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Boardz > Cancer Rehab > Flashcards

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
Q

Rehab implications of bone mets

A

Weight bearing status
MMT/resistive exercises not recommended
Increased pathologic fx at shoulder girdle/pelvis

ECT, body mechanics, task modification

26
Q

Neurological complications of Ca

A

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
Q

Ca Rehab goals

A

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
Q

Ca dx effects on occupational performance

A

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
Q

12 common symptoms of Ca

A

Weakness
Dry mouth
Anorexia
Depression
Pain
Insomnia
Swollen LE
Nausea
Constipation
Vomiting
Confusion
Dyspnea

30
Q

Commonly treated oncology symptoms in OT

A

Pain, chemoinduced peripheral neuropathy
Psychosocial challenges
Ca-related fatigue
Chemobrain

Address to increase occupational performance

31
Q

Cancer Pain

A

Nociceptive mosaic, acute, chronic, tumor-specific, tx related pain, ongoing psychological distress

Sensory/cognitive/physical
Risk of chronic oain

32
Q

Assessment of Ca related pain

A

Subjective experience- McGill pain short form, DASH, shoulder pain and disability index, manual ability measure

Physical signs/biomechanical
Changes

33
Q

Treating Ca pain

A

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
Q

Chemoinduced neuropathy

A

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
Q

Assessment of chemo induced neuropathy

A

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
Q

Intervention for chemo-induced polyneuropathy

A

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
Q

Psychosocial Challenges of Ca

A

Disruption of roles, routines, and habits
Altered social context
Loss of control
Occupational disturbances
Facing mortality and uncertainty
Decreased QOL

38
Q

Assessment of the psychosocial challenged of Ca

A

MOHO-client centered goal settung
Impact of Event Scale
QOL Measurements
Role checklist
Anxiety Management Assessment

39
Q

Tx of psychosocial challenges of Ca

A

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
Q

Cancer related fatigue

A

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
Q

Assessing Ca related fatigue

A

Self-report assessments
Revised Piper Fatigue Inventory
Multidimensional fatigue inventory
Fatigue symptom inventory
Multidimensional Fatigue symptom inventory short form
Brief Fatigue inventory

42
Q

Ca related fatigue treatments

A

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
Q

Fatigue/intensity pyramid and tx

A

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
Q

ECT

A

Deliberate planned management of one’s personal energy resources to prevent depletion

Planning, prioritizing, pacing, positioning, permission

45
Q

Chemobrain

A

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
Q

Assessment of Chemobrain

A

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
Q

Compensatory Tech for chemobrain

A

Social skills training, self-instructional training, reading material, applied relaxation

Computer based attention tasks

COOP: client develops own strategies

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