Oncofertility, Osteonecrosis Emerge as Patient Concerns

Teresa K. Woodruff, PhD

Chief, Division of Fertility Preservation Director, Institute for Women’s Health Research Thomas J. Watkins Professor of Obstetrics & Gynecology Feinberg School of Medicine Northwestern University Chicago, IL

Supportive care is a crucial component of personalized oncology care. Several supportive care topics were covered at the 3rd Annual Conference of the National Coalition of Oncology Nurse Navigators (NCONN), held September 8-10 in San Diego, California. Here are some of the highlights.

Early Intervention Deemed Vital in Fertility Issues

Approximately 800,000 young women in the United States face reproductive issues related to cancer treatment, and 40,000 new cancer patients join this list every year. Oncofertility intervention should take place at diagnosis, or even earlier if genetic screening reveals patients are at risk for certain cancers, according to Teresa K. Woodruff, PhD, who helped launch the Oncofertility Consortium at Northwestern University with a grant from the National Institutes of Health (http://goo.gl/lQEVR).

Woodruff also noted the importance of informing patients that fertility issues can develop long after treatment ends. Some women are not immediately sterile following treatment, and can even experience the return of a somewhat normal menstrual cycle.

However, cancer treatments can cause menopause to start 5 to 10 years earlier than in the average healthy woman. Survivors who think they are in the clear after treatment could eventually become sterile.

Some of the oncofertility options available to women include embryo banking, which involves freezing fertilized eggs for future use, and egg banking, in which the eggs are extracted and frozen instead of fertilized. The Oncofertility Consortium is also working on isolating follicles and enclosed eggs from the ovarian tissue, and subsequently fertilizing the eggs in vitro.

Osteonecrosis of Jaw Related to Antiresorptive Therapy

Bisphosphonates are associated with an increased risk of osteonecrosis of the jaw (ONJ). At NCONN 2011, Kenneth E. Fleisher, DDS, who has researched numerous issues concerning oral malignancies, discussed ONJ related to antiresorptive therapy.

Fleisher said current evidence-based research suggests ONJ is a process that involves immunologic, bacterial, and anatomic changes.

Bisphosphonate-related ONJ (BRONJ) mostly occurs in patients taking zoledronic acid (Zometa), pamidronate (Aredia), or a combination of both drugs. Fleisher said that denosumab (Xgeva), a monoclonal antibody, has rates of ONJ incidence similar to bisphosphonates.

Most BRONJ cases are preceded by dental extraction; however, Fleisher noted that spontaneous development can occur. Other BRONJ risk factors include poor oral health, chemotherapy, anemia, diabetes, hypertension, methotrexate use, and steroid therapy.

To reduce BRONJ risk before starting bisphosphonate treatment, patients should have dental examinations and complete all oral procedures, including tooth extractions, restorative dentistry, and periodontal treatment.

The American Association of Oral and Maxillofacial Surgeons has developed a staging system for BRONJ with accompanying treatment recommendations (http://goo.gl/ Q7EcI). Treatments range from antibiotics and antibacterial mouth rinses to surgical removal of necrotic bone.