bone health in focus breast cancer

7/30/2019 Bone Health in Focus Breast Cancer

1/28

A RepoRt About

Bs CCsImpC o Bos


2/28


3/28

1

the significAnce ofbone heAlth in pAtients

with bReAst cAnceR

todAys pAtient with cAnceR fAces A dAunting Amount of

infoRmAtion. soRting thRough it All And deciding whAts

impoRtAnt cAn be An immense chAllenge. And with so mAny

impoRtAnt issues to consideR, b hhmAy not be At

the top of A pAtients AgendA.

but bReAst cAnceR-RelAted bone diseAses Resulting fRom

the consequences of cAnceR tReAtment oR fRom metAstAses

to bone cAn Result in significAnt pAin And disAbility. studies

hAve Also shown A coRRelAtion between cAnceR-RelAted

bone diseAses And incReAsed Risk of moRtAlity.1 At the sAme

time, it is An undeR-Recognized issue thAt mAy not Receive

enough Attention fRom pAtients And sometimes even fRom

theiR heAlthcARe pRovideRs.

this RepoRt Aims to fill the educAtionAl gAp by illustRAting

the seRious consequences of cAnceR-RelAted bone diseAses,spuRRing impRoved communicAtion between pAtients with

bReAst cAnceR And theiR heAlthcARe pRovideRs, And inspiRing

Action to impRove bone heAlth in pAtients with cAnceR.

Bo HLH

in fOcus


4/28

2

bReAst cAnceR-RelAted bone diseAses include

two pRimARy conditions:

CC m-IuC Bo Loss (CIBL): b

ra ra ar ra, a araa r (Ai).

Bo msss: car a ara r rar r a

ra r a r. t r ar

a a r . t aa r a

a r a r r a, a a-

ra (sRe).

skeletal-related event (s) can ccur when

cancer ha read t the bne (etataized)

and weakened it. s include:

Paolocal fracur

Spnal cord comprsson

Nd for surry o bon

Radaon o bon

may a ar a a r

r r ra. Ar a ar, a ar

raa r a xr ar, ar, rra, a

. t a ar r ra r a a xa

a ra, r a r r aar rr

ar. br r a, a a a ar r a r

ar r r, a a ra a

r a a.


5/28

3

Amy(atient with breat cancer, diagned 2005)

My doctor mentioned something about it. I couldnt give you a whole lot of

information about what he said just because It was almost like he was speaking

a foreign language to me because I didnt understand any of it.

R ra ar a ar a

r r a, a r a aa a A

r a ary r ar . t

a r arr harr ira a

a a ar a a a a

a r -aa r aa ar, a r

aar a r a a a ar. t r r

harr ira sr, a - r ra a

ar, ar rr. fr r ra a harr ira

sry a y , a rr a 19 rr. t rr

a ra aar, r a, a ra a r a-ya

a ar ra a.

donnA(atient with breat cancer, diagned 2005)

No one wants cancer, but its a journey and an opportunity to learn about yourself.

I learned that its tough but doable.


6/28

4

cAnceR tReAtment-induced bone loss in pAtients

with non-metAstAtic bReAst cAnceR

Aja ra ra r ra ar a ra

ar rar ra ra a -r ra. i ra ar araa r (Ai), ar r r

ra y, a a ara a ra r

rar. b Ai a a ar ra-

(ctibl). s ra r aja ra ar Ai ar r 65

a ay a r r r-x , Ai ray a a a

rar r a rar.2

t ar, a a a a rar, r a ra r r

aa rar.3 i a a, a

a a rar.4 t Ara s ca o (Asco) r

r a a/r ra ra ar a

r rar a a a.5

ir ar ar, arr a a ra

a ra ra ra, a ar r

a a rar r ar-ra a.6 t ra ctibl

ra ar a ra ar,

ar ra ar a ara .7

DeSPite the SigNiiNe O tiBL, N PtieNtS with BReSt NeR

hve ReLtiveL LOw ONeRN BOt BONe LOSS De tO iS,8 ND wOLD

BeNeit RO ONgOiNg DiSSSiONS with theiR PhSiiNS ROND the

iPt O i tReteNt.

