Cancer OT and End of Life Care

Question 1

Describe hospice care

Answer 1

• Care for individuals with an end-stage terminal illness (within 6 mo. of death)
• Concentration on comfort rather than treating

Question 2

Describe palliative care

Answer 2

-Specialized medical care focused on relief from symptoms of pain, dyspnea, and stress related to chronic or serious illness; delivered @ ANY TIME (e.g. during other tx)

Question 3

List at least 6 goals of OTs in palliative care

Answer 3

• Pain management
• Dyspnea management
• Back precautions
• Energy conservation
• Task simplification
• Positioning
• Adaptive equipment/DME
• Recommendations for home safety/modifications
• Caregiver training

Question 4

What are the basic risk factors for DISEASE related decline in function for patients with cancer?

Answer 4

• Primary or metastatic tumors of skeletal system, brain, or spinal cord
• Obstruction of circulatory or lymphatic system ej: Superior vena cava syndrome
• Physical and psychological response to disease-pain, stiffness, fatigue, anxiety
• Sensory-perceptual alterations

Question 5

What are the basic risk factors for TREATMENT related decline in function for patients with cancer?

Answer 5

• Surgical Intervention-nerve and muscle damage, weakness and sensory changes, localized to area of surgery
• Chemotherapy-distal weakness–>proximal weakness, sensory deficits including neuropathies
• Side effects of radiation therapy-generalized fatigue and weakness
• Side effects of corticosteroid therapy-proximal weakness→ distal weakness

Question 6

What are the primary side effects of chemotherapy?

Answer 6

• alopecia (hair loss)
• peripheral neuropathy (can include neuropathic pain)
• thrombocytopenia (low platelet count, slower clotting time of blood)
• fatigue
• changes in the red blood cell composition of blood (e.g. anemia)
• function limited anxiety and fear
• greater likelihood of infections due to suppressed immune system
• can compromise sensory systems
• can impact cognition (“chemo brain”)

Question 7

What are the primary side effects of radiation therapy?

Answer 7

• fatigue
• immunosuppression
• tissue fibrosis (changes to tissues; can get axillary webbing)
• burns
• changes in skin (dryness, itching, blistering or peeling)

Question 8

How can an OT play a role in helping a patient and family plan for death?

Answer 8

• Adapt the environment
• Train caregivers to assist with daily living tasks
• Counsel for psychological or emotional issues related to the disease process
• Provide assistance with issues concerning death and dying
• May work with patient on activities the help the patient plan for death.

Question 9

How long does Medicare pay for hospice care?

Answer 9

-benefit continues as long your doctor and a hospice doctor continue to certify that you are terminally ill, even if you live longer than 6mo

Question 10

List typical OT interventions for an OT on a palliative care unit.

Answer 10

• Assist in promoting positioning for comfort
• Provide treatment to prevent or relieve pain
• Promote engagement in activity that is physically tolerable
• Create an opportunity to engage in a “full occupational life review” as part of the process of planning for death
• Assistance in resolving life issues

Question 11

What are typical OT interventions in hospice care?

Answer 11

• Incorporate positioning for comfort and pressure relief
• Family teaching of how to provide care, typically at bed level
• Appropriate when the individual wishes to be able to complete self-care at a higher level of independence
• Primarily compensatory approach

Question 12

Where is lymphedema most likely to occur?

Answer 12

1. Arms-following axillary lymph node dissection for breast cancer
2. Legs-following groin lymph node dissection for melanoma, soft tissue sarcomas, gynecologic cancers
   - Can involve the trunk-upper trunk with axillary involvement’ genitalia with groin involvement

Question 13

Describe in lay terms what cancer is.

Answer 13

The body is made up of cells, these cells constantly divide to create new cells or to replace old ones. Cancer is a disease caused by the uncontrolled division of abnormal cells in a part of the body.

Question 14

What happens in Stage I of cancer?

Answer 14

-localized cancer (surgically removed)

Question 15

What happens in Stage II and III of cancer?

Answer 15

• locally advanced (in area; designated as II or II dependent upon specific type of cancer)
• treated by surgery, chemo, radiation

Question 16

What happens in Stage IV of cancer?

Answer 16

Metastasized

Question 17

T/F

Your stage diagnosis changes as you progress through treatment.

Answer 17

FALSE: Your diagnosis when you’re first diagnosed is the diagnosis you keep throughout treatment.

Question 18

Define Orthostasis

Answer 18

trouble regulating blood pressure

Question 19

Define thrombus

Answer 19

a clot of blood formed within a blood vessel and remaining attached to its place of origin

Question 20

Define lymphedema

Answer 20

swelling of the UEs or the LEs due to the damage or removal of lymph nodes (often caused by cancer treatment)

Question 21

Define hypercalcemia

Answer 21

too much calcium in the blood (can cause cognitive impairments)

Question 22

Metastasis

Answer 22

the spread of cancer or other diseases from one organ or body part to another not directly connected to it (these new occurrences of disease are often referred to as “mets”)