Cancer Rehab Flashcards
Most common Ca in men
Descending order
Prostate
Lung/bronchus
Colon/rectal
Urinary bladder
Melanoma of skin
Kidney/renal
Non-hodgkins lymphoma
Oral/pharynx
Leukemia
Pancreas
Most common Ca in women
Descending order
Breast
Lung/bronchus
Colon/rectum
Uterine
Thyroid
Melanoma of skin
Non-hodgkins lymphoma
Kidney/renal
Pancreas
Leukemia
Benign tumors
Cell of origin + oma
Not Ca, slow growing rarely life threatening local, non-invasive
Malignant tumors
Epithial tissue +sarcoma/carcinoma
Ca rapid growth, may be life threatening, capable of spreading by invasion or metastasis
Carcinoma
Skin/tissue lining covering, internal organ
Sarcoma
Bone, cartilage, fat, muscle, blood vessel, connective/supportive tissues
Leukemia
Bone marrow, blood forming tissue
Lymphoma/myeloma
Cells of immune system
Central nervous system
Tissue of brain and SC
TMN scale
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
Cancer spread
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
Cancer treatments
Surgery
Radiation (external, internal, systemic)
Chemotherapy
Hormone tx
Bone marrow/stem transplant
Clinical trials
Surgery side effects
Pain, fatigue, limited endurance, infection risk, blood clot/PE, altered body image, weight bearing restrictions, swellings
Radiation side effects
Fatigue, headaches, nausea, vomiting, skin changes, radiation fibrosis, mucositis, cognitive changes, GI disorder, pulmonary fibrosis, infertility
Chemotherapy: neoadjuvant vs adjuvant
Neoadjuvant-shrink ca before removal
Adjuvant- kills remaining Ca cells
Chemo side effects
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
Hormone therapy side effects
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
Bone marrow/stem cell replacement
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
Bone marrow sx side effect
Low blood count, poor nutrition, fatigue, gradt vs host disease, infections, GI infections
Graft vs host disease
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
Ca tx continuum
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
Considerations when treating Ca patient
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
Hematological considerations
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
Bone Mets: osteolytic vs. osteoblastic
Osteolytic- bone breakdown
Osteoblastic- areas with decreased bone production
Can have both
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
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
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
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
12 common symptoms of Ca
Weakness
Dry mouth
Anorexia
Depression
Pain
Insomnia
Swollen LE
Nausea
Constipation
Vomiting
Confusion
Dyspnea
Commonly treated oncology symptoms in OT
Pain, chemoinduced peripheral neuropathy
Psychosocial challenges
Ca-related fatigue
Chemobrain
Address to increase occupational performance
Cancer Pain
Nociceptive mosaic, acute, chronic, tumor-specific, tx related pain, ongoing psychological distress
Sensory/cognitive/physical
Risk of chronic oain
Assessment of Ca related pain
Subjective experience- McGill pain short form, DASH, shoulder pain and disability index, manual ability measure
Physical signs/biomechanical
Changes
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
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
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
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
Psychosocial Challenges of Ca
Disruption of roles, routines, and habits
Altered social context
Loss of control
Occupational disturbances
Facing mortality and uncertainty
Decreased QOL
Assessment of the psychosocial challenged of Ca
MOHO-client centered goal settung
Impact of Event Scale
QOL Measurements
Role checklist
Anxiety Management Assessment
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
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
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
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
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
ECT
Deliberate planned management of one’s personal energy resources to prevent depletion
Planning, prioritizing, pacing, positioning, permission
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
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
Compensatory Tech for chemobrain
Social skills training, self-instructional training, reading material, applied relaxation
Computer based attention tasks
COOP: client develops own strategies
