Cancer Exercise Bone Health Beyond the Break Web

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 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 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 • HER 2 positive • Triple positive Bone Cancers Metastasizes to bone • • • Prostate Cancer Endometrial Cancer Uterine Cancer Ovarian Cancer Testicular Cancer

Bone Cancers (Osteosarcoma, Chondrosarcoma, Ewing Sarcoma) • 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. AND adults AFFECT BONE INTEGRITY CELLand PRODUCTION children

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 • 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

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

Surgery • Bone cancer • 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 • 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 • Bisphonates

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 +

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-d 8 Y 6 fbr. QA

Questions?

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