mr a -r (69 r) a -aa ra ar

r harr ira r aar a Ai ra a ,

a a (39 r) a r aar a r r

r r r a .8 i ra, a ajr (95 r)

r a r r r a -

aa ra ar Ai ra.8


7/28

5

the impAct of bReAst cAnceR tReAtment on bones

i ra ar, Ai ra a a ara ra

ra , r ra r rar.9 n- r

ra a ra ar r harr ira

r a r r r -aa a Ai ra.8

A, a ajr (63 r) rr a r a ar r a .8 i a

a ra, ary a ra ar r Ai ray a a

21 r ra r rar, ry r r , ar

-aa ra ar r Ai ray.10

OSt ONOLOgiStS (63 PeReNt) BeLieve theiR PtieNtS Re ONeRNeD

BOt tReteNt-ReLteD BONe LOSS.8 hOweveR, PtieNt-RePORteD

ONeRN Be LOweR thN the BeLieve. ONL 39 PeReNt O PtieNtS

RePORteD RkeD ONeRN BOt BONe LOSS De tO i theRP.8

frar a r a a r a a ar r

r.11 pa a ay r a rra rar a a r ra yar.12

ma aa (32 r) r a r rar

rr r r ay a r , a

(83 r) rr a a a.13

t harr ira sr r r a r q

rar. ma ra ra ar a rar

q ctibl:

t r aa a r (90 r)8

irr ar ra (55 r)8

ca ra r (51 r)8

t a ajr ra a ra ar a a

a a (92 r) a a a (89 r) a a r

a (90 r) ar rr a q

rar ctibl. t ar r rr (81 r) a

a r r raa a (77 r).8

i a a ra qa , a rar a a a

r r a ar a rar. fr xa, a ra

ra x--- a rra rar.14


8/28


9/28

7

bisphosphonAtes

A a a r a ,

ar aa ra a .19

d r a a , ar aaa ra

a ra, a a r a, r .

A ya (67 r) ar ray a rr ra

, a aa ra ar a. A ra ra

ar, harr ira sr a a a -r (29 r) r

a r r a ra r ctibl a a

ra ar.8

cAlcium And vitAmin d supplements

And lifestyle chAngesi a r ra, naa or fa r

-araa r r rar r r ra a.

t ra aqa a a a a d, rar

-ar a -r xr, ra r r a a

aa a a x a a.20

bone metAstAses: bone is A

common site foR metAstAsesin pAtients with bReAst cAnceRsx 75% a aa ra ar a a

aa r r r a.21 i r, ar

ra r rar r , r a r. t

r ar a a ry ar r a a r

a r r a a a-ra (sRe), ar

aa ra a, a a.1,22,23

the jORit O ONOLOgiStS Re ONeRNeD BOt theiR PtieNtS with

BReSt NeR DeveLOPiNg BONe etStSeS (82 PeReNt) ND SReS

(85 PeReNt). hOweveR, ONveRStiONS BOt the tReteNt O BONe

etStSeS Re NOt ReqeNt. ONL 34 PeReNt O PtieNtS RePORteD

DiSSSiNg tReteNt OPtiONS OR BONe etStSeS with theiR PhSiiN.8


10/28

8

b a r a ar a rr ar,24 a a

arxa 70 r a ar a ra .25 b

a a a a a aa a a a

ararz a r.26 i ra r a a ay -ra

r r a a a a a rr r aa ar r.

