Cancer, Exercise & Bone
Health
Beyond the Break Web Module
Kate Smith, BKin. (Hons), R.Kin.
Program Manager
Wellspring Cancer Support Foundation
(GTA)
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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!
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brittle
porous
weak
easily damaged
subject to fracture
calcium
mineralization
bone density
strength
T-score
= bone weakness and skeletal deformation
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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
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Lower peak bone density than normal
Not as low as osteoporosis
Can develop into osteoporosis
Bone fragility
Risk of fracture
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Hips
Spine
Wrist
Shoulder
• Asymptomatic
Osteoporosis
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Low bone mass
Deterioration of bone tissue
Range in severity
Bone fragility
Risk of fracture
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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
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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
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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
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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
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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
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Suppression of hormones
Tamoxifen (breast)
Arimidex (breast)
Aromatase inhibitor
(breast)
• LHRH (prostate)
• Anti-nauseates
• Steroids
• Bisphosphonates
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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
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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