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Caring for Bones During Cancer

Posted Aug 24 2008 1:49pm
ANNOUNCER: A major concern of many of those living with cancer is how to prevent their disease from spreading and causing further complications, particularly to their bones.

ROGER WALTZMAN, MD: Bone complications from cancer are varied. It usually implies that the cancer has spread to a bone and those complications can be pain, for sure or they can be fractures of the bone, and certainly that leads to pain, as well.

BOB SMITH, MD: In the instance of bone metastases, I think the three diseases that I think most about from that standpoint are patients with multiple myeloma, patients with advanced breast cancer and patients with prostate cancer.

ANNOUNCER: When patients first begin cancer treatment, one goal is to try and stop the spread of the disease to other parts of the body.

ROGER WALTZMAN, MD: Surgery, chemotherapy, radiation therapy, hormonal therapy, all these are used with curative intent for patients when they first present with a cancer to try to prevent it from recurring in any other part of the body.

ANNOUNCER: But some cancer treatments can actually contribute to bone loss.

HOPE RUGO, MD: When you have cancer and you get treated for that cancer, some of the medications can either hasten bone loss because of their own damage. So that kind of quick loss of bone means that you're at higher risk for osteoporosis, thinning of the bone, and for bone fractures, which can cause a lot of problems.

BOB SMITH, MD: Men with prostate cancer are at especially high risk of osteoporosis. Treatment of men with drugs that prevent testosterone production are more osteoporosis-causing than actually even treatment, say, with corticosteroids. So it's a major problem, and becoming a major problem in men with prostate cancer.

ANNOUNCER: When bone complications do happen, there are several treatment options available especially to manage the pain that usually occurs.

ROGER WALTZMAN, MD: One primary therapy is pain medication. So strong pain medications are used and should be used. There are radiation therapies that are used very effectively to control pain so what we call spot radiation therapy where it's just given to a small, isolated area where there might be involvement of a bone with cancer and that can be delivered usually over a couple of weeks as an outpatient.

And ultimately surgery is used if bones fracture and need to be stabilized for both safety's sake as well as for mobility.

ANNOUNCER: There are also medications called bisphosphonates which can help prevent further bone destruction.

ROGER WALTZMAN, MD: Bisphosphonates help prevent the bone resorbing cells from continuing to resorb bone and therefore weaken the bone and potentially cause fractures. The ones that we use typically these days are intravenous bisphosphonates and they're called Zometa and Aredia and they're given about every three to four weeks so not particularly often, over anywhere between 15 minutes for Zometa and a couple of hours for Aredia.

ANNOUNCER: As with many medications, there are some side effects with bisphosphonates.

HOPE RUGO, MD: What they do is they can cause a sort of muscle aching and fever syndrome that occurs just the 24 hours after the first infusion. And for most people, it doesn't happen again and it just lasts a few hours and usually if you take an anti-inflammatory medication, like for example, ibuprofen it's well controlled.

ROGER WALTZMAN, MD: There's short and long terms risks from the use of the drug. The most important one is probably kidney problems, so patients' kidney function needs to be checked before the drug is used each time to make certain that there has been no complication related to that.

ANNOUNCER: To help reduce the risk of bone complications, there are steps a cancer patient can take. First up is calcium intake.

HOPE RUGO, MD: Most adults are not taking in enough calcium from their diet for that to be their only source. So we really recommend that women and men who are in these situations take at least a 1000 mg of calcium a day; a gram is another way to describe that amount. On the other hand, we don't recommend that they take many grams of calcium, because then they can get complications like kidney stones, which are quite painful.

The second is to maintain exercise levels; that helps with bone density and it also helps with quality of life and ability to stand the treatment with better quality of life.

ROGER WALTZMAN, MD: It's important to keep your bones strong, because weakening of the bones can result in fractures for any reason at all, whether there's cancer in the bone or not and certainly a patient's ability to continue therapies is highly dependent on what their functional status is, what their ability is to get up and around and pursue treatment and be able to tolerate potential side effects of treatment.

ANNOUNCER: Despite the tendency of bone complications to arise, those with cancer can take a lead role in helping to protect themselves from the potentially debilitating effects.

ROGER WALTZMAN, MD: There's always something the patient can do. The most important thing really is being aware of symptoms. So being able to inform their doctor or nurse when there is a new bone pain, or something that seems more severe than it has been so we can investigate it quickly and try to stop the problem before it becomes more serious.

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