K!N4E4 Midterm 1 Flashcards
What is a disease?
an abnormal condition of the body or mind that negatively affects the structure or function of an organism that is not due to an external injury
What does a disease broadly refer to?
any condition that impairs the normal functioning of the body or mind
What is a chronic disease?
- a disease that persists for a long time
- long-lasting conditions that usually can be controlled but not cured
What are chronic diseases defined as?
conditions that last >1 year and require ongoing medical attention and/or limit activities of daily living
What are 6 key features of a chronic disease?
- persistent or long duration (at least 1 year)
- not passed from person to person (no vaccine)
- not curable by medical treatments (“managed”)
- does not disappear on its own (can be relapsing)
- generally gets worse over time (progressive)
- progression is usually slow (i.e., years)
What are 7 major categories of chronic disease?
- Cardiovascular diseases (CHF, PAD)
- Respiratory diseases (COPD, asthma)
- Metabolic diseases (diabetes, obesity)
- Immunological/hematological (cancer, HIV)
- Orthopedic diseases (arthritis, lower back pain)
- Neuromuscular diseases (stroke, Parkinson’s)
- Cognitive/psychological (mental health)
How many organs and organ systems does the human body have?
≈80 organs and ≈12 organ systems
What are 11 key characteristics “steps” of a chronic disease?
- biology / “pathophysiology” of the disease
- etiology (causes) of the disease
- subtypes (classifications, categories)
- severity (mild, moderate, severe)
- signs/symptoms (indicators of disease)
- diagnosis (identification) of the disease
- prognosis of the disease (probable course/outcome)
- complications (further problems from disease/treat)
- treatments (pharmacology, medical management)
- treatment side effects (nausea, diarrhea)
- scope/epidemiology (incidence, prevalence, mortality)
What 4 terms indicate a “problem”?
- Sign: objective evidence of disease that can be observed by others (especially doctors)
- Symptom: subjective evidence of disease that is experienced (felt) by the patient
- Side effect: unintended adverse reactions (effects or events) to a treatment for the disease
- Complication: a secondary disease/disorder arising as a consequence of another disease (or treatment)
What are 3 types of symptoms?
- Remitting symptoms: symptoms that improve or resolve completely.
- Chronic symptoms: long-lasting or ongoing symptoms.
- Relapsing symptoms: symptoms that have occurred in the past, resolved, and then returned
What are 3 types of side effects?
- Acute: side effects that occur during treatment and remit when treatment is stopped.
- Chronic: side effects that occur during treatment and continue (linger) after treatment is stopped.
- Late-appearing: side effects that do not occur during treatment but appear long after treatment is stopped.
What are the 2 ultimate outcomes in medicine?
longevity and QoL
What is the prevalence of chronic diseases among Canadian adults?
44% of adults 20+ have at least 1 of 10 common chronic conditions
What are top 5 most common Canadian chronic conditions for adults 20+?
Hypertension (25%)
Osteoarthritis (14%)
Mood / Anxiety Disorder (13%)
Osteoporosis
Diabetes
What is the prevalence of chronic diseases among Canadians ages 65+?
73% have at least 1 of 10 common chronic diseases
What are the top 5 most common chronic conditions for adults aged 65+?
Hypertension (65.7%)
Periodontal Disease (52%)
Osteoarthritis (38%)
Ischemic heart disease
Diabetes
In women aged 65+, what are they most likely to be diagnosed with for CD? (5)
Osteoarthritis
Osteoporosis
Dementia
Asthma
Rheumatoid Arthritis
What CD do women have a 196% higher chance of getting than men?
Osteoporosis
What CD do men have a 88% higher chance of getting than women?
Gout
In men aged 65+, what are they most likely to be diagnosed with for CD? (5)
Hypertension
Ischemic Heart disease
Chronic Obstructive Pulmonary Disease
Diabetes
Heart Failure
How many adults in the US have a CD?
6 in 10
How many adults in the US have two or more CD?
4 in 10
What is the #1 risk factor for CD?
