Cancer‐ and Chemotherapy‐Induced Musculoskeletal Degradation

Abstract

Mobility in advanced cancer patients is a major health care concern and is often lost in advanced metastatic cancers. Erosion of mobility is a major component in determining quality of life but also starts a process of loss of muscle and bone mass that further devastates patients. In addition, treatment options become limited in these advanced cancer patients. Loss of bone and muscle occurs concomitantly. Advanced cancers that are metastatic to bone often lead to bone loss (osteolytic lesions) but may also lead to abnormal deposition of new bone (osteoblastic lesions). However, in both cases there is a disruption to normal bone remodeling and radiologic evidence of bone loss. Many antitumor therapies can also lead to loss of bone in cancer survivors. Bone loss releases cytokines (TGFβ) stored in the mineralized matrix that can act on skeletal muscle and lead to weakness. Likewise, loss of skeletal muscle mass leads to reduced bone mass and quality via mechanical and endocrine signals. Collectively these interactions are termed bone‐muscle cross‐talk, which has garnered much attention recently as a prime target for musculoskeletal health. Pharmacological approaches as well as nutrition and exercise can improve muscle and bone but have fallen short in the context of advanced cancers and cachexia. This review highlights our current knowledge of these interventions and discusses the difficulties in treating severe musculoskeletal deficits with the emphasis on improving not only bone mass and muscle size but also functional outcomes. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Sarcopenic Factors May Have No Impact on Outcomes in Ovarian Cancer Patients

“…Second, gastrointestinal (GI) symptoms reduce oral food intake in cancer patients, causing malnutrition-induced sarcopenia. GI symptoms are more frequent in patients with GI and hepatobiliary and pancreatic cancer than in those with other cancers, including ovarian cancer [22]. While ovarian cancer symptoms are often unspecific, they rarely include GI symptoms [23].…”

Working cancer survivors’ physical and mental characteristics compared to cancer-free workers in Japan: a nationwide general population-based study

“…Oncotherapy could lead to a long-term decrease in the physical functional capacity in gastric and colorectal cancer patients [43,44]. Chemotherapy, hormonal therapy, and radiation therapy could induce bone loss and muscle weakness in survivors of breast or prostate cancer, which were prevalent in working-age individuals [45,46]. Oncotherapy could also cause cardiovascular side-effects [47,48] and peripheral neuropathy [49].…”

Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice

“…As well as the ongoing loss of muscle mass, several anti-cancer therapies (both hormonal and non-hormonal) promote bone loss through direct dysregulation of bone turnover and indirectly through hypogonadism and nephrotoxicity. The rate of bone loss from cancer therapy can be ten times higher than in the general population (75–79) but is highest in breast and prostate cancer (75) due to commonly administered therapies such as endocrine therapy (breast cancer) and androgen deprivation therapy (prostate cancer). Chemotherapy drugs (cisplatin, doxorubicin, cyclophosphamide, ifosfamide, FOLFIRI, carboplatin, methotrexate and targeted therapies) cause reduced bone volume and radiation therapy, orchiectomy and oophorectomy also result in bone loss.…”