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A RepoRt About
Bs CCsImpC o Bos
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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
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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.
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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.
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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
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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
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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
7/30/2019 Bone Health in Focus Breast Cancer
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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
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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.
7/30/2019 Bone Health in Focus Breast Cancer
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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.
7/30/2019 Bone Health in Focus Breast Cancer
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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
7/30/2019 Bone Health in Focus Breast Cancer
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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
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14
teAR-out foR youR neXt visit
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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?
7/30/2019 Bone Health in Focus Breast Cancer
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16
7/30/2019 Bone Health in Focus Breast Cancer
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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 .
7/30/2019 Bone Health in Focus Breast Cancer
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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.
7/30/2019 Bone Health in Focus Breast Cancer
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19
wr r r, a a a :
A aar ar a r r a
a ra a a ar r .
c a ar- ra 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.
7/30/2019 Bone Health in Focus Breast Cancer
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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
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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.
7/30/2019 Bone Health in Focus Breast Cancer
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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.
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