Age
What % of US adults have more than 1 chronic condition? What % have at last 1?
42%
60%
What is the estimated amount of years that people will gain by 2040 with a major illness? Any illness?
2.5 years longer
5.5 years longer
Exercise may benefit (or harm) patients with CDs by affecting what?
- the disease
- the symptoms
- the side effects of other treatments
- potential complications
can be direct or indirect
Exercise may benefit (harm) patients with CDs by affecting what exercise-treatment interactions?
- treatment necessity (avoid or require)
- treatment volume (dose/duration)
- treatment adherence/completion (tolerance)
- treatment response (make treatments more/less effective)
- treatment eligibility (fitness/health)
What 3 things are greater while using exercise as CD management?
- potential benefits are greater
- potential risks/harms are greater
- potential barriers are greater
What is the goal of chronic disease management?
To prevent or slow down CD
What 4 outcomes is exercise trying to directly or indirectly influence?
(1) treat disease
(2) prevent complications,
(3) treat symptoms/side effects
(4) improve general health (fitness, function)
What does the level/quality of evidence inform?
the strength of the recommendation, along with other factors
What does quality of evidence indicate?
the extent to which one can be confident that estimates of effects are correct
What does the strength of a recommendation indicate?
the extent to which one can be confident that adherence to the recommendation will do more good than harm
What is a Systematic Review?
an attempt to gather all available empirical research using systematic methods to answer a specific research question
What is a meta-analysis?
the statistical process of combining results from several independent but similar studies
What does a SRMA provide?
a more precise estimate of effect than any single study
What should SRMA be based on?
PICOS
What is PICOS?
Population
Intervention
Comparison
Outcome
Study quality
What are RCT’s?
Developed in 1950s to measure and compare the outcomes of two or more clinical (medical) interventions
What is the goal of RCT’s?
Avoid bias (any factor or process that causes the results or conclusions of a trial to divert systematically from the truth)
What are randomized RCT’s?
all participants have the same chance of being assigned to each study group
What are controlled RCT’s?
one of the study groups does not receive the experimental intervention (standard of care, placebo, no intervention at all)
What is the intervention group in an RCT?
also referred to as experimental group, treatment group, or specific intervention group (exercise group)
What is the control group in an RCT?
also referred to as comparison group, placebo group, standard care, usual care, wait-list
What are the 2 ethical basis of RCT?
Clinical equipoise
Uncertainty principle
- you must have proof, not belief
What is clinical equipoise?
“genuine uncertainty in the professional community over whether or not the treatment will be beneficial”
What is the uncertainty principle?
“physicians who are convinced that one treatment is better cannot ethically randomize their patients”
What determines external validity or generalizability?
Sampling and setting
How do you sample for RCT’s?
randomly selected from a well-defined population with minimal eligibility criteria (selection bias)
What is the crucial component of high quality RCTs?
Randomization! all units have the same chance of being assigned to each study arm
What are 2 important steps in randomization?
- generation of an unpredictable allocation sequence.
- concealment from persons enrolling participants
What is blinding in an RCT?
“any attempt to keep one or more of the people involved in the trial unaware of the group assignment, endpoints (outcomes), or hypotheses”
What is the purpose of blinding?
to reduce ascertainment or observation bias
What 4 things can you blind for group assignment?
(a) participants
(b) interventionists (care providers)
(c) outcome assessors
(d) data analysts
What is an intention-to-treat (ITT) analysis?
all participants are analyzed according to their group assignment.
missing data is estimated (multiple imputation)
What are 3 important things when reporting results for RCT’s?
- present baseline demographic/medical variables for each group
- present all primary and secondary
endpoints for each group (baseline, posttest, change scores, precision estimates, and exact p level) - avoid selective reporting (endpoints, time points, or subgroup analyses)
What are 5 limitations of RCT’s?
- difficult to test multiple interactions.
- labor-intensive and expensive.
- difficult to standardize across sites.
- time consuming to complete.
- some questions do not lend themselves
to RCTs (natural disasters, negative events or behaviors, rare outcomes, long term effects)
What are 6 challenges of exercise RCT’s?
is there really clinical equipoise?
recruitment/selection biases
impossible to blind patients/staff.
adherence/contamination problems.
problems with drop outs (attrition).
long term RCTs are challenging
What trial provides the highest level of evidence?
RCT’s
- should conduct RCT’s whenever feasible
What is cancer?
- a series of genetic mutations that allow cells to grow and divide indefinitely
- cancer cells often accumulate and adhere together to form a “tumor” or “neoplasm”
What are benign tumors?
tumors that grow and enlarge only at the site where they began
What are malignant tumors?
tumors that invade and destroy normal tissue
What are the 2 main categories of cancer?
Hematologic (blood) cancers
Solid tumor cancers
What are hematologic cancers?
cancers of the blood cells, including leukemia, lymphoma, and multiple myeloma
What are solid tumor cancers?
cancers of any of the other body organs or tissues. Most common are breast, prostate, lung, and colorectal cancers
What are the 5 major categories of cancer?
Carcinomas
Sarcomas
Leukemias
Lymphomas
Central Nervous System Cancers
What are carcinomas?
occur on skin or tissues that line internal organs
What are sarcomas?
occur in the bone, cartilage, fat, muscle, blood vessels, or other connective or support tissue
What are leukemias?
occur in the cells of the blood and bone marrow
What are lymphomas?
occur in the cells of the immune system and appear within the lymphatic system
What are central nervous system cancers?
occur in the cells of the brain and spinal cord
How many mutations occur every time a normal cell divides?
~3
Cancer is caused by what 3 types of mutations?
inherited (5%),
environmentally induced (29%),
random errors during normal DNA replication (66%).
What % of cancers are preventable?
42%
(smoking 19%
obesity 7.8%)
How are most cancers detected?
by symptoms/signs, incidentally by other medical tests, or screening
What is usually needed to confirm cancer?
usually a biopsy reviewed by pathologist under a microscope
What is a benefit and disadvantage of screening?
benefit: screening detects cancers early (asymptomatic)
disadvantage: screening cannot diagnose cancer (suspicious)
What is tumor grade?
how abnormal tumor cells/tissues look under a microscope
- indicator of how quickly a tumor is likely to grow and spread
What is the tumor grading system (GX-G4)?
GX: Grade cannot be assessed (undetermined grade)
G1: Well differentiated (low grade)
G2: Moderately differentiated (intermediate grade)
G3: Poorly differentiated (high grade)
G4: Undifferentiated (high grade)
What is cancer severity?
severity or extent to which the disease has spread.
most common is Tumor, Node, Metastasis (TNM)
What is TNM?
Tumor, Node, Metastasis
What is Tumor in TNM?
indicates the size of the primary tumor and the degree of spread into nearby tissues (local invasion)
What is Node in TNM?
indicates whether or not the cancer has spread to nearby lymph nodes, the size of the nodes that contain cancer and how many lymph nodes contain cancer
What is metastasis in TNM?
indicates whether or not cancer has spread (metastasized) to distant organs
What is stage 0?
carcinoma in situ
What is stage I and II?
the cancer is limited to the organ or location where it began or it may have spread to nearby structure (localized spread)
What is stage III?
the cancer has spread further into a surrounding structure or to the regional lymph nodes (regional spread)
What is stage IV?
the cancer has spread to a distant site in the body (metastatic spread)
What is the #1 “modifiable” cause of cancer?
Smoking!
What is the situ stage?
Abnormal cells are present but have not spread to nearby tissue
What is the localized stage?
Cancer is limited to the place where it started, with no sign that it has spread
What is the regional stage?
Cancer has spread to nearby lymph nodes, tissues, or organs
What is the distant stage?
Cancer has spread to distant parts of the body
What is the unknown stage?
