Bone Health in Cancer - Dr. Sandy Sehdev
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Bone Health in Cancer - Dr. Sandy Sehdev

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Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.

Dr. Sehdev explains bone health as it relates to cancer, including bone metastases, treatment options, the impact of cancer treatment on bone health, and what you can do to keep your bones strong.

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  • 1. Bone Health in Cancer Dr. Sandy Sehdev Medical Oncologist William Osler Health Centre
  • 2. 2 What will we discuss ● About our bones ● About bone metastases ● The complications of bone metastases ● Treatment options for bone complications ● The impact of cancer treatment on bone health ● What else can you do to keep your bones strong? ● Ask the expert
  • 3. 3 Our bones ● Bone is living tissue, which is constantly being broken down and rebuilt, a process called remodeling ● The loss of living bone tissue makes bones fragile and more likely to fracture
  • 4. 4 Bone function ● The major functions of bones are to: ● Provide structural support for the body ● Provide protection of vital organs ● Provide an environment for marrow (where blood cells are produced) ● Act as a storage area for minerals (such as calcium) “Facts about bones” accessed at http://www.iofbonehealth.org/patients-public/about-osteoporosis/facts-about-bones.html on August 9, 2010
  • 5. 5 About bone metastases ● One of the most common places for prostate or breast cancer to spread is to the bone ● Approximately 65 to 75 per cent of people with advanced prostate or breast cancer experience bone metastases ● Growing cancer cells weaken and destroy bone around the tumour ● Can lead to debilitating complications
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  • 7. 7 Cycle of bone destruction ● Cancer cells travel from original site to bone where they stimulate bone cells called osteoclasts ● Osteoclasts increase bone destruction making room for the tumour to grow in the bone ● As bone is destroyed, proteins are released that can cause cancer cells to grow… …and the cycle of bone destruction continues
  • 8. 8 Warning signs ● No warning signs in some patients ● Bone pain ● One of the first signs that cancer has spread to the bone − Up to two-thirds of people with bone metastases experience debilitating pain ● May require pain medication (may develop tolerance) ● Can severely impact quality of life
  • 9. 9 Warning signs ● Fractures (broken bones) ● Hypercalcemia (a result of excess calcium released into blood stream) ● Symptoms may include: − Constipation or diarrhea − Confusion − Dehydration − Nausea or vomiting − Memory loss and depression
  • 10. 10 Diagnosing bone metastases ● To determine if the cancer has spread to the bones, a doctor may order several tests, including: ● Imaging tests (X-rays and radionuclide bone scans, CT scans, MRI scans and PET scans) ● Blood tests ● Urine tests ● Biopsies
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  • 17. 18 Bisphosphonates reduce the risk of SREs in breast cancer patients
  • 18. 19 Study Schema
  • 19. 20 Primary End Point: Time to First On-Study SRE
  • 20. 21 Secondary End Point: Time to First and Subsequent SREs
  • 21. 22 Pain Progression: Denosumab vs. ZA
  • 22. 23 Quality of Life – Denosumab vs. ZA
  • 23. 24 ZOOM: A Prospective, Randomized Trial of ZA for Long-Term Treatment of Bone-metastatic BrCa after 1 Year of ZA Treatment
  • 24. 25 ZOOM: Primary Efficacy Analysis: SMR
  • 25. 26 Select AEs with ZA and Denosumab During the 2- Year Open-Label Treatment Phase
  • 26. 27 Risk Factors for ONJ in Cancer Patients
  • 27. 28 Treatment options for complications of bone metastases ● Several treatment options are available ● Your doctor will determine which is right for you based on your health needs and lifestyle Bisphosphonates RANK-Ligand inhibitor
  • 28. 29 Treatment options for complications of bone metastases Medication can be administered in different ways • By mouth (tablets/liquids) • By intravenous/IV infusion (into the vein) • By subcutaneous injection (under the skin) Many people may go untreated, remaining at risk of developing serious bone complications Speak to your doctor about treatment options that are right for you
  • 29. 30 Current approved bone-targeted therapies in Canada Breast Cancer ● Denosumab (Xgeva®) ● Administered as subcutaneous injection every 4 weeks ● Zoledronic acid (Zometa™) ● Administered every 3 or 4 weeks via a 15-minute infusion ● Pamidronate (Aredia™) ● Administered every 3 or 4 weeks as a 2 hour intravenous/IV infusion ● Clodronate (Ostac™) ● Administered as oral tablets daily Prostate Cancer ● Denosumab (Xgeva®) ● Administered as subcutaneous injection every 4 weeks ● Zoledronic acid (Zometa™) ● Administered every 3 or 4 weeks via a 15-minute infusion
