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Cancer Rehab Flashcards

1
Q

Most common Ca in men

A

Descending order
Prostate
Lung/bronchus
Colon/rectal
Urinary bladder
Melanoma of skin
Kidney/renal
Non-hodgkins lymphoma
Oral/pharynx
Leukemia
Pancreas

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2
Q

Most common Ca in women

A

Descending order
Breast
Lung/bronchus
Colon/rectum
Uterine
Thyroid
Melanoma of skin
Non-hodgkins lymphoma
Kidney/renal
Pancreas
Leukemia

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3
Q

Benign tumors

A

Cell of origin + oma
Not Ca, slow growing rarely life threatening local, non-invasive

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4
Q

Malignant tumors

A

Epithial tissue +sarcoma/carcinoma
Ca rapid growth, may be life threatening, capable of spreading by invasion or metastasis

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5
Q

Carcinoma

A

Skin/tissue lining covering, internal organ

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6
Q

Sarcoma

A

Bone, cartilage, fat, muscle, blood vessel, connective/supportive tissues

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7
Q

Leukemia

A

Bone marrow, blood forming tissue

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8
Q

Lymphoma/myeloma

A

Cells of immune system

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9
Q

Central nervous system

A

Tissue of brain and SC

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10
Q

TMN scale

A

Scale size location extent of mestasis
Primary tumor, lymph node involvement

Guides tx and prognosis
T Tumor size 1-4
N lymph involvement 0-3
M absence/presence of metastasis M0 M1

Stages
1 T1 N0 M0
2 T2 N1 M0
3 T3 N2 M0
4 T4 N3 M1

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11
Q

Cancer spread

A

Invasion-direct migration/penetration of neighboring tissues

Metastasis-penetrate into lymphatic/blood vessels, circulate through bloodstream, invades normal tissue else where in the body, certain body sites sites are more likely to develop mets than other sites

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12
Q

Cancer treatments

A

Surgery
Radiation (external, internal, systemic)
Chemotherapy
Hormone tx
Bone marrow/stem transplant
Clinical trials

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13
Q

Surgery side effects

A

Pain, fatigue, limited endurance, infection risk, blood clot/PE, altered body image, weight bearing restrictions, swellings

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14
Q

Radiation side effects

A

Fatigue, headaches, nausea, vomiting, skin changes, radiation fibrosis, mucositis, cognitive changes, GI disorder, pulmonary fibrosis, infertility

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15
Q

Chemotherapy: neoadjuvant vs adjuvant

A

Neoadjuvant-shrink ca before removal

Adjuvant- kills remaining Ca cells

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16
Q

Chemo side effects

A

Bone marrow suppression, nausea, vomiting, hair loss, ototoxicity, appetite loss, change in taste, mucositis, diarrhea/constipation, fatigue, multiorgan damage, central cranial nervous system change, peripheral neuropathy, cognitive changes, reproductive/sexual changes

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17
Q

Hormone therapy side effects

A

Systemic-adds, block, removes hormones, used with breast/prostate Ca, delivered via medication or surgery

Weight gain, hot flashes, night sweats, nausea, changes in fertility, loss of libido, joint pain

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18
Q

Bone marrow/stem cell replacement

A

Autologous transplant: pt receives own stem cell

Syngeneic transplant: pt received from identical twin

Allogenic transplant: receives from brother, sister, or parent, unrelated donor may be used

Process: collect pt’s bone marrow/blood- process in lab to purify/concentrate stem cell-reinfuse after thawing

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19
Q

Bone marrow sx side effect

A

Low blood count, poor nutrition, fatigue, gradt vs host disease, infections, GI infections

20
Q

Graft vs host disease

A

When blood of donor attacks blood cells of host

Sx: damage skin, liver, and intestine

Skin leads to joint contracture, fmc, gmc, decreased ambulation

Tx with serial splinting, stretching, and activity modification

21
Q

Ca tx continuum

A

Pretreatment: newly dx, no tx initiated
Active care: tx with curative goal
Maintenance: LT therapy to maintain remission/control
Postcare: tx complete with no evidence of d/s
Palliation: tx for incurable Ca

22
Q

Considerations when treating Ca patient

A

Where is client in tx phase of dx
Progression of disease, obtain activity parameter MD
Ca pain
Ca fatigue
Edema/lymphedema
DVT/PE
Psychosocial
Hematological
Bone mets
Neurological change
Sudden changes in fxnal/neurocog level

23
Q

Hematological considerations

A

Not ca type specific
Thrombocytopenia which is decreased platelets leading to increased bed risk, norm 200-400k/mm3, less than 20K avoid activities that increase bleeding risk

Anemia, decreased HgB, norm 10-12, avoid high intensity

Decreased WBC, neutropenia, increased risk for infection, norm is 4000-10000 mm3 if febrile avoid strenuous exercise

