Cancer Flashcards
Cancer Stats
40% of Americans in their lifetime; nearly two-thirds of cancer survivors live for at least five years, not the leading cause of death, second behind heart disease
Causes of Cancer
Tobacco, obesity, diet, lack of exercise, occupation, viruses, family history, alcohol, UV and ionizing radiation, prescription drugs, reproductive factors, pollution, unknown
Physical activity reduces risk of colorectal cancer by up to 50%, obesity and physical inactivity increase risk of breast cancer in women by 50%
Pathophysiology of Cancer
A disease in which abnormal cells divide uncontrollably and destroy body tissue
- results from DNA damage form internal or environmental factors
- has potential to for metastasis
Carcinoma:
from epithelial tissues, most common (lung, colon, prostate, breast)
Sarcoma
from connective tissues like bone, fat, cartilage, nerves
Leukemia and lymphoma
from blood forming cells called hematopoietic cells
Development of Cancer
Normal tissue undergoes a progression of abnormal changes from hyperplasia (increase in number of cells but cells still appear normal under a microscope)
then dysplasia occurs (where cells look abnormal)
then cancer
Treatment/Management of Cancer
Medications
Chemo
Radiation Therapy: damage DNA of cancerous tissue
Surgery: primary method, remove the tumor
Hormone Therapy
Targeted Therapies( form of chemo): targets specific molecular differences between cancer and normal cells
Exercise: overall physical function is generally diminished because of losses of aerobic capacity, muscle tissue and ROM
Exercise Response (cancer)depends on
Tumor site, cancer stage, grade, treatment, timing since diagnosis and interactions of all elements with general health, well being and fitness
Medical Assessments before exercise
Recommend evaluation for peripheral neuropathies, musculoskeletal morbidities
If the patient has hormonal therapy it could lead to fracture risk
Breast Cancer Evaluation
Arm/shoulder morbidity to upper body exercise
Prostate Cancer Eval
Evaluation of muscle strength and wasting
Colon Cancer Eval
Eval patient as having established consistent and proactive infection prevention behaviors for an existing ostomy prior to engaging in exercise training that is more vigorous than a walking program
Gynecologic Cancer Eval
Patients that are morbidly obese may require additional medical assessment for the safety of activity beyond cancer-specific risk. Eval the lower extremity lymphedema prior to vigorous aerobic exercise or resistance training
Recommendation for Exercise Testing Cancer (High functioning)
an exercise test to establish current baseline and determine if treatments affected exercise response is useful
Recommendation for Exercise Testing Cancer (Low functioning)
an exercise test might provide a barrier to physical activity
Exercise Testing (general concepts)
No assessment required to start a light, walking progressive strength training, or flexibility program in survivors
Be aware of a survivors health history, comorbid chronic health conditions and diseases, and any exercise contraindications
Ideally patients with cancer should receive a comprehensive assessment
General Physical Activity Guidelines
Avoid Inactivity
Exercise as much as possible
require modifications to avoid fracture with matastatic bone disease
Walk up to 150 min/wk
Understand that setbacks with treatment might occur and make modifications
Monitor symptoms of disease and treatment
Exercise in a supervised setting with a certified cancer exercise trainer
Exercise (breast)
fracture risk for aerobic training, take into consideration arm/shoulder morbidities, No upper limit on weight, watch fro arm and shoulder symptoms
Exercise (Prostate)
Fracture in aerobic,
Add pelvic/floor exercises for those who undergo radical prostatectomy, watch for fracture (resistance), Include flexibility as normal
Exercise (Colon)
If an ostomy is present, modifications will be needed for swimming or contact sports, flexibility is the same but watch for intra-abdominal pressure with patients with ostomies, In resistance training, patients with a stoma need to start with low weight and be progressive to avoid hernation at the stoma, is ostomy- patient needs medical clearance
Exercise (Adult Hematologic))
not many reccomendations
Exercise (Adult HSCT)
avoid overtraining given the immune effects of vigorous exercise, resistance training may be more important,
Exercise (Gynecologic)
If peripheral neuropathy is present, a stationary bike might be preferable over weight bearing cardio, Proceed with caution in resistance training if the patient has had lymph node removal and or radiation to lymph nodes in the groin
FITT REC for cancer
aerobic: gradual increase to 3-5 dys/wk, mod to vig, several short bouts per day during active treatment, prolonged rhythmic
resistance: 2-3 d/wk, moderate (60-70% of RM), any kind
Flexibility: daily
Tolerance of intensity, several short bouts and no different amount of time then healthy population
Special Considerations for Cancer
90% of all survivors experience fatigue from chemo, radiation
This fatigue persists for months-years
avoid physical inactivity
Bone is the most common site for metastases so modify exercise program and watch for bone fragility and fractures
Cachexia
Identify when a patient is in an immunosuppressed state due to those medications after a bone marrow transplant or undergoing chemo/radiation therapy
Cachexia
muscle and fat wasting-may limit exercise capacity
If platelets are
50,000
Avoid activities that increase risk of injury, bruising or bleeding
If white blood cells
3,000
Avoid public facilities where risk of exposure to bacteria is high and adhere to infection control guidelines
If hemoglobin
10g*dL^-1
Prescribe only low intensity activities, shorter periods and allow adequate rest
If fever of vommitting
no formal exercise training, wait until asymptomatic for 48 hours
Peripheral neuropathy;
categorized by loss of sensation and poor balance-avoid free weights and treadmill, use well-supported positions for exercise
Osteoporosis bone issues
avoid high impact activities
General Pain
investigate the pain and make modifications
Radiotherapy cancer related fatigue and severe reaction in region
closely monitor exercise response
avoid exercises that compromise the skin and tissue in the region
Side effects of surgery
swelling pain constipation
pain lymphedema, limited ROM, lymphedema, difficulty communicating/swallowing/eating, sexual dysfunction, hernia, bowel or bladder dysfunction, difficulty breathing, pain , fatigue
Side effects of radiation
fatigue, vomitting, hair loss, skin changes, pain limited rom, fatigue, lymphedema, second cancers, fibrosis in the area tested
Side effects of chemo
fatigue, nausea, hair loss, peripheral neuropathy, altered executive cognitive function
Side effects of hormone therapy-antiestrogens
hot flashes, cognitive impairment, arthralgia, myalgia, eight gain, osteoporosis, metabolic syndrome
Side effects of hormone therapy-anti-androgens
vasometer flushing, fatigue, vertigo, weakness, altered body comp, decreased muscle, decreased bone mass, depression, frailty, osteoporosis, metabolic syndrome
Effect of Exercise
improved quality of life, decreased fatigue, improved aerobic capacity, sleep, mood and energy levels
decreased side effect severity, recurrence and death from breast and colon cancers
Greater body satisfaction and maintenance of body weight
_______ is a type of cancer that is identified from connective tissues, such as bone and cartilage.
Sarcoma
More than half of the causes of cancer is related to individuals’ lifestyle choice. T/F
True
Cancer patients in early stage treatment should avoid physical activity. T/F
False
