and-Hyperkyphosis%3A-What-Does-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