L10 Oncology Flashcards
Ped cancer epidemiology
- 9620 kids under 15 will be diagnosed with cancer
- 85% of children with cancer now survive 5 years or more, depends on type and other factors
- second leading cause of death in kids 1-14, accidents #1
Most common cancers for kids
leukemia
brain
lymphoma
rhabdyomyosarcoma
retinoblastoma
bone
Adolescent and Young Adult cancer epidemiology
- AYA are diagnosed 84,100 a year (ages 15 to 39)
- 4th most common cause of death for 15-19 yo
- clinicians need to be aware of cognitive, emotional, and social development of AYA, b/c it can impact their functions
Most common cancers for AYA
breast
thyroid
testicular
melanoma
Child leukemias
acute lymphoblastic
acute myeloid
chronic myeloid
Acute lymphoblastic leukemia
80% of all childhood leuk cases
5 year survival rate is 90%
Acute myeloid leukema
less common
5 year survival rate is 65-70%
Chronic Myeloid Leukemia
lowest incidence in children
treated with oral chemp
S/s of leukemias
- start in bone marrow where new blood cells are created
- leukemia cells grow and divide until they crowd out the other normal blood cells
- marrow produces less normal, healthy blood cells leading to lower blood cell ocunt
Phases of Tx for Leukemia
- based on cancer stage and pathologic characteristics
- includes 3 phases Induction, Consolidation, Maintenance
- those with ALL with receive a bone marrow transplant
Induction
4 weeks of intense chemo
check for minimal residual disease
Consolidation
12-16 weeks of more chemo
Maintenance
2-3 years with less frequent,, mostly oral chemo and intrathecal to maintain remission
ALL may begin to move to spinal fluid if not watched closesly
Hematopoietic Stem CEll transplant
Involves several types: PBSCT, autogenic (bone marrow of child), allogenic (bone marrow of donor
- intense chemo prior to transplant, sometimes total body irridiation
Post-Transplant Complications, Acute
infection
veno-occlusive disease
mucositis
acute graft vs host disease (only in allogenic)
Post-Transplant Complications chronic
Chronic graft vs host disease, allogenic BMT only, treated with steroids
opportunistic infections due to immunosuppression to minimize failure of transplant
PT exam post BMT
- Graft vs Host –> ROM in UE
- CIPN – balance
- Fatigue –6MWT
- not meeting PA guidelines
- cognitive
- sarcopenia –5STS
Graft vs Host disease
stem cells develop into new blood cells, immune cells may attack host tissues
skin changes can cause loss of ROM of joints, may require splinting in severe cases
CAR-T cell therapy
- chimeric antigen receptror
- an immunotherapy to treat several blood cancers
- targets CD19, called Kymriah
- very expensive
Side effects of CAR-T cell therapy
- mass die off of antibody producing B cells and infections
- cytokine release syndrome (CRT)
- immune effector cell-associated neurotoxicity syndrome (ICNS)
CRS
dangerously high fevers
drops in BP
can be fatal
treated with steroids
ICANS
severe confusion, seizures, impaired speech
treated with steroids
CNS Tumors
- 2nd most common
- most common solid tumor, responsible for 25% of peds cancer deaths
- most common form is astrocytomas, with medulloblastomas the most common aggressive type
Diffuse Intrinsic Pontine Glioma
- 10-20% of all childhood brain cancers
- most common between 5-10 yrs
- limited treatment options
- survival rate is low, no cure
CP of DIPG
- problems with eye movements
- impaired balance and walking
- problmes with chewing and swallowing
- nausea and vomiting
- morning headache
- facial weakness
Sarcomas
- two types; bony and soft tissue
- bony is more prevalent in kids and YA
Osteosarcoma
- affects metaphyseal joints in long bones
- more common in males and adolescents
- osteoblasts are affected, resulting in poor reconstruction of bones. lots of fractures and brittle
- 60%+ survival rate
- treatment involves removal of bone, chemo, radiation
Ewing Sarcoma
- occurs in children and young adults
- highly aggressive and mets quickly
- typically in pelvis, tibia, femur, ribs
- treatment is chemo, surgery, radiation
- 60-75% survival, but low survival if it mets
- presents as swelling and pain in affected area
- may impact soft tissue like thorax, lungs, gluteal muscles
PT Tx Planning Tips for Cancer
- possible effects of disease on systems of mobility
- possible effects of treatment on systems of mobility
- prioritizing impairments for treatment plan
Prehabilitation
time between dx and start of medical treatment for cancer
should perform baseline assessment of global development, functional mobility, and body structure/function
exercise program
Baseline Assessment during Prehabilitation
- CP status and aerobic capcity
- functional mobility testing
- strength and ROM assessment
- sensory testing
- cognition assessment
- balance and coordination
- developmental milestones
Prehabilitation exercise program should
- decrease debility due to treatment related impairments
- patient and family education
Bone Health (PT considerations related to treatment effects)
- bone loss during treatment and decreased bone formation due to impaired mobility and muscle mass loss
- osteopenia and osteoporosis occur in lone bones and spine
- osteonecrosis may occur in kids after glucocorticoids or radiation
Osteonecrosis
- symptoms include pain, avoidance of area
- can be asymptomatic
- at risk for fracture
- possible WB restrictions or activity restrictions
CIPN
- common neurotoxic chemotherapies used to treat kids
- present with pain, sensory loss, motor loss, autonomic symptoms
- PT treatment is similar to adults, should include assessment for AFO to improve participation in gait/play
- majority of children will show CIPN or motor impairments due to chemo
____ is more common in children than adults with CIPN
foot drop
Childhood Lymphedema
- relatively rare
- carries significant burden for lifelong management and risk of secondary complications
- exam and treatment is similar to that of adults
Developmental Progression and Cognition
- infants and toddlers living with and beyond cancer display delayed developmental milestones when compared to their same aged healthy peers
- children who receive whole brain radiation and chemo may demonstrate cognitive impairments
- not sure who is at higher risk, need more research
Children treated before age 4
- progress more slowly in areas including vocab, attention, and memory, motor skills
- social and emotional development delays to lesser extent
Cognitive impairments after whole brain radiation include
- decreased IQ, processing speed, working memory, executive function, attention
- can be persistent 3 years post radiation
- cognitive rehab is effective to help treat
< 18 yo social issues
- interrupted social skills development
- high school achievement graduation delays
- delays in living independently
- difficulty establishing employment
18-25 yo Social Issues
- delays in higher education
- interruption in employment
- barriers to achieving financial independence
- difficulties obtaining health insurance
- difficulty establishing relationships
26+ yo social issues
- difficulties establishing and maintaining relationships
- difficulties with intimate relationships
- fertility issues
- challenges managing multitude of life roles
- barriers to achieving financial independence
- barriers to health insurance
Palliative and End of Life Care
children w/cancer who receive ped palliative care were significantly more likely to have fun, experience events that added meaning, and die comfortably at home
Adult survivors of childhood cancers are at higher risk of
- heart or lung problems (CVD, more likely to die from it too)
- lymphedema
- slowed or delayed growth and development
- changes in sexual development and ability to have children
- learning problems
- increased risk of other cancers later in life