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  • 32. 33 Possible side effects RANK-Ligand Inhibitor ● The most common are fatigue and asthenia; hypophosphatemia; and nausea ● It can cause hypocalcemia ● Osteonecrosis of the jaw has been reported in patients with denosumab Bisphosphonates ● Fever, flu-like symptoms, fatigue, nausea, asthenia, severe hypophosphatemia ● Osteonecrosis of the jaw ● Worsening of kidney function
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  • 34. 36 The impact of cancer treatment on bone health ● In addition to bone metastases, some cancer treatments can also cause bone loss ● Androgen deprivation therapy (prostate) ● Aromatase inhibitors (breast) ● Bone loss can increase risk of fractures ● Fractures can lead to hospitalization, nursing home admissions, and home care support services ● Currently no drug therapies are specifically approved for cancer treatment-induced bone loss in Canada
  • 35. 37 Tips for maintaining strong bones ● Speak to your doctor before starting a new exercise regimen ● Participate in weight-bearing exercise and strength training ● Brisk walking ● Dancing ● Make your diet count, and include calcium ● Eat low-fat and nonfat dairy products, leafy greens, and calcium-fortified foods ● Fruits and vegetables provide other bone-building nutrients ● Avoid falls or injuries
  • 36. 38 Tips for maintaining strong bones ● Intake at least 500 mg calcium daily and at least 400 IU vitamin D daily (except patients with hypercalcemia) ● Limit caffeine to 2-3 cups per day ● Do not smoke ● Take care to avoid falls which can lead to fracture
  • 37. 39 Summary ● Bone is the most common site for cancer to spread in people with advanced prostate or breast cancer ● Bone pain is often the first sign the cancer has spread ● Bone metastases can be detected with bone scans and other diagnostic tools ● Bone metastases can lead to serious complications which are associated with disability, hospitalization and death ● Talk to your doctor about available treatments to reduce the risk of serious complications
  • 38. 40 What else can you do? ● Talk to your doctor about bone health ● Tell your doctor right away if you have unexplained pain in your bones ● Keep active and eat a good diet, supplement with calcium and vitamin D
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  • 42. Ask the expert Questions?
  • 43. Bone Health Awareness Program
  • 44. 46 Bone health awareness program objectives ● Raise awareness about the importance of bone health in advanced breast and prostate cancer ● Inspire patients to educate others and take action
  • 45. 47 Program overview Ambassadors Original artwork Media Events Website Awareness with government
  • 46. 48 Program elements ● Men and women who have had bone metastases OR have an interest in bone health ● Willing to take action to help raise awareness and help others access the treatments they need Bone health ambassadors
  • 47. 49 Program elements ● Local artists engaged in Vancouver, Calgary & Toronto ● Visual representation of survivor stories Original artwork
  • 48. 50 Program elements ● Events held in Toronto, Vancouver, Calgary ● Sunday, June 2: National Cancer Survivor Day ● Artwork unveiled for survivors, supporters, groups Local events
  • 49. 51 Program elements Media ● Generating media coverage of ambassador stories
  • 50. 52 Website: bonehealthincancer.ca
  • 51. 53 Program elements Awareness with government ● Call to action to make bone-targeted treatment options available to all who need them ● Awareness that bone metastases as a concern for cancer survivors ● Advocates creating awareness with elected and government officials through letters and meeting
  • 52. 54 Public access to bone-targeted treatment denosumab zoledronic acid British Columbia Covered (palliative only) Covered (palliative only) Saskatchewan Covered Covered Alberta Not covered Not covered Manitoba Covered Covered Ontario Covered Covered Quebec Covered Not covered Newfoundland and Labrador Not covered Covered New Brunswick Covered Covered Nova Scotia Covered Covered Prince Edward Island Not covered Not covered Prostate cancer
  • 53. 55 Public access to bone-targeted treatment Breast cancer denosumab zoledronic acid pamidrondate clodronate British Columbia Covered (palliative only) Not covered Covered (palliative or specific criteria) Covered (palliative or specific criteria) Saskatchewan Not covered Not covered Covered Covered Alberta Not covered Not covered Covered Covered Manitoba Not covered Not covered Covered Covered Ontario Not covered Covered Covered Covered Quebec Covered Covered Covered Covered Newfoundland and Labrador Not covered Not covered Covered Covered New Brunswick Not covered Not covered Covered Covered Nova Scotia Not covered Not covered Covered Covered Prince Edward Island Not covered Not covered Not covered Not covered
  • 54. Will you join us? Contact: Jackie Manthorne, President and CEO, CCSN Phone: 613-898-1871 Email address: jmanthorne@survivornet.ca
  • 55. Questions?
  • 56. Thank you!