Cancer Treatment Side Effects--The Gift That Keeps on Giving

Jim was diagnosed in 2002 with lung cancer. In 2008, he had a recurrence outside the lung which was treated with radiation. In 2009 he had another recurrence, this time to the bone. For that metastasis , in addition to four therapeutic chemo agents, he took Zometa, a bisphosphonate (like the drugs given for osteoporosis) used to build the bone in cancer patients.

In 2010, after nine months of treatment, which thankfully eradicated the metastasis, Jim developed osteonecrosis of the jaw—one of the less frequent and more unpleasant side effects of Zometa. We had excellent oncologists—none of whom had seen osteonecrosis resulting from Zometa treatment. While uncommon, it does happen. It was I who suggested to them the possibility of a connection.

Unlike menopausal women who have the option of taking bisphophonates to prevent osteoporosis, cancer patients don’t have much of a choice. They have to weigh benefits verses risks and if you have bone cancer the scale tips in favor of the benefits.

Osteonecrosis is painful (Amen) and difficult to treat (Amen again).

In Jim’s case, exposed bone around the back molars led to painful infection resulting in loosening of the teeth and necessitating a root canal. The oral surgeon and other experts whom we consulted predicted the eventual loss of the treated tooth and possibly surrounding teeth. Because healing problems would likely occur with the cancer-compromised immune system, the doctors decided against extraction of any teeth but warned us they would probably fall out on their own eventually.

Unfortunately the soothsayers were right. Three years forward and the prophecy has come to pass. Jim can’t chew on the affected side where one molar is giving up the valiant fight to retain its rightful place. Saturday night, he was awake for hours with an excruciating tooth/jaw/ear ache. We applied hot compresses, gave him oxycodone and finally dilaudid before he got any relief.

If you are taking Zometa:
1. Visit your dentist or prosthodontist on a regular basis.
2. Your cancer center may employ a dentist who specializes in treating cancer patients. Make an appointment.
3. If you have any pain in the jaw, face or teeth inform your oncologist immediately.