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Medcon Rehab III > Oncology: Principles in Oncology Rehab 1 > Flashcards

Oncology: Principles in Oncology Rehab 1 Flashcards

1
Q

WHY do PTs need to know about pts w/ Cx

A
  • ALL systems affected
  • ALL ages affected
  • Cx and Tx affects function + mobility
    • ​ICF
      • ​Body function and Structure==Impairments
      • Activity=Limitations
      • Participation=Resstrictions on life situations
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2
Q

PT settings where you will see oncology pts

A

ALL of them!!!

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3
Q

Estimated New Cx Cases in US

A

see pics

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4
Q

Carcinogenesis Terminology:

what is Cx?

A
  • Alteration of differentiation so that malignant cells cannot be recognized by its origin parent cells
    • ​**ANAPLASTIC
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5
Q

Carcinogenesis Terminology:

Dysplasia

A
  • GENERAL disorganization of cells
  • MAY BE REVERSIBLE
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6
Q

Carcinogenesis Terminology

Metaplasia

A
  • DISORDERLY cell patterns
  • REVERSIBLE AND BENIGN
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7
Q

Carcinogenesis Terminology

Hyperplasia

A
  • INCd # of cells creating a tissue mass
  • NEOPLASTIC HYPERPLASIA
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8
Q

Tumor, Neoplasm, Malignancy

A
  • a NEW growth
  • Any abnormal mass or tissue which exceeds the growth of NORM tissue
  • SERVES NO USEFUL PURPOSE
  • Benign OR malignant
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9
Q

Cx defined:

A

A group of dis’s characterized by uncontrolled growth and spread of abnorm cells

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10
Q

Benign

Characteristics:

A
  • SLOW growing
  • Encapsulated (one area)
  • NON-invasive
  • Tumor cells are SIMILAR to originating tissue
    • ​HIGHLY differentiated
  • **can still be very serious or life-threatening depending on location or size
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11
Q

Malignant

Characteristics:

A
  • RAPID uncontrolled growth
  • NON-encapsulated (spread out)
  • Destructive to surrounding tissue
  • NOT WELL-DIFFERENTIATED
  • **Ability to metastasize
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12
Q

Dx of Cx:

S/S

A
  • PAIN
  • Fatigue
  • Palpable lump
  • Wt. Loss—-often unexplained
  • Fx***
    • iatrogenic fx’s
    • *sometimes FIRST sign of metastatic cx
  • Dis specific sx’s
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13
Q

Dx of Cx

S/S

Paraneoplastic Syndromes

A
  • Tumor producing s/s AWAY from primary or metastatic site
    • ​thru production/secretion of hormones
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14
Q

ONLY WAY TO DEFINITIVELY Dx A Cx

A

BIOPSY ***

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15
Q

Dx: Exams and Tests to detect Cx

A
  • Blood tests
  • Palpation + Clinical exam
  • Radiography
  • US
  • MRI
  • Bone Scan****
  • Lab tests
    • stool sample
    • sputum
    • cytology
  • Site specific Tests
    • ​colonoscopy
    • mammography
    • sigmoidoscopy
    • Pap smear
    • bronchoscopy
  • BIOPSY***
    • ​ONLY definitive way to Dx Cx

​

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16
Q

BIOPSY

*only way to definitively Dx Cx

Different methods:

A
  • Curettage (Pap smear)
  • fluid aspiration
  • Fine needle aspiration
  • Core needle biopsy
  • Dermal punch
  • Endoscopy
  • open excision
  • Sentinel lymph node biopsy
  • stereotactic biopsy
  • robotic needles
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17
Q

Dx of Cx and Genetics???

A

Only a SMALL portion of cx’s linked to a single gene are inherited

*only 5-10%

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18
Q

Dx of Cx: Genetics

MOST COMMON Cx WITH A FAMILIAL PATTERN:

PBOC

A
  • Prostate
  • Breast
  • Ovarian
  • Colon
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19
Q

Dx of Cx: Genetics

Oncogenes

A
  • Ability to transform norm cells INTO malignant cells by hyperactivation
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20
Q

Dx of Cx: Genetics

Tumor suppressive genes

A
  • Regulate growth and inhibit carcinogenesis
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21
Q

Dx of Cx: Genetics

What leads to aggressive cell proliferation? (dividing and spreading of cx cells)

A
  • Defects in BOTH oncogenes and tumor suppressive genes leads to aggressive cell proliferation
    • ​MORE oncogenes and LESS tumor suppressive genes==> Aggressive cell proliferation
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22
Q

Research ID and cataloguing genes that are assoc’d w/ Cx

A
  • BRCA 1, BRCA2
    • Cx suppressor is mutated
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23
Q

Dx of Cx: Genetics

In contrast to genetics, ________ all cx may be caused by environmental agents (carcinogens) OR viruses

A

50%

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24
Q

NON-modifiable risk factors for Cx

A

Age

Genetics+Family Hx

Gender

Race

Ethnicity

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25
Q

MODIFIABLE Risk Factors for Cx

A
  • Dietary improvements
    • ​HIGH fruits+veggies
    • limtd animal meat/fat
    • multivitamin w/ folate–> DNA repair
  • Limtd alcohol intake
  • safe sex
  • wt. control + obesