Cancer rehabilitation and Fatigue CBM Flashcards
1
Q
What is Cancer Rehabilitation?
A
- Helping a person with cancer to reach maximum physical, social, psychological and vocational functioning within limits of disease and treatment.
2
Q
What are the goals of rehabilitation?
A
- Preventative rehab.
- pre-op education
- eg how to maintain strength and ROM in arm after breast surgery
- Restorative care
- return person with minimal functional impairments to pre morbid state
- Supportive care
- reduce functional difficulties and compensate for permanent deficits.
- Palliative treatment
- maintain functional capacity and mobility for a period of time
- Conserve energy, assist devices, body mechanics
- symptom management
3
Q
What roles do team members play in rehab?
A
- Nurse
- triage, screening, assessment, follow up, navigation of hospital system, arranging home care
- teaches strategies for managing symptoms
- Physiotherapist
- evaluates strength, moblity, endurance, joint ROM
- exercises (transfers, gait, stairs)
- Occupational therapist
- self care, leisure activities, chores, physical and social environment
- cognition
- CHAMPS score weekly
- energy conservation
- goal setting, counselling
- cognitive retraining
- communication with community agencies
- joint/bone protection
- neuropathy management
- scar management
- Dietitian
- nutritional status
- weight/BMI
- screening tools
- Supplements
- Social worker
- psychosocial needs of cancer patients
- financial / legal needs
4
Q
What is cancer related fatigue? Asthenia
A
- distressing, persistent subjective sense of tiredness or exhaustion related to cancer or tretaments that is not proprotional with recent activity
- Interferes with function
- general fatigue, physical fatigue, emotional fatigue, mental fatigue
- not relieved by rest
5
Q
Contributors to Fatigue
A
- Cancer
- Treatment (chemo, RT, surgery). Can persist for months or years beyond treatment
- Nutrition
- Symptoms
- Activities
- Emotions
- Poor sleep
6
Q
Changes associated with fatigue
A
- decreased cognitive function
- decreased muscle endurance
- decreased sleep quality
- decreased control over body processes
- increased social withdrawal
- increased emotional reactivity
7
Q
What is the pathophysiology of cancer related fatigue?
A
- Pain
- Symptoms of energy imbalance (anorexia-cachexia, linfection, paraneoplastic syndromes, metabolics disorders)
- anemia
- chronic inflammatory state
- cytokines
- treatment
- Chronic stress
- HPA axis –> increased cortisol levels.
- fatigue
- depressio
- Neuroendocrine dysfunction
- interferon alpha –> severe fatigue
- hypothyroidism –> fatigue
- Cardiac or pulmonary dysfunction
8
Q
Assessment of fatigue
A
- National Comprehensive Cancer Network rating scale
- FACT-F scale
- Multidimensional Fatigue INventory MFI
9
Q
Mangement of CRF
A
- multidimensional treatment
- nutritional counselling
- exercise
- ergonomic advice
- correction of hormonal and metabolic abnormalities
- pharmacological
- energy conservation
- sleep therapy
- stress reduction
10
Q
Exercise and CRF
A
- best evidence for effectiveness
- counteracts negative effects of tumour and therapy
- improved cardiovascular, pulmonary and muscular functioning
- imrpoved 02 consumption, stroke volume, cardiac output, vascularization, lymphatic circulation, muscle tone, strength, coordinationg, balance, metabolic rate
- sedentary behaviour = deconditioning, poor symptom control and poorer clinical outcome
11
Q
Guidelines for exercise program?
A
- evaluate for peripheral neuropathies and MSK morbidities
- fracture risk evaluation (hormonal therapies, metastatic bone disease)
- known cardiac condition (treatment related or not) need risk assessment
ACSM (America College of Sports Medicine) guidelines for cancer survivors:
150 min / week of moderate exercise OR
75 minutes / week of vigorous exercise
12
Q
Pharmacological treatment for CRF
A
- review drugs that cause fatigue (BB, benzos, antihistamines, opioids, barbituates)
- Erythropoeitin
- anemia related to chemotherapy ONLY
- Transfusion Hg< 70-80
- chemotherapy
- SSRI for depression -related fatigue
- paroxetine 20 mg od
- double blind placebo study - no improvement in fatigue
- Methylphenidate
- CRF, depression, somnolence, cognition
- Modafinil
- narcolepsy, shift work sleep disorder, OSA
- DBPCT in chemo patients, oral modafinil benefitted severe fatigue
- Steroids
- duration 4-6 weeks only
- Short term only, antiinflammatory effect
13
Q
List components of an interprofessional cancer nutrition and rehab program
A
- Nursing interventions
- Patient passport
- caregiver support
- medication teaching and followup
- regular symptom evaluation
- dietary interventions
- nutritional advice, food related discomfort, mealtime routines
- psychosocial interventions
- individual therapy
- couples therapy
- legal and financial support
- group interventions
- physiotherpay
14
Q
Group interventions for CFR
A
- what is Cancer rehab?
- recognizing CRF
- managing anxiety
- complementary therapies and activities that heal
- nutrition
- exercise and cancer
- life after cancer
- massage therapy
15
Q
Physiotherapy for rehab
A
- aim to relieve fatigue
- supervised exercise 2x/week for 30-45 min
- cardiovascular on bicycle and treadmill
- strengthening, stretching, ROM
- balance exercises
- patient education re: walking aids
- patient/caregiver support