24
Q

Bone Mets: osteolytic vs. osteoblastic

A

Osteolytic- bone breakdown
Osteoblastic- areas with decreased bone production

Can have both

25
Rehab implications of bone mets
Weight bearing status MMT/resistive exercises not recommended Increased pathologic fx at shoulder girdle/pelvis ECT, body mechanics, task modification
26
Neurological complications of Ca
Seizures, increased jntracranial pressure, spinal precaution, hydrocephalus, change in mental status Signs: abnormal gait, dysarthria, decreased balance, weakness, lethargy, change in cognition, sudden confusion, impaired judgment, decreased safety awareness
27
Ca Rehab goals
Preventative stage: preop education/training, improv general health/function Restorative: establish, restore, prevent, return to PLOF Supportive: modify, prevent, maintain, accommodation training for existing disabilities, minimize debility Palliative: modify, maintain Best QOL for client and family Balance b/n fxn and comfort
28
Ca dx effects on occupational performance
Negative impact on volition, habits, mind/body performance Affects return to work and meaningful roles Associated with fear/anxiety, altered roles Negative effects on family unit Adapt/promote new performance pattern Change context/environment Modify activity demands
29
12 common symptoms of Ca
Weakness Dry mouth Anorexia Depression Pain Insomnia Swollen LE Nausea Constipation Vomiting Confusion Dyspnea
30
Commonly treated oncology symptoms in OT
Pain, chemoinduced peripheral neuropathy Psychosocial challenges Ca-related fatigue Chemobrain Address to increase occupational performance
31
Cancer Pain
Nociceptive mosaic, acute, chronic, tumor-specific, tx related pain, ongoing psychological distress Sensory/cognitive/physical Risk of chronic oain
32
Assessment of Ca related pain
Subjective experience- McGill pain short form, DASH, shoulder pain and disability index, manual ability measure Physical signs/biomechanical Changes
33
Treating Ca pain
May need clearance, prep for occupational performance Therex Graded purposeful activity Postural re-education STM, mob, massage Tens/heat/cold need clearance Psychosocial: distraction, anxiety mgmt Lifestyle readjustment: goal setting, task modification, work simplification Adapt environment, seating, pressure care Education Pain awareness/identifying triggers
34
Chemoinduced neuropathy
Polyneuropathic, early at fingers/toes, symmetric stocking-glove distribution May occur after/during chemo tx Symptoms: paresthesia, hyper/hypothesis, dyesthesia, pain, numbness/tingling, hyporeflexia, areflexia, impaired proprioception, decreased vibratory/cutaneous sensation, decreased discrimination
35
Assessment of chemo induced neuropathy
Sensory 2 point discrimination, temp awareness Balance berg balance, ABC scale Outcome measures: moberg pick up test, DASH Functional time test-typing speed or error rate
36
Intervention for chemo-induced polyneuropathy
CIPN education: s/s, foot care/proper shoes, compensatory strategies visual input, risk of ischemic/thermal Injury, fall prevention, sx management of autonomic dysfunction AE for CIPN: button hook, zipper pulls, finger tip moisteners/grips, built Up handles, thimbles, nonslip matting, elastic lace, AD, jar opener Therex Activity pacing/grading: retrace old handwriting, take breaks, ECT, task with visual feedback, Practice/simulate occupation Desensitization: graded exposure, TENs, vibration, movement
37
Psychosocial Challenges of Ca
Disruption of roles, routines, and habits Altered social context Loss of control Occupational disturbances Facing mortality and uncertainty Decreased QOL
38
Assessment of the psychosocial challenged of Ca
MOHO-client centered goal settung Impact of Event Scale QOL Measurements Role checklist Anxiety Management Assessment
39
Tx of psychosocial challenges of Ca
Use occupational engagement to recognize assets, success/abilities, assist with goal setting, face mortality through occupation, foster social relationships, renegotiating identity Guided imagery Stress mgmt Adapt activity demands for success Awareness/mindfulness Relaxation technique Breathing technique Lifestyle redesign/mgmt CBT
40
Cancer related fatigue
Distressing, persistent, subjective sense of physical, emotional, cognitive tiredness or exhaustion related to Ca and treatment, not proportional to activity, interferes with function General fatigue Mental fatigue Physical fatigue Emotional fatigue
41
Assessing Ca related fatigue
Self-report assessments Revised Piper Fatigue Inventory Multidimensional fatigue inventory Fatigue symptom inventory Multidimensional Fatigue symptom inventory short form Brief Fatigue inventory
42
Ca related fatigue treatments
Pharmacological approach Complementary and alternative treatment Exercise/graded activity Education/psychosocial (guided imagery, CBT): decreased sx if distress, increase adherence to tx, increased social support, increased QOL Life
43
Fatigue/intensity pyramid and tx
7-10 Low intensity: grooming at EOB, education seated at EOB, eating EOB, handwriting/typing, breathing tech, reading standing Mild intensity: slow walking, yoga, stretching, light housekeeping, tai chi 4-6 moderate intensity: swimming, stairs, sweeping, vacuuming, meal prep, fast speed walking, showering 1-3 high intensity: running, cycling, body building, IADLs, high impact aerobics
44
ECT
Deliberate planned management of one’s personal energy resources to prevent depletion Planning, prioritizing, pacing, positioning, permission
45
Chemobrain
24-50% Cognitive disturbances Increases upon return home and resuming roles Sx: memory lapse, decreased concentration, decreased multi-tasking, slower processing speed, difficulty with word retrieval Resolves 6-9 months
46
Assessment of Chemobrain
Cognitive assessment may not quantify impairment Top-down assessment in everyday environment: EFPT, kettle test, multiple errands test Bottom up in specific areas of dysfunction like attention or memory after top-down assessment: test of everyday attention, rivermead behavioral memory test-extended Neuro behavioral assessment A one
47
Compensatory Tech for chemobrain
Social skills training, self-instructional training, reading material, applied relaxation Computer based attention tasks COOP: client develops own strategies

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