oncology in physical therapy

Question 1

what makes cancer patients so different?

Answer 1

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

Question 2

what type of professionals might work on this multidisplanary team?

Answer 2

Radiologist
Pathologist
Surgical Oncologist
Medical Oncologist
Radiation Oncologist
Physical and Occupational Therapist
Social Worker
Dietitian
Nurse Case Manager
Plastic Surgeon

Question 3

what are the effects of exercise before and after treatment?

Answer 3

Exercise post therapy associated w/ reduced:
Fatigue
Shortness of breath
Pain
Depression

Exercise 6 mos latter associated w/ reduced:
Sleep disturbance
Memory problems
Fatigue

Question 4

what are the physiologic benefits of exercise during treatments

Answer 4

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

Question 5

what are the quality of life benefits of exercise

Answer 5

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

Question 6

How does exercise improve fatigue

Answer 6

slide 7 diagram

Question 7

how does one treat CRF

Answer 7

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

Question 8

what is cancer?

Answer 8

a group of disease characterized by uncontrolled growth and spread of abnormal cells

Question 9

what does neoplasm mean?

Answer 9

“new growth”- that is not nessarly cancer

Question 10

what does benign mean

Answer 10

innconcusous harmless to the host unless large enough to compress or obstruct the surrounding tissues

Question 11

what does malignant mean?

Answer 11

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

Question 12

what does it mean to be in remission?

Answer 12

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

Question 13

what does it mean to cure cancer?

Answer 13

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

Question 14

what are the stages of cancer and the invasion and spread

Answer 14

slide 12

Question 15

what is the medical treatment for cancer?

Answer 15

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

Question 16

what are the persistent and late effects of cancer

Answer 16

Persistent effects: began during chemotherapy, often worsen & don’t necessary go away
Late effects: develop months to years after treatment

Question 17

what must you CAUSIOUS about with chemotherapy and lab values

Answer 17

Anemia < 7 mg/dl hemoglobin
Fever ≥ 38/100.4
Elevated blood pressure/rapid heart rate
Systolic >95 and < 180
Resting HR >50 and < 120
Careful use of resistance bands w/ thrombocytopenia & lymphedema

Question 18

general guidelines for thrombocytes

Answer 18

Thrombocytopenia (100-400 k/ul)
150K- PRE’s, swimming, biking
30K-50K - AROM, amb. as tol.
20K-30K- Light exercise (AROM and AAROM)
<20K - ADL’s as tolerated, no exercise

Question 19

what does low Platelet counts look like symptoms and signs wise

Answer 19

Bruising
Malaise and fatigue
Nosebleeds
Bleeding gums
Blood filled bullae in mucous membranes
Continuous bleeding

Question 20

what are the general guidelines for hemoglobin?

Answer 20

Hemoglobin: Anemia less than 13.5 g/dL male and 12.0 g/dl female

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

Question 21

what are the general guidances with white blood cells and absolute neutrophil counts?

Answer 21

White blood cells
Hand washing
Clean equipment
Absolute Neutrophil Count (ANC)
Determined by differential CBC
Neutrophils are the precursor to WBC’s and help to predict infection risk

Question 22

what is occurring when a patient has a lab value of low levels of neutrophils or neutropenia?

Answer 22

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

Question 23

what are the preventions to perform for patients with cancer?

Answer 23

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