Cancer OT and End of Life Care Flashcards
Describe palliative care
- Specialized medical care focused on the relief from symptoms of pain, dyspnea, and stress related to chronic or serious illness
- palliative care can be provided at any point from when a person receives his/her diagnosis
-Provided in acute care hospital settings
Describe hospice care
Care for persons with an end-stage terminal illness
*hospice care provided more for people that are given months (not years) to live
Provided in the setting that is most appropriate for the person being served (e.g. home, SNF, inpatient hospice setting
Comfort care only; no curative procedures or treatments
Services typically covered by Medicare, Medicaid, VA, and most insurances
List at least 6 goals of OTs in palliative care.
- Pain management (prevent and/or relieve pain, pg. 1224 Pedretti)
- Dyspnea management (dyspnea = short/labored breathing)
- Back precautions
- Energy conservation
- Task simplification
- Positioning (promotion of positioning for patient comfort)
- AE/DME
- Recommendations for home safety/modifications
- Caregiver training
- Promoting engagement in activity that is physically tolerable
- Creating opportunities to engage in occupational life review as part of the process of planning for death
Know the basic risk factors for decline in function for patients with cancer - disease related
- Primary or metastatic tumors of skeletal system, brain, or spinal cord
- Obstruction of circulatory or lymphatic system ((e.g. Suzanne described superior vena cava syndrome in which a tumor might be pressing on the SVC, which compresses the flow of blood back to the heart, and can cause trouble breathing or edema etc.)
- Physical and psychosocial response to disease (e.g. pain, stiffness, fatigue, anxiety…Suzanne described that when a person hears the word Cancer, h/she may fall into “patient” mode and become immobile etc.)
- Sensory-perceptual alterations
Know the basic risk factors for decline in function for patients with cancer- treatment related
- Surgical intervention (nerve and muscle damage, weakness and sensory changes, localized to area of surgery)
- Side effects of chemotherapy (distal weakness → proximal weakness, sensory deficits including neuropathies)
- Side effects of radiation therapy (generalized weakness and fatigue)
- Side effects of corticosteroid therapy (proximal weakness → distal weakness) Suzanne described how this type of steroid actually wastes away the muscles and therefore patients may have trouble for example, sitting at EOB due to lack of core muscles
What are the primary side effects of chemotherapy?
- Nausea/emesis/fatigue/loss of appetite
- Pancytopenia (this is a shortage of all types of blood cells, which can consist of thrombocytopenia (diminished platelet levels & slow clotting time of blood) or changes in RBC composition of blood (e.g. anemia)
- Neuropathy (nerve pain can cause transient wristdrop and footdrop and/or a burning tingling pain)
- Compromised sensory systems (diminished or loss of vision or ototoxicity, which is damage to the inner ear)
- Cardiac/pulmonary neurotoxicity
- Hair loss (chemotherapy is more destructive to rapidly replicating cells, such as hair and lining of the intestines/mouth)
- Psychological effects (anxiety & fear)
- Fatigue (associated with factors like impaired liver function)
What are the primary side effects of radiation therapy?
- Early Adverse Effects
- More radiosensitive tissue affected
- Adverse effects proportional to dose
- Oral mucosa, small bowel, stomach, colon, vagina, lymph nodes
- Fatigue/immunosuppression/erythema (erythema is superficial reddening of the skin) - Late Adverse Effects
- Can take months to years
- Lymph vessels, bones, cartilage, pancreas, uterus, muscle, lung
- Tissue fibrosis (this is the axillary webbing/cording that Suzanne mentioned - when there is actual change to the tissue; if a patient complains of tightness/a feeling of fullness and/or soreness, it is important to stretch and complete ROM to prevent this from forming)
- Secondary cancer
How can an OT play a role in helping a patient and family plan for death?
“OT’s may work with the patient on activities that help the patient plan for death. Reminiscence activities, such as creating memory scrap books, making video “cards,” writing letters, making telephone calls, and arranging visits, are examples of creative tasks that can help a dying person revisit relationships and review life.”
“For a client involved in the active process of dying, having an opportunity to resolve life issues is critical.”
How long does Medicare pay for hospice care?
Medicare will cover the hospice care you get for your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice program.
Hospice care is intended for people with a life expectancy of 6 months or less (if the disease runs its normal course). If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill (with a life expectancy of 6 months or less).
Important: Hospice care is given in benefit periods. You can get hospice care for two 90-day periods followed by an unlimited number of 60-day periods. At the start of each period, the hospice medical director or other hospice doctor must recertify that you’re terminally ill (with a life expectancy of 6 months or less), so you can continue to get hospice care. A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends. Note: You have the right to change providers once during each benefit period.
List typical OT interventions for an OT on a palliative care unit.
“Palliative care is directed directed toward achieving comfort & ease of participation in activity.”
“In palliative care, the OT may assist in promoting positioning for comfort, providing treatment to prevent or relieve pain, promoting engagement in activity that is physically tolerable, & creating an opportunity to engage in a full occupational life view as part of the process of planning for death.”
Typical OT interventions in hospice care?
- “OT’s involved in hospice care may intervene directly with the person who is dying or indirectly with families, volunteers, & caregivers as educators, trainers, & intermediaries to improve the QOL of the person who is dying and those around them. Some examples of this role are to adapt the environment, train caregivers to assist with daily life tasks, counsel for psychologic or emotional issues related to the disease process, and provide assistance with issues concerning death and dying.”
- “OT’s may work with the patient on activities that help the patient plan for death. Reminiscence activities, such as creating memory scrap books, making video ‘cards,’ writing letters, making phone calls, and arranging visits, are examples of creative tasks that can help a dying person revisit relationships and review life.”
- “For a client involved in the active process of dying, having an opportunity to resolve life issues is critical.”
- Primarily a compensatory approach
- Incorporate positioning for comfort & pressure relief
- Family teaching of how to provide care, typically at bed level
Where is lymphedema most likely to occur?
Arms (following axillary lymph node dissection for breast cancer)
Legs (following groin lymph node dissections for melanoma, soft tissue sarcoma, gynecologic cancers)
Can involve the trunk (upper trunk with axillary involvement; genitalia with groin involvement)
Describe in lay terms what cancer is.
Uncontrollable division and spread of cells within the body
In lay terms, what do Stages I-IV of cancer mean?
Stage 1 usually means that a cancer is relatively small and contained within the organ it started in.
Stage 2 usually means the cancer has not started to spread into surrounding tissue but the tumour is larger than in stage 1. Sometimes stage 2 means that cancer cells have spread into lymph nodes close to the tumour. This depends on the particular type of cancer.
Stage 3 usually means the cancer is larger. It may have started to spread into surrounding tissues and there are cancer cells in the lymph nodes in the area.
Stage 4 means the cancer has spread from where it started to another body organ. This is also called secondary or metastatic cancer.
an upright standing position & hypotension means low BP, an excessive fall in BP when an you stand up from sitting or lying down. The consensus definition is a drop of > 20 mm Hg systolic, 10 mm Hg diastolic, or both.
An effect of immobility
Orthostasis
