oncology in physical therapy Flashcards
what makes cancer patients so different?
Limited prognosis
Extensive medical co-morbidity
High degree of pain
Psychosocial distress
Dynamic disease process
Side effects of antineoplastic therapy
Unique goals of care
what type of professionals might work on this multidisplanary team?
Radiologist
Pathologist
Surgical Oncologist
Medical Oncologist
Radiation Oncologist
Physical and Occupational Therapist
Social Worker
Dietitian
Nurse Case Manager
Plastic Surgeon
what are the effects of exercise before and after treatment?
Exercise post therapy associated w/ reduced:
Fatigue
Shortness of breath
Pain
Depression
Exercise 6 mos latter associated w/ reduced:
Sleep disturbance
Memory problems
Fatigue
what are the physiologic benefits of exercise during treatments
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
what are the quality of life benefits of exercise
Decreased fatigue
Decreased nausea
Improved sleep patterns
Lower pain perception
Less emotional and psychological distress
Lower depression and anxiety
How does exercise improve fatigue
slide 7 diagram
how does one treat CRF
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
what is cancer?
a group of disease characterized by uncontrolled growth and spread of abnormal cells
what does neoplasm mean?
“new growth”- that is not nessarly cancer
what does benign mean
innconcusous harmless to the host unless large enough to compress or obstruct the surrounding tissues
what does malignant mean?
Aggressive, if left untreated will invade other organs and result in death
what does it mean to be in remission?
Operationally defined according to diagnosis, usually associated with being free of symptoms
what does it mean to cure cancer?
No evidence of disease and same life expectancy as person who was never diagnosed
what are the stages of cancer and the invasion and spread
slide 12
what is the medical treatment for cancer?
Multimodal!
Strategies include:
Surgery
Chemotherapy
Radiation Therapy
Immunotherapy
Hormonal Therapy
what are the persistent and late effects of cancer
Persistent effects: began during chemotherapy, often worsen & don’t necessary go away
Late effects: develop months to years after treatment
what must you CAUSIOUS about with chemotherapy and lab values
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
general guidelines for thrombocytes
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
what does low Platelet counts look like symptoms and signs wise
Bruising
Malaise and fatigue
Nosebleeds
Bleeding gums
Blood filled bullae in mucous membranes
Continuous bleeding
what are the general guidelines for hemoglobin?
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
what are the general guidances with white blood cells and absolute neutrophil counts?
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
what is occurring when a patient has a lab value of low levels of neutrophils or neutropenia?
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
what are the preventions to perform for patients with cancer?
Hand Washing!
Encourage good pulmonary toileting
Encourage hygiene
Encourage ambulation
Mask and gown
Food restrictions?
Live plant restrictions?
Kitty litter?