There is not enough info to figure out the stage
What is incidence?
how many people get cancer (new cases)
What is probability of developing?
what % of people get cancer
What is mortality?
how many people die from cancer
What is the probability of dying?
what % of people die from cancer
What is the relative (net) survival? (short)
likelihood of surviving cancer
What is the prevalence?
how many people have (or survived) cancer
What % of cancers that women get are related to sex organs?
40%
What % of deaths are from cancer? Heart disease? in canada
28.2% cancer
18.5% heart disease
What is absolute (observed) survival?
the percentage of people alive at a certain time point (usually 5 years in cancer)
What is the relative (net) survival?
the percentage of people alive at a certain time point after accounting for deaths from other causes (usually 5 years in cancer)
what does the relative survival rate show?
shows whether the disease shortens life
How is relative survival calculated?
calculated by dividing the % of patients with the disease who are alive at the end of a time period by the % of people in the general population (same sex and age) who are alive at the end of the same time period
What are the 2 most common prevalence’s in Canada?
Breast 19.4%
Prostate 17.8%
How many Canadians are diagnosed with cancer a year?
229,200
What are the 3 goals of cancer treatment?
cure (i.e., “curative intent”)
control (slow/reverse the growth/spread)
relieve symptoms (i.e., “palliative intent”)
What are the 7 cancer treatment modalities?
Surgery
Radiation therapy
Chemotherapy
Hormone (endocrine) therapy
Immunotherapy (biologic therapy)
Targeted therapy
Stem cell transplant
Cancer treatments are often: (5)
multimodal (more than one type)
sequential (one after the other)
and/or concurrent (at the same time)
with multiple “lines” of treatment (after failed treatments)
for a disease that can progress or recur multiple times
What is the goal of surgery as treatment?
prevent, diagnose, treat, palliate, reconstruct
removal of tumor and surrounding tissue.
oldest/most common treatment for cancer
primary treatment for most “solid” tumors
generally for “early stage” or “localized” tumors
often curative on its own (or combined)
What is the goal of radiation therapy as treatment?
high-energy particles/waves such as x-rays, gamma rays, electron beams, or protons, damage cancer cells.
common treatment for many “solid” tumors
generally for “early stage” or “local” tumors
external radiation, internal radiation (brachytherapy), or systemic radiation (radioactive drugs).
external is most common (5-6 weeks)
What is the goal of hormone therapy for treatment?
some cancers are “fueled” by sex hormones.
eliminating/blocking hormones slows the cancer
done through surgery or drugs (years).
common treatment for breast and prostate cancers
common side effect for men is breast enlargement
What is the goal of immunotherapy (biologic therapy) for treatment?
boost the body’s immune system in general or train the immune system to attack cancer cells.
monoclonal antibodies, vaccines, CAR-T, ICIs.
used in a growing number of cancers (rapid progress).
given by pills/IV/injection every 2-4 weeks
side effects are similar to allergic reactions
What is the goal of targeted therapy for treatment?
drugs to target specific genes and proteins that help cancer cells survive and grow.
based on cancer biology and mechanisms.
there are many different “targets”.
breast cancer (HER2); colorectal (EGFR; VEGF)
some may “cut across” cancers (tumor-agnostic)
What are the 3 steps in Multimodal Therapy (Treatment Sequencing)?
Neoadjuvant therapy - reduce primary tumor size, eliminate cancer cells that spread to other locations
Primary therapy - eliminate tumor
Adjuvant therapy - eliminate remaining cancer cells
What are the different cancer treatment responses? (8)
complete response (no evidence of disease)
clinical vs pathological
remission vs cure
partial response (reduction in disease)
stable disease (no change in disease)
progressive disease (worsening of disease)
CR+PR = “objective response” or “major response”
duration of response (how long response lasts)
What does de novo resistance mean?
Progressive disease
What are the different grades for the side effects of treatment?
Mild (grade 1), moderate (grade 2), severe (grade 3), life-threatening (grade 4), and death (grade 5)
- may cause treatments to be reduced, delayed, discontinued, switched, or not offered (especially at/after grade 3)
