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oncology Flashcards

1
Q

what is cancer

A

abnormal cells within a tissue which proliferate in an uncontrolled manner

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1
Q

cancer prevalance

A

1 in 6
50%
~2 mmill diagonisis per year

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2
Q

semantics

A

names for the type of cell or organ it startsin

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3
Q

why are some cancers more common than others

A

certain cell types more likely to aquire mutations- cells which proliferate rapidly–> endothelial cells, fibroblasts, smooth ms cells, sites of exposureto carcinogens

skin
lung
breast
colorectal

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4
Q

curable by surgery alone

A

melanoma
pancreatic cancer
early stage lung or colo
renal cell carcinoma
breast - if early

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5
Q

physiologic result of oncologic intreventions

A

Impaired range of motion
 Lymphedema
 Impaired organ function
 Fibrosis of tissue
 Pulmonary/Cardiac Dysfunction
 Cognitive change  Radiation-induced
cognitive decline

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6
Q

recommendations for interventions

A

Return to usual activity as soon as
possible after surgery
 Maintain exercise
 Increase slowly
 Pay attention to body signals

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7
Q

PT tc lymphedema

A

patient education
complete decongestive therapy

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8
Q

risk of lymphedema

A

Stronger Risk Factor
Extent of surgery
Obesity

Weak Risk Factor
Number of lymph
nodes removed

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9
Q

systemic therapy purpose

A

cure –> eliminate cancer that might have escaped site of origin - adjuvant –> following first line of tx

control –> decreasing size to make surgery easier

neoadjuvant –> before the primary tx

palliative –> control disease that is metastatic

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10
Q

traditional chemotherapy

A

The use of chemical agents to treat or
to control disease
 Most drugs interfere with the synthesis
or function of DNA
 Low Therapeutic Index  Toxic
Dose50/Effective Dose50
 Use repeatedly

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11
Q

physiologic result of systemic therapy**

A

Bone marrow suppression  RBC, WBC,
platelets
 Anemia, neutropenia, thrombocytopenia
 Cardiotoxicity
 Pulmonary impairment
 Peripheral Neuropathy
 Sarcopenia
 Cognitive Dysfunction
 Endocrine Changes
 Bone Loss

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12
Q

symptom challenges of acute therapy

A

fatigue
nasuea
deconditionoing
infection

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13
Q

functional end result

A

Loss of muscle mass
 Decreased strength
 Less endurance
 Overall decline 
physiologic reserve
 Less able to tolerate
additional therapy
Cancer
Speeds
up this
Process

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14
Q

cancer tc impacts that improve w rehab and exercise

A

Fitness
 Strength
 Functional Ability
 Cancer Related Fatigue
 Range of Motion
 Lymphedema
 Weight gain
 Sarcopenia

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15
Q

effects of exercise in leukemia patients

A

Muscular endurance increased
 Fatigue decreased
 Depression decreased
 It was safe
Battaglini et al 2009

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16
Q

side effects before, after, and during treatment - exercise

A

Exercise post therapy associated w/ reduced:
 Fatigue
 Shortness of breath
 Pain
 Depression
 Exercise 6 months latter associated w/ reduced:
 Sleep disturbance
 Memory problems
 Fatigue

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17
Q

benefits of exercise during tc: physiologic

A

Increased lean tissue mass
 Increased VO2 max
 Decreased resting heart rate
 Improved training distance
 Increased upper and lower body strength
 Improved flexibility
 Higher physical functioning scores

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18
Q

QoL benefits of exercise during tx

A

Decreased fatigue
 Decreased nausea
 Improved sleep patterns
 Lower pain perception
 Less emotional and psychological distress
 Lower depression and anxiety

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19
Q

exercise caution!!

A

Anemia: hemoglobin < 7 g/dL
 Fever ≥ 38 C
 Elevated blood pressure >200 SBP or >110 DBP
 Rapid heart rate >120bpm
 Desirable Ranges:
 Systolic >95 and < 180
 Resting HR >50 and < 120
 Careful use of resistance bands w/
thrombocytopenia & lymphedema

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20
Q

persistent effects

A

Began during chemotherapy, often worsen &
don’t necessarily go away

21
Q

late effects

A

develop montsh to years after tx

cardiomyopathies
arrythmias
lung parenchyma change resulting from radiation –> fibrosis

22
Q

persistent effect: cancer related fatigue

A
  • Most distressing
    symptom associated
    with cancer & its
    treatment
  • Experienced by 70-
    100%
  • Can last months to
    years
23
Q

cancer related fatigue

A

Persistent subjective sense of exhaustion
related to cancer or cancer treatment that
interferes with usual function

Not relieved by rest or sleep
 Does not correspond to level of exertion
 More severe and distressing
 Disproportionate level of fatigue

24
Q

therapy for cancer related fatigue - exercise

A

~25% reduction in fatigue in cancer
survivors randomized to the exercise group

25
Q

direct mechanism of hoe exercise improves fatigue

A

Muscle strength &
endurance
 Cardiopulmonary fitness
 Dampened
Inflammatory response
 Improved insulin
function

