Cancer Treatment

Question 1

What is mechanism of cancer? (In other words, what is cancer the result of?)

Answer 1

Rapid, uncontrolled proliferation of primitive and undifferentiated cells

Question 2

What are the 3 main cancer treatments?

Answer 2

1. Surgery (Resection)
2. Radiation
3. Chemotherapy

Question 3

Cancer Drug Strategy #1 - Cytotoxicity

Answer 3

Goal = Limit cell proliferation by killing cancer cells or limiting growth

Question 4

What risk is associated with cancer drugs that target the killing of cancer cells?

Answer 4

These drugs lack specificity - Not only will cancer cells be destroyed, but normal, healthy human tissue will be negatively impacted as well

Question 5

Cancer Drug Strategy #2 - Cell Kill Hypothesis

Answer 5

Each round of chemotherapy will kill a certain % of cancer cells, which is why multiple rounds are needed. As a result of this hypothesis, chemotherapy can never completely kill/eliminate the tumor because some cells will survive each round

Question 6

What happens once the chemotherapy can no longer eliminate the tumor, but the tumor has shrunk significantly

Answer 6

The body’s endogenous defense mechanisms will take over (leading to remission)

Question 7

Adverse effects of chemotherapy

Answer 7

GI disturbances, anemia, weight loss, cough, constipation

Question 8

What kind of therapeutic index do chemotherapy drugs have?

Answer 8

VERY LOW TI

Question 9

Which group of chemotherapy drugs prevent DNA function and replication?

Answer 9

Alkylating agents

Question 10

Which group of chemotherapy drugs impair cell’s ability to synthesize normal DNA and RNA?

Answer 10

Antimetabolites

Question 11

Which group of chemotherapy drugs have side effects that are too toxic for the treatment of anything other than cancer?

Answer 11

Anticancer antibiotics

Question 12

Which group of chemotherapy drugs disrupt mitosis and keep the cell from dividing/proliferating?

Answer 12

Topoisomerase inhibitors

Question 13

What kind of cancer drugs can be used as adjunctive therapy (to surgery, radiation, or other chemo drugs) to block the effects of hormones that exacerbate certain types of cancer?

Answer 13

Anticancer hormones
Ex: Estrogen receptor blockers – Prevent & treat breast & uterine cancers stimulated by estrogen

Question 14

What kind of cancer drugs attempt to find biochemical characteristics that are specific to cancer cells?

Answer 14

Monoclonal Antibodies - “Targeted” therapies

Question 15

What is the potential benefit of Monoclonal Antibodies?

Answer 15

Since they are manufactured using cell cloning, they do NOT effect healthy tissue when administered & are only attracted to the cancer cells – One of the most promising advancements!

Question 16

What are angiogenesis inhibitors?

Answer 16

Form of monoclonal antibodies that inhibit the formation of blood vessel growth within tumors

Question 17

Which group of chemotherapy drugs consist of small proteins that play a role in modulating immune responses & stimulate immune mechanisms that would normally deal with abnormal cell proliferation?

Answer 17

Cytokines

Question 18

Which group of chemotherapy drugs can prevent colorectal cancer as well as reduce the risk of stomach, esophagus, breast, prostate & lung cancer?

Answer 18

Aspirin & other NSAIDs
Mechanism is likely platelet inhibition

Question 19

Can chemotherapy drugs be used in combination?

Answer 19

Yes! Several types can be administered together and have shown increased success in treating the cancer

Question 20

Cancer side effects

Answer 20

Pain, Depression/Anxiety, Premature Menopause (osteoporosis risk)

Question 21

What PT implications do cancer drugs present?

Answer 21

Patients may be extremely fatigued, dealing with blood disorders and GI problems, or experiencing neurotoxic effects (peripheral neuropathy, convulsions, ataxia, confusion, and anxiety)

Educate patient on transient nature of side effects

Question 22

More side effects of chemotherapy

Answer 22

Immunosuppression!!
Anemia, hemorrhage, cardiac/pulmonary compromise, neuropathies, mood changes
“Chemo Brain”

Question 23

Cancer patients should NOT exercise within how many hours after chemotherapy administration?

Answer 23

2 hours

Question 24

After chemotherapy how quickly does fatigue typically set in?

Answer 24

Rises sharply within the first 24-48 hours

Question 25

When does fatigue PEAK after chemotherapy?

Answer 25

4-5 days post-treatment

Question 26

What exercise plan is best for this patient population?

Answer 26

Balance between rest & exercise, fall prevention
Include strength (high rep, low weight), energy conservation, & endurance

Question 27

What exercise prescription has shown decreased fatigue and improved physical performance?

Answer 27

6 weeks of LOW-MODERATE endurance training + 30 minutes on treadmill per day

Question 28

What are some long-term effects of cancer treatment?

Answer 28

Skin ulcers – Develop 10-20 years after
Fibrosis + Loss of skin elasticity
CNS Neuropathies – 20-30 years after
Osteoporosis, heart/lung disease, metastasis, etc.

Question 29

How can we prevent chronic connective tissue changes & fibrosis?

Answer 29

Emphasize stretching for 18-24 months after treatment to counteract effects

Question 30

What is cancer related fatigue (CRF)?

Answer 30

Most common reported symptom of cancer/cancer treatment that is NOT relieved with rest or related to excess activity
Lasts > 2 weeks & can persist for months to years

Question 31

Epidemiology of CRF

Answer 31

NEGATIVELY correlated with age (younger > older)
Most common in lung, GI, UG & hematologic pts
Can be a result of tumor induced hypermetabolic state or a cumulative effect (increased risk with more chemo)

Question 32

Interventions for CRF

Answer 32

EXERCISE! ~ 15-30 mins 4 days/week (aerobic)
Education on stress relief, energy conservation, & pain relief. “Attention restoring activities”