oncology and cancer rehab Flashcards
Survival rate at 5 yrs
3/5 will survive longer than 5 years but remains the leading cause of death in canada.
survival rates are increasing, incidence of cancer is decreasing and the survival rates will vary depending on the type of cancer, staging and time of dx
Why is cancer rehab so important
What is the TNM system
T - size of tumor? (t1 - t4)
N - spread to lymph nodes? (n0 - n3)
M - spread to different parts of body? (M0 - M1)
Staging system for cancer
0 - abnormal cells present, no spread to other tisses
1 - small local, no spreading
2 - tumor is bigger, remain localized
3 - tumor spread to nearby lymph nodes, organs, tissues
4 - spread to distal parts of body
What are some prevention programs
What are some screening programs
Why is prehabilitation important
want to get pt as strong as possible to limit the amount of deconditioning occurring. Get them in the best shape possible to be able to handle intense treatment.
Common side effect of chemo
Fatigue, nausea, vomiting, constipation, oral mucositis, loss of hair + appetite, fertility problems, neurotoxicity, skin problems, cognitive difficulties
Common side effects of radiation
fatigue, nausea, vomiting, loss of hair, loss of appetite, skin reactions
Hormonal therapy side effects
hot flashes, muscle + joint pain, nausea, vomiting, weight gain, fatigue, OP, fertility issues, tx induced menopause
What is immunotherapy
immunotherapy boosts the immune system so it can efficiently fight cancer
What are the side effects of immunotherapy
flu like symptoms, fatigue, skin reactions
What is cancer related fatigue
complains of generalized weakness, having decreased motivation or interest to engage as usual, non-refreshing sleep, hard time completing daily tasks, trouble with short term memory, marked emotional reactivity
What is the prevalence of cancer related fatigue
59 - 100% of people are effected, worst symptom of cancer and side ffects of treatment
What are the causes of cancer related fatigue.
increased levels of pro-inflammatory molecules, deregulation of serotonin, cortisol and circadian rhythm
MULTIFACTORIAL
Fatigue and cancer treatments
chemo (cycles) - increases in days following treatment then decreases until next treatment. gets worse depending on number of cycles
radiation - increases with number of treatments
starts 1 - 2 weeks after beginning treatment
targetted therapies/hormonal - occurs during or after treatment
Fatigue after treatment
improves after treatment
some level of fatigue can persist for months to years after treatment is done which impacts quality of life and compromises return to activity
Distress, anxiety, depression
affects 15 - 25 percent of cancer patients
family member are also at risk
What tools can you give to cancer patients with depression
NCCN Distress thermometer and problem list
ESAS-r
What are risk factors of depression in cancer patients
hx of depression, poor family support, poor prognosis, poorly controlled symptoms
What are the benefits of physical activity in cancer patients
some exercise is better than none, and it’s better for it to be supervised or done in a group
Guidelines for physical exercises
90 minutes weekly, consider comorbidities, respect contraindications and precautions, combine aerobic and strengthening
What is the definition of bone metastases
Cancer cells from primary cancer site break away into the bloodstream to the bones where the bones grow and form new tumours.
Cancer cells will usually go where there is the highest flow of blood (blood flow to bones)
Prevalence of metastases
3rd most common site of metastases for many solid tissue cancers (prostate. breast, lung, thyroid, kidney)
It affects 10-20% of people with cancer and pathological fractures occure in 10 - 30% of patients with bone lesions
Symptoms of bone metastases
can be asymptomatic
pain
hyperkalemia
random fracture with no known cause
spinal cord compression (bladder/bowel dysfunctions, etc…)
Diagnosis
xray
CT/BONE SCAN (most accurate)
MRI
Types of lesions
Osteoblastic - too much bone
Osteolytic - empty space (more prone to fractures)
Mixed lesions - a mix of the two above
Treatment for patients with lesions
radiation, bisphosphonates, pain management, surgery
Exercise considerations for patients with lesions/metastases
physical activity shouldn’t be avoided, risk of fractures should be minimized, need to consider location and risk of fracture, may change over time depending on progession of disease, benefits are higher is supervised,
Use of AD, avoid excessive WB, avoid straining muscles that attach to affected bone, avoid torque, long lever arm and excessive additional weight, AROM only on affected areas.
What is chemo induced peripheral neuropathy
degeneration of peripheral fibers that can start before, after or during treatment for CA.
Symptoms of chemo induced peripheral neuropathy
Starts distal
hyperesthesia, dysesthesia,paresthesia, glove and stocking syndrome, hypoesthesia, allodynia, neuropathic pain
Decreased proprioception, standing balance, strength, fine motor skills
Causes of chemo induced peripheral neuropathy
certain types of chemo
certain types of targetted therapy
radiation
surgery
tumor
Treatment for chemo induced peripheral neuropathy
Fall prevention, exercise, strength, PROM, Pharmacological management for pain, patient education, non-pharm management (relaxation techniques, meditation, acupuncture
injury prevention
Functional impact of chemo induced peripheral neuropathy
affects QOL
Decreased autonomy with ADL’s, increased fall risk and sleep disturbances
symptoms of cognitive difficulties for people with CA
distractibility,forgetfulness, inability to retain info, slower processing time, mental fatigue
Prevalence of chemo-fog
30% of patients experience it
Lymphedema definiton
chronic swelling caused by fluid build up and it’s retained d/t lymphatic system not working properly
Symptoms of lymphedema
swelling,pain, limbs feel heavy, clothes/jewelry too tight