Ar r r harr ira ry, r a a (53 r)

ra ra ar ry a r a r aa,

a a , 46 r aa a 35 r a r x .8

far a a aa ra ar. h, a a

ra ar, a a harr ira r, b ar rr, a i

. ta a ay rr . i rr a

a. t rr r aa. t ar aa r...a i a ar

.

seRious consequences RequiRe

pRoActive communicAtion: bone metAstAses

And skeletAl-RelAted events

sr a a aa a r a a a a

. i a, -r a aa r ar

xr r a a a.27 tra a a r

sRe a ra ar aa aa a a

a ar a ya a a.

iLiRit with SkeLetL-ReLteD eveNtS iS veR LOw ONg PtieNtS

with BReSt NeR, t 30 PeReNt.8

t ajr a (66 r) xr r a rr

rar ar ra a sRe, ar

harr ira sr.8 hr, r ra ra

ra aa a a ra a a

a.8,28 t harr ira sr a ajr a

aa ra ar r (66 r) a aa

ra r a.8

tReAting bone metAstAses And skeletAl-RelAted

events in pAtients with bReAst cAnceR

pa ar r, a ra a

xr a sRe.6 sRe a a a q, a a

ra ar a rar a r r a


11/28


12/28

10

pAtients with bReAst cAnceRspeAk out About bone heAlth

he etinal cnequence f cancer can be difcult t anage. nd when cancer

ha etataized t bne, the etinal reercuin can increae exnentially.

diklA*Dla, 40, from Los nls, as rs danosd n 2002 sa

3 bras cancr. t danoss as upradd o yars lar o sa

4 n bon masass r clarly dn. Pet/t scans, cnabl pyscans o s umor, sod a sub-cnmr spc on

r t7 rbra (oracc spn). Bu a yar afr cmorapy and radaon, Dla

dlopd xcrucan bac pan. in 2004, anor Pet/t scan and bopsy found

a ron umor on r spn (r spc as rs found), c causd a

fracur and rand r spnal cord. Soon afr radaon ramns ban,

umor as rmod surcally. wl s sll as masass small bu sabl lsons

n r luns danosd n 2007 non ar prsn n r bons.

Dla as sn on oncolos unl 2007, n oncolos mod. No s

ss an oncolos and an nra oncolos** smulanously, bo a L andbo p abras of ac ors or. Dla says r pyscans ar accssbl; y

rspond o mals and ansr all r qusons.

Bon masass, or, r no dscussd n Dla as rs danosd, snc

r bon problms r no dscord mmdaly. Nrlss, s found ou abou

bon al ssus rou suppor roups. S says r rs oncolos ddn n

consdr a bon dnsy s; s ad o rqus on. t focus, Dla says, as on

bras cancr. t only on o brou up as nra oncolos. i sll

a o rmnd my rular oncolos o do scans.

Oncoloss prod ra car bu somms y ar so focusd on problm a

and a y may for abou accumulan donsram ffcs of cancr and

sd ffcs of ramn, s says.

s a slf-dscrbd pan acs s ors ou, as amn supplmns and

parcpas n suppor roups a L and onln Dla says s ould a ld

a pan adoca o ud r a ry bnnn a pon prson i could a

ald o. S says nurs naaors ar sarn o appar n ara bu s sll

spoy. Som clncs ar ood a prodn adocas, ors ar no. i rand myslf.

**L as a nr for inra Oncoloy.


13/28

11

lAuRAlee*Laural, o s 56 and ls n Sandusy, Oo, as sa 4 bras

cancr, rs danosd n 2002. S as ad sncan bon

masass n r rbra, dscord by a bon bopsy andmanc rsonanc man (Ri). Laural sa a local oncolos,

om s n (Laural s a nurs). t oncolos rcommndd an Nih (Naonal

insus of hal) proocol, c as ndorsd by a scond opnon. s a rsul,

s as rad an aromaas nbor.

hr pyscan prscrbd an iv bspospona o srnn bon and o lp

dmns masass. hr oncolos alays conducd rnal ss bfor ry

nfuson o ma sur r dnys r funconn ll. fr r and alf yars,

r pyscan rcommndd a Laural sop nfusons bcaus r bons ad

mprod, ou s ad o rsum bon loss ramn n la 2009, bcaus aDeX scan ndcad prsnc of osopna.

Laural s ry nold n Bras ancr Nor of Srn and as consuld

or 100 omn smlar condons. S rularly dscusss r condon

and plan of acon r oncolos, usually armd usons and

las scnc arcls. S bls nformaon and op ar sron mdcns.

i as old i ad a 9 prcn canc of surn my cancr and my docor sad

pan of s o surd lons sa 4 lasd 14 yars. Bu im plannn

o b r for my 50 ddn annrsary, jus l my parns and randparns.

