oncology and cancer rehab

Question 1

Survival rate at 5 yrs

Answer 1

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

Question 2

Why is cancer rehab so important

Question 3

What is the TNM system

Answer 3

T - size of tumor? (t1 - t4)
N - spread to lymph nodes? (n0 - n3)
M - spread to different parts of body? (M0 - M1)

Question 4

Staging system for cancer

Answer 4

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

Question 5

What are some prevention programs

Question 6

What are some screening programs

Question 7

Why is prehabilitation important

Answer 7

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.

Question 8

Common side effect of chemo

Answer 8

Fatigue, nausea, vomiting, constipation, oral mucositis, loss of hair + appetite, fertility problems, neurotoxicity, skin problems, cognitive difficulties

Question 9

Common side effects of radiation

Answer 9

fatigue, nausea, vomiting, loss of hair, loss of appetite, skin reactions

Question 10

Hormonal therapy side effects

Answer 10

hot flashes, muscle + joint pain, nausea, vomiting, weight gain, fatigue, OP, fertility issues, tx induced menopause

Question 11

What is immunotherapy

Answer 11

immunotherapy boosts the immune system so it can efficiently fight cancer

Question 12

What are the side effects of immunotherapy

Answer 12

flu like symptoms, fatigue, skin reactions

Question 13

What is cancer related fatigue

Answer 13

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

Question 14

What is the prevalence of cancer related fatigue

Answer 14

59 - 100% of people are effected, worst symptom of cancer and side ffects of treatment

Question 15

What are the causes of cancer related fatigue.

Answer 15

increased levels of pro-inflammatory molecules, deregulation of serotonin, cortisol and circadian rhythm
MULTIFACTORIAL

Question 16

Fatigue and cancer treatments

Answer 16

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

Question 17

Fatigue after treatment

Answer 17

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

Question 18

Distress, anxiety, depression

Answer 18

affects 15 - 25 percent of cancer patients
family member are also at risk

Question 19

What tools can you give to cancer patients with depression

Answer 19

NCCN Distress thermometer and problem list
ESAS-r

Question 19

What are risk factors of depression in cancer patients

Answer 19

hx of depression, poor family support, poor prognosis, poorly controlled symptoms

Question 20

What are the benefits of physical activity in cancer patients

Answer 20

some exercise is better than none, and it’s better for it to be supervised or done in a group

Question 21

Guidelines for physical exercises

Answer 21

90 minutes weekly, consider comorbidities, respect contraindications and precautions, combine aerobic and strengthening

Question 22

What is the definition of bone metastases

Answer 22

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)

Question 23

Prevalence of metastases

Answer 23

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

Question 24

Symptoms of bone metastases

Answer 24

can be asymptomatic
pain
hyperkalemia
random fracture with no known cause
spinal cord compression (bladder/bowel dysfunctions, etc…)

Question 25

Diagnosis

Answer 25

xray
CT/BONE SCAN (most accurate)
MRI

Question 26

Types of lesions

Answer 26

Osteoblastic - too much bone
Osteolytic - empty space (more prone to fractures)
Mixed lesions - a mix of the two above

Question 27

Treatment for patients with lesions

Answer 27

radiation, bisphosphonates, pain management, surgery

Question 28

Exercise considerations for patients with lesions/metastases

Answer 28

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.

Question 29

What is chemo induced peripheral neuropathy

Answer 29

degeneration of peripheral fibers that can start before, after or during treatment for CA.

Question 30

Symptoms of chemo induced peripheral neuropathy

Answer 30

Starts distal
hyperesthesia, dysesthesia,paresthesia, glove and stocking syndrome, hypoesthesia, allodynia, neuropathic pain

Decreased proprioception, standing balance, strength, fine motor skills

Question 31

Causes of chemo induced peripheral neuropathy

Answer 31

certain types of chemo
certain types of targetted therapy
radiation
surgery
tumor

Question 32

Treatment for chemo induced peripheral neuropathy

Answer 32

Fall prevention, exercise, strength, PROM, Pharmacological management for pain, patient education, non-pharm management (relaxation techniques, meditation, acupuncture
injury prevention

Question 33

Functional impact of chemo induced peripheral neuropathy

Answer 33

affects QOL
Decreased autonomy with ADL’s, increased fall risk and sleep disturbances

Question 34

symptoms of cognitive difficulties for people with CA

Answer 34

distractibility,forgetfulness, inability to retain info, slower processing time, mental fatigue

Question 35

Prevalence of chemo-fog

Answer 35

30% of patients experience it

Question 36

Lymphedema definiton

Answer 36

chronic swelling caused by fluid build up and it’s retained d/t lymphatic system not working properly

Question 37

Symptoms of lymphedema

Answer 37

swelling,pain, limbs feel heavy, clothes/jewelry too tight