Cancer Flashcards
What is cancer?
Cancer is what is described as the uncontrolled, abnormal growth (neoplasm) and proliferation of cells resulting from damage to DNA by internal factors (e.g. inherited mutations) or environmental exposures (e.g. tobacco smoke)
What lifestyle habits reduce risk of cancer?
1) Don’t Smoke
2) Limit Alcohol consumption
3) Be physically active
4) Eat 5+ servings of fruit and vegetables, whole grains and foods low in saturated and trans fat per day
5) Practise safe sex
6) Protect skin from excessive light
7) Maintain a healthy weight
8) Have regular screenings
What treatment options are available to suffers of cancer?
1) Surgery
2) Radiation
3) Chemotherapy
4) Hormones
5) Immunotherapy
What are the acute and chronic effects of the treatment options?
1) Surgery- Acute effects= Pain, Lymphoedema, fatigue, limited ROM/ chronic effects= Pain, loss of flexibility, nerve damage
2) Radiation- Acute effects= Pain, Fatigue, skin irritation (radiation dermatitis), Pulmonary inflammation/ Chronic effects= Scar tissue build up at radiation site (cardiac and lung scarring), loss of flexibility and fractures
3) Chemotherapy- Acute effects= Fatigue, nausea, anaemia, nerve damage, muscle pain, weight gain, neuropathy/Chronic effects= Cardiomyopathy, lung scarring, nerve damage, fatigue, bone loss, leukaemia and neuropathy
4) Hormones- Acute effects= Constipation/ diarrhoea, nausea, loss/decrease appetite, impotence/decrease in sex drive, alterations in menstruation
5) Immunotherapy: Acute effects= Weight gain or loss, fatigue, flu- like symptoms/Chronic effects: Nerve damage, Myopathy
What are the common problems encountered with cancer?
Pain (tumour of musculoskeletal system)
Neural deficits and seizures (Brain and CNS)
Anaemia (Bone marrow)
Fatigue (common side effect of treatment)
What are the adverse effects of cancer and treatment?
Fatigue Weight changes Urinary & bowel problems Peripheral neuropathy Osteoporosis Cardiotoxicity Lymphoedema Hot flushes Night sweats Anxiety Depression Memory or concentration difficulties
As fatigue is an inevitable problem associated with cancer, what role can exercise play?
Exercise does not exacerbate existing fatigue, may help reduce during and after cancer treatment and may prevent patients from becoming trapped in a perpetual cycle of deteriorating physical function and increasing fatigue.
What do goals of exercise therapy depend on?
Initial treatment for new cancer diagnosis In remission Treatment for reoccurrence prevention Local or metastatic disease Side-effects of treatment Control of co-morbidities
What are the effects of exercise training prehabilitation?
Aim= Maintain strength, endurance and level of function.
Beneficial effects: reduced levels of fatigue (cancer-related), greater body satisfaction (breast cancer), maintenance of body weight, improved mood, reduced severity of side effects, improved aerobic capacity, reduced muscle weakness/wasting and improved quality of life
When should physical activity be done?
1) Before cancer: as a preventive measure
2) During cancer treatment: PA improves, or prevents, decline in physical function without increasing fatigue
3) After cancer treatment: PA helps recover physical function
4) During and after treatment: PA can reduce risk of cancer recurrence and mortality for some cancers and can reduce the risk of developing other long-term conditions.
5) Advanced cancer: PA can help maintain independence and wellbeing
What are the effects of exercise training after completion of treatment?
Improves functional status prior to treatment or prevent/attenuate functional decline during treatment (Maintain muscle mass and strength/maintain/optimise CRF and maintain joint ROM.
Address treatment specific impairments during and following treatment (Pain, fatigue/anaemia, muscular weakness, deficits in joint ROM, Poor balance/co-ordination, lymphoedema / oedema / swelling, Peripheral neuropathy
Bone: osteopoenia / osteoporosis
Steroid-induced myopathy)
Optimise general health in the recovery/rehabilitation phase following treatment: (Improve body composition (reduce fat mass & increase lean mass, Improve muscular endurance, Improve muscular strength, Improve CRF, Improve flexibility and Improve physical functioning)
What are the possible outcomes of physical activity for cancer sufferers?
General outcomes: Physical fitness (improved function)
Body size (BMI, waist circumference, etc.)
Quality of life
Psychosocial (wellbeing, satisfaction with life, etc.)
Reduced fatigue
Reduced anxiety
Reduced depression
Self-esteem (breast cancer survivors)
Physiological (VO2, strength, flexibility, haematocrit, immune function, etc.)
Balance
Weight Balance
Cancer specific:
Pain relief
Fewer nights in hospital / medical consultations
Support (social from exercise group / instructor during difficult period)
Shoulder ROM
Fatigue
Body image
Sense of control
Quality of life (well-being)
Relief of treatment-related side effects (e.g. nausea, pain, fatigue, etc.)
What are the potential adverse effects of exercise on cancer and what modifications can be put in to reduce these effects?
1) Exacerbation of symptoms (e.g. pain, fatigue, nausea, dyspnoea, numbness, etc.)- Avoid high-intensity exercise; monitor symptoms; modify exercise type based on treatment (e.g. avoid seated exercise after prostate / rectal surgery).
2) Immunosuppression-If patient has low white blood cell counts avoid high-intensity / volume of exercise (stick to light – moderate intensity / volume).
3) Increased risk of falls- Patient suffers with dizziness, frailty, peripheral sensory neuropathy: incorporate balance & co-ordination exercises (e.g. tai chi) & avoid activities needing considerable balance / co-ordination (e.g. treadmill exercise).
4) Bone fracture- If patient has bone metastases / osteoporosis risk avoid high impact or contact activities (e.g. sports).
5) Lymphoedema- To prevent lymphoedema progress resistance exercises in small & gradual increments. To avoid exacerbation of lymphoedema avoid strenuous repetitive exercise with affected limb; wear compression garment.
What are the exercise testing recommendations for cancer sufferers?
1) Aerobic (cycle 25-50W/ 3 mins stages)/ Treadmill (1-2 METS/ 3 mins. stages) with measures such as 12 lead FCG,HR or BP, RRE and RPE. Endpoints= VO2peak / work rate or ECG changes (>2mm ST-segment depression / elevation); ischaemic threshold.SBP > 250 mmHg or DBP > 115 mmHg or Exaggerated or hypotensive response
2) Endurance (6 to 12 min. walk) with measures as distance. Endpoints= Volitional fatigue.
3) Strength (Isokinetic or Isotonic) with measures include 1RM or 3RM. Endpoints= Volitional fatigue.
4) Functional (ADLs, sit to stand and stair climbing) with endpoint being use to determine how much fatigue is experienced
5) Flexibility (Goniometry and sit and reach) with endpoint being angle of flexion and extension
6) Neuromuscular (Gait analysis and balance) with the measuring being individualised to be better suited
What are the considerations for exercise testing?
1) Obtain basic history of diagnosis and treatment
2) Assess for adverse acute, chronic and late effects of cancer treatment
3) Evaluate other co-morbidities that may influence safety to exercise
4) Select, modify and interpret fitness test according to how cancer and treatment effects balance, agility, speed, flexibility, endurance and strength
5) Medical clearance required before testing
6) Consider relative and contraindications to testing
7) Psychological and social impact of disease