26
Q

indirect mechanism of how exercise improves fatigue

A

Diminished anxiety and
depression
 Improved sleep
 Improved cognition

27
Q

how exercise improves survival

A

Breast Cancer: 30% lower risk of morality
 Prostate Cancer: 30% lower risk
 Colo-rectal Cancer: 50% lower risk
 Brain Tumors: 36% lower risk

28
Q

why does exercise reduce cancer recurrance and mrotality

A

Decreased circulating hormone levels
 Decreased inflammation
 Improved insulin sensitivity
 Promotes weight loss/controls weight gain
 Helps maintain weight loss

29
Q

PA among cancer survivors

A

76.8% without cancer DID NOT meet
recommendations of 150 min/week
 95.5% cancer survivors DID NOT meet
recommendations

30
Q

ACSM rountable guidelines on exercise - breast cancer

A

Aerobic fitness is improved (2010&2019)
 Muscular Strength improved (2010&2019)
 Physical Function improved post therapy (2010&2019)
 Exercise is safe (2010&2019)
 Anxiety (2019)
 Depression (2019)
 Fatigue (2019)
 Lymphedema (2019)
Evidence Category A: Breast Cancer

category B
Fatigue levels decline (2010)
 Quality of life improves (2010)
 Depression & Anxiety declines (2010)
 Body size & composition improves (2010)
 Bone Health (2019)
 Sleep (2019

31
Q

gaps in the literature related to exercise

A

Falls
 Cardiotoxicity
 Peripheral Neuropathy
 Cognitive Function
 Nausea
 Pain
 Sexual Function
 Treatment Tolerance

32
Q

what is exercise based oncology rehab

A

Use of physical therapy and exercise modalities to
improve or maintain function, ameliorate or prevent
side effects of cancer/cancer therapy, and improve
fitness and strengt

33
Q

increased emphasis on PT

A

Focus on specific impairments Encouraging exercise
without assessing and treating physical impairments
can cause problems
 Skills to deal with many cancer related side effects:
ROM, lymphedema, balance, strength, fatigue
 Training in exercise assessments and interventions
 PT evaluation  insurance reimbursement

34
Q

patient with cancer are different

A

Limited prognosis
Extensive medical co-morbidity
High degree of pain
Psychosocial distress
Dynamic disease process
Side effects of antineoplastic therapy
Unique goals of care

35
Q

Exercise post therapy associated w/ reduced:

A

 Fatigue
 Shortness of breath
 Pain
 Depression

36
Q

exercise 6 months latter associated with reduced

A

sleep disturbance
memory problems
fatigue

37
Q

physiological benefits of exercise during tx

A

Increased lean tissue mass
Increased VO2 max
Decreased resting heart rate
Improved training distance
Increased upper and lower body strength
Improved flexibility
Higher physical functioning scores

38
Q

benefits of exercise during tx: qol

A

Decreased fatigue
Decreased nausea
Improved sleep patterns
Lower pain perception
Less emotional and psychological distress
Lower depression and anxiety

39
Q

treating cancer related fatigue

A

Physical Activity
* Walking program throughout treatment tends to decrease CRF
Mock 2007
* Aerobic training
*  blood flow
*  hemoglobin
* Strength training
*  muscle enzymes
* Enlarges muscle fibers
* Too much of a good thing?
* Gentle moderate exercise decreased inflammation
* Overly aggressive exercise increases inflammation

40
Q

neoplasm

A

“new growth”- not necessarily cancerben

41
Q

benign

A

innocuous, harmless to host unless large enough to compress or obstruct surrounding tissue

42
Q

malignant

A

Aggressive, if left untreated will invade other organs and result in death

43
Q

remission

A

Operationally defined according to diagnosis,
usually associated with being free of
symptoms

44
Q

cure

A

No evidence of disease and same life
expectancy as person who was never
diagnosed

45
Q

medical tx

A

Multimodal!
Strategies include:
* Surgery
* Chemotherapy
* Radiation Therapy
* Immunotherapy
* Hormonal Therapy

46
Q

persistent effects

A

began during chemotherapy, often worsen & don’t necessary go away

47
Q

late effects

A

develop months to years after treatment

48
Q

thrombocytopenia

A

Low Platelet Counts
* Bruising
* Malaise and fatigue
* Nosebleeds
* Bleeding gums
* Blood filled bullae in mucous membranes
* Continuous bleeding

49
Q

neutropenia

A

low levels of neutrophils’

Immune system compromise from cancer therapies increase the risk for infection
ANC (absolute neutrophil count)
* the precursors of the WBC’s
* found in the bone marrow
* A more accurate measure of infection risk

50
Q

what we do prevention

A

Hand Washing!
Encourage good pulmonary toileting
Encourage hygiene
Encourage ambulation
Mask and gown
Food restrictions?
Live plant restrictions?
Kitty litter?

51
Q

hemoglobin values

A

10-12: - Aerobic Exercise as tolerated
8-10: - Ambulation and ADL’s as tolerated
- Monitor for lightheadedness, chest pain,
SOB, weakness
<8: - Limited activity
- Patients will become more
symptomatic with activity and have lower
tolerance for exercise

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