Office of Nursing Research, Memorial Sloan Kettering Cancer Center, New York, NY.
Semin Oncol Nurs. 2022 Apr;38(2):151273. doi: 10.1016/j.soncn.2022.151273. Epub 2022 Apr 25.
The treatment of breast cancer requires the use of multiple modalities to achieve local control of disease and to prevent distant recurrence. Among patients whose tumors are hormone-receptor positive, endocrine therapy for up to 10 years in the adjuvant setting can be an important component of such therapy, but it is not without adverse events. Ovarian suppression or estrogen restriction can have a rapid and clinically significant detrimental effect on bone mineral density, leading to potential osteoporotic fracture. This article reviews the major causes of breast cancer treatment-induced bone loss and pharmacologic and nonpharmacologic management strategies to maintain bone health in this population.
PubMed and international clinical practice guidelines were used.
A holistic, long-term approach is needed to identify and offer early intervention to patients at high-risk of significant bone density loss. A combination of routine screening, use of oral or intravenous bone-modifying agents, oral supplementation of calcium and vitamin D, and physical activity, including weight-bearing exercise, are required to maintain adequate bone health during treatment for breast cancer.
Oncology nurses are well-situated in the primary and survivorship care teams for patients with breast cancer to provide proactive education on the need to assess and actively manage bone health. Nonpharmacologic interventions such as dietary supplementation and physical activity are essential to health promotion and are within the nursing scope of practice to emphasize with this patient population.
乳腺癌的治疗需要采用多种方法来实现疾病的局部控制，并预防远处复发。在肿瘤激素受体阳性的患者中，辅助内分泌治疗长达 10 年可以成为这种治疗的重要组成部分，但并非没有不良反应。卵巢抑制或雌激素限制会对骨密度产生快速且具有临床显著意义的不利影响，导致潜在的骨质疏松性骨折。本文综述了乳腺癌治疗引起的骨丢失的主要原因，以及维持该人群骨骼健康的药物和非药物管理策略。
使用了 PubMed 和国际临床实践指南。
需要采用整体的、长期的方法来识别和为高风险发生显著骨密度丢失的患者提供早期干预。需要常规筛查、使用口服或静脉用骨修饰剂、口服钙和维生素 D 补充剂以及包括负重运动在内的身体活动，以在乳腺癌治疗期间维持足够的骨骼健康。
肿瘤护士在乳腺癌患者的初级和生存护理团队中处于有利地位，可以提供关于评估和积极管理骨骼健康的积极教育。非药物干预，如饮食补充和身体活动，对于健康促进至关重要，并且在护理实践范围内，应特别强调这一患者群体。