*Pan smonals r collcd sparaly from harrs inrac Sury and ar no aflad harrs inrac.


14/28

12

Be OR OwN DvOte. DO OR ReSeRh ND LeRN LL O N.

get iNvOLveD with PtieNt DvO ORgNiztiONS. DONt Be RiD

tO Sk qeStiONS.

Role of effective communicAtion

A a a , a, ara a a

a a a ar ra . nr a a

a a r a, a a ra a

a a ra, r a q a ra

a .

infoRmAtion is AvAilAble

k r. t a r r a ra ar. s, a

a r aar, a a a a r

ra a. ira aaa a ra

r a a ra .

A a ra ar, R, , i a a a a

a r aaa. A, a, i r arra a r

a r a .

i a, a a ra ar r harr ira, a

a a ar r ra a a arr r

ar ra.8

pra rr aar r , ar a

a ra ar (40 r) ay a

ra.8 fr a ra a

, ir rar a r rr r ra ra

a (60 r), r (26 r).8

the suppoRt of fAmily And fRiends

A netwoRk of suppoRt

ha r a r a a r ra.

br a a a, r xa, r

a r, a a a ra a-; a

ar r, a, a rr a

a a a r.39


15/28

13

iN the hRRiS iNteRtive SRve, LOSt thRee-qRteRS O PtieNtS

with BReSt NeR (72 PeReNt) ReLieD ON RieNDS, ND 61 PeReNt ReLieD

ON theiR SPOSe OR SigNiiNt OtheR ON theiR Pth tO ReOveR.8

keep RecoRds

t r a aa a, a rar a

ra a r r r r aar

rr, r ra r r r r a

a.39 ta a a r ra ar

r r ra r rar. i ay a r a

a-rr r , r .

39

(may ay ar a a rr .) pa rr r a

ra aa r ar ay r r r.

Ar a r a rr ra a r a a

ra a a jra r . i a a ra

j a, , a a , r a

a, a .

speAk up

i a ra a r, a r ar. i

a a r a r ra r r, a a

r a. pa a a rq a a r - r

r .39


16/28

14

teAR-out foR youR neXt visit


17/28

15

Ask key questions

Here are e quetin atient with breat cancer ight ak their dctr

r nure abut their treatent and fllw-u39:

whAt ARe my tReAtment options?

whAt is the Recommended tReAtment? why?

how often will i Receive tReAtment?

whAt ARe the possible side effects?

whAt ARe the possible benefits And Risks

of this tReAtment?

if my doctoR is not AvAilAble, who cAn i Ask?

foR eXAmple, is A nuRse, sociAl woRkeR oR otheR

speciAlist AvAilAble?

is theRe Any infoRmAtion thAt i cAn ReAd About

this tReAtment oR pRoceduRe?

is theRe Anything else i should know?


18/28

16


19/28

17

RecommendAtions foReffective communicAtion

between cliniciAnsAnd pAtients

mAnAging communicAtions

s a r ar arra a a

r, a raa r ra . A a r,

a r r ra a r ra,

a a.

prr a ara a r ra a rar

-ar r a , ra a

r a a ar r a. w a r ar r

a r (r a a) ray, a ar a r,

r arr ra r a.

m r ra r a a, r

aa ara a rrr a a aa r r.

w r a ara, r r a a ra ar

rr.

n a r ar a a a a a. i a r

r, h, a a ra ar, a, [m r] a

a [a sRe] , a a a. m r a r

a. w a , a a

a ar a. s j a , xa.

tr ar a j a a , h a. s

ar a q, a aaa -a[] i r aa

a rar a r.

ma, a a arra ra q,

aa, a r . A a r a

r a a r, a i rr r a, i

a, r i a ra .


20/28

18

pAtients need to be theiR own best AdvocAte

ba rar a ra rr, ar a:

car-ra a ar a r r a ra a a

aa a a.

t a aa ra ar, ra, a a a

r a a ra r

pa a a a a , a

a a r ra. e a a ar a

a ra aaa , a a rrr r

ra a a arr ar ra r.

mr a r qa a a a r

a, a a a r a a ra r rra, a r r ra r.

t aa a a a ra a ra ar a

aar a r a a a ar , r

a ar ar ra .

t r aar y a ra a a ar-ra

a r a rr r ra . br

a a a a r r aar rr a. t r

ra a ra ar r a a r a ar . i a,

a, a, r r a r aa a a ra a r

aa a a r a r a a a

ar-ra a rr a ra .

the eetive tReteNt O NeR ReqiReS ONSiDeRBLe

eORt B the PtieNt ND PhSiiN. ORiNg StRONg PRtNeRShiP,

whih ShOLD LSO iNLDe iL, RieNDS, ONOLOg NRSeS, SOiLwORkeRS ND PtieNt SPPORt gROPS, iS NOt ONL heLPL Bt RiL

tO eetive DiSeSe NgeeNt ND tReteNt.


21/28

19

wr r r, a a a :

A aar ar a r r a

a ra a a ar r .

c a arra a. i r r

r , a ra.

ta xa ra ra a aa a

a aar rr a r rr a ra .

ma r ar q a r aar rr.

oa r ra a r r r a a

rr.

s a, a a raa r a a r

ar ra.

the following ResouRces cAn pRovide

A helpful stARt:

bra car nr sr (.rr.r)

cuRe (.ra.)

yrs 24/7 bra car sr cr (1-800-221-2141)

self-RepoRted pAtient suRvey methodologyt a ra ar ry a u sa

harr ira frar 17 a mar 8, 2010, a A

a arr bra car nr sr. R

212 a ra ar r rr r harr cr i pa.

bra ar aa a rra r a

a. A a r ara 10 .

self-RepoRted physiciAn suRvey methodology

A a r r harr ira frar 19 a

Ar 16, 2010, a A a arr bra car nr

sr. R 141 a . ma r

rr y a a Ara ma Aa (AmA) ar ya

, a a a r r harr pya pa.

A ya ry ara 10 . pya aa a

rra a r ya a.


22/28

20

definitions

skeletal-related event (s) a r ar a ra

(aa) a a . sRe :

pathlgical fracture: A rar r a a aa ar

a a a rqr rr. i a a r ar a a

a a.22

spinal crd cprein: i aa r ar rra

, xa r a rr a r. t a a

r a a ara, a .40

surgery t bne: i a a r rar r a ara rar, rr

rr aa r r rr a. w a

aa ar, rr a ajr ra, a rr a

a a rr aa.22,23

adiatin t the bne: Raa rr ra

aa a aa a.41 hr, raa ,

ra rr ar ara.

overall rvival rate: t r rr ra a r

ra r ar a r a ra r ar r a

r ra r a a. t ra ra ra a a a -ar

ra ra, ra a r ra r

ar a ar ar a r ra.42


23/28

21

RefeRences

1 y m, J A, Ja J, nraar m, fr J, sr h. t

aa a a-ra ra ar a: a a-a r

dar (19992007). car R 2009;69(24 s). Ara a r.

2 br Am. car ra- : a a a

r. ncologist. 2008;13:187-195.

3 kr cm, R pd, laa pm, A tA, brr m. pa rr

rar a a ra r r rar: a ar rar a

aa .J bone Miner Res. 2000;15:721-729.

4 naa or fa. fa a r. 2006:1-7.

5 hr be, i Jn, c Rt, a. Ara s ca o 2003

a r a a a ra

ar.J Clin ncol. 2003;21:4042-4057.6 paa pJ, sa od, gaa ec, a. Aa a a a

a aa a aa. rthopedics. 2006;29:609-622.

7 ma lb, g s. car-ra- , ar 1.m J ealth-Syst

Pharm. 2006;63:419-430.

8 harr ira b ha sr. daa . A i. J 27, 2010.

9 haj p, b JJ, Aar ms, a. praa a r aa araa

r-aa .nn ncol. 2008;19:1407-1416.

10 m bA, d ms, ta sk, a. R ar ra-aa a

rar a ra ar r araa r. Clin breast

Cancer. 2006;7:127-132.1 1 br R, da-h b, s dh, w Jb, k A, t A. i a

r r-ra rar u sa, 2002-2005.

J bone Miner Res. 2007;22:465-475.

12 R pd, da Jw, e Rs, wa Rd. pa a a aa

rra rar a r a .J Clin pidemiol. 1994;47:231-239.

13 f hA, er ke, n db, a. steoporos Int. 2003;14:69-76.

14 ca JA, t de, er kc, s Jc, ba d. R ra a

rar. steoporos Int. 2000;11:556-561.

15 ea R, Aa Je, ca Re, a. e aar ra :

5-ar r r Aar, tax, A r ca tra 18233230.

J Clin ncol. 2008;26:1051-1058.

16 t AtAc tra gr. Aar a r a ax r

ax a r aja ra aa ar-a ra

ar. Cancer. 2003;98:1802-1810.

17 l A. tar r: r a ra. ncologist. 2004;9

( 4):38-47.

18 bmd . naa or fa . ://..r/r/

.. A A 31, 2010.

19 za (r a) rr ra, nar.

20 ca g pr a tra or. naa or

fa . ://..r/ra//nof_cag2009_7..

A sr 19, 2010.


24/28

22

21 ca Re. sa a aa. Cancer. 1997;80():1588-1594.

22 ca l, baa X, c e, l A, wary A. ia a a a

ay , y, a a . Support Care Cancer. 2008;16:879-889.

23 wr kp, Ar kJ, ca ld, sa kA, saa f. e zr a a

aa aaa a ra ar.nn ncol. 2006;17:986-989.

24 Ra c, far f. maa a: a a ra.

Curr Rev Pain. 2000;4:187-196.

25 ca cs, g R, ha Ak, a. pa a ra a

aa ar. ngl J Med. 1994;330:592-596.

26 d i. e a a a qa ra ar

a aa a: a r. Support Care Cancer. 2007;15:1243-1249.

27 gra J, tra, d. maa aa a: r a.

J Pain Symptom Manage. 2007;33:462-472.

28 mrr Je, sa k, k Jd. par a u sa

ra aa a. Clin breast Cancer. 2007;7:682-689.

29 saa f, l A, c R, c ym, s m, ca R. pa rar rra r ra a aa a. Cancer. 2007;110:1860-1867.

30 R ls, gr d, ta ns, a. l-r a a a r

a ra a aa a a ara

a r r: a ra, pa iii, -, a-r ra.

Cancer. 2004;100:2613-2621.

3 1 saa f, ga dm, mrra R, a. l-r a r a r

r a a a a r-rrar ra

ar.J atl Cancer Inst. 2004;96( 11):879-882.

32 l A, tra Rl, nra gn, a. para r a a

a aa ra ra ara a

aa. Cancer. 2000;88( 5):1082-1090.

33 l A, u R, Aa RJ, a. t a ra a .

J atl Compr Canc etw. 2009;7:s1-s29.

34 Ara (ara ) rr ra, nar.

35 cr rar a. naa lrar m .

://...///ar/000443.. A A 31, 2010.

36 dar car trraa. naa car i .

://.ar./ar. A A 31, 2010.

37 dar car trra raa ra. naa car i

. ://.ar./ar. A A 31, 2010.

38 d t t b. crtay . ://.ray.. A A 31, 2010.

39 dr ca w ta? car car . ://.arar.r//a_/

_r_a_.. A A 31, 2010.

40 dar car tra r r. naa car i .

://.ar./ar. A A 31, 2010.

41 Jaja nA. Raa r aa. Cancer. 2000;80:1628-1645.

42 dar car trra ra ra. naa car i .

://.ar./ar. A A 31, 2010.

43 sar sm. ira nr Ara.J Soc Integrative ncol. 2006;4

( 1):27-39.


25/28

23


26/28

24


27/28

25


28/28

bone health in focus breast cancer

Documents