| The following is a list of questions to ask your doctor about bone issues in cancer, as well as tips for preparing for these conversations. |
| 1. What are effects of cancer on bone health? |
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| | Both the treatments for cancer and the cancer itself can affect the integrity of bones. Certain cancer treatments such as hormonal therapy, radiation therapy and chemotherapy affect the delicate balance of bone formation and breakdown, weakening bones and causing osteoporosis. These treatments are often used to treat certain breast cancers and prostate cancer. Bone complications may also be the first sign of cancer or a signal that the cancer has spread. They are caused by bone cancer such as multiple myeloma, and cancer that originates elsewhere in the body and travels in the blood or lymph (metastasizes) to the bones, replacing healthy bone tissue. Any type of cancer can spread to the bone, but the most common metastasizing cancers are breast, lung, kidney, thyroid and prostate. Bone complications can weaken bones, making them unstable. Untreated, bone complications can cause pain, increase the risk of bone fracture, limit physical activities, and contribute to a poor quality of life. |
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| How you can prepare for this discussion |
- Gather all your medical notes and laboratory notes in a three-ring binder
- Write down all questions in advance of your appointment
- Know your type of cancer and the treatments you have received in the past
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| 2. What are the symptoms of bone involvement? |
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| | It may be difficult for you to know if you are experiencing bone complications because there aren't always symptoms, particularly in the early stages. But both bone metastases and osteoporosis may cause bone pain that may come and go over time, or become more apparent during physical activity. Later, pain may be more constant. Other symptoms may include, fatigue, decreased appetite and difficulty sleeping. |
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| How you can prepare for this discussion |
- Make note of any changes in your ability to perform physical activity
- Notice if you are guarding any part of the body
- Note the characteristics and location of any pain
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| 3. How are bone complications diagnosed? |
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| | The only way to tell if you are having bone complications is to do imaging studies on the bone. Your doctor may perform a blood test to measure certain chemicals released during bone damage and an X-ray or a bone scan, which allow the doctor to visualize the integrity of bone. In some cases a biopsy is required so that characteristics of the cancer cells can be examined under the microscope. All of this information is used to guide treatment decisions. |
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| How you can prepare for this discussion |
- Make a list of all symptoms you are experiencing
- Bring results of any bone density test performed in the past
- Gather all prior laboratory and imaging study results
- Tell your doctor if you have been diagnosed with osteoporosis
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| 4. What are the treatments for bone complications? |
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| | The goal of therapy is to prevent further bone damage, to stabilize the bone, to quell bone pain and to improve overall quality of life. Treatments for bone complications include the following:
- Hormone therapy
- Radiation therapy
- Immunotherapy
- Surgery
- Chemotherapy
- Intravenous (IV) bisphosphonates
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| How you can prepare for this discussion |
- Make note of all concerns about any potential treatments
- List all past treatments and experiences with any of these treatments
- List all current medications
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| 5. Is there anything I can do to help strengthen bones? |
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| | In addition to medical treatments there is a lot you can do to support bone strength. Maintaining a calcium-rich healthy diet, incorporating a weight-bearing exercise plan, and practicing healthy behaviors (not smoking and limiting alcohol intake) can all benefit bone health. It is important to speak to your doctor before embarking on an exercise program as some people may require special instructions. Your doctor may recommend calcium and vitamin D supplements. |
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| How you can prepare for this discussion |
- Take a close look at your dietary intake, particularly calcium-rich foods
- List all physical activities and types of exercise you currently perform
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| Supported through an educational grant from Novartis Oncology |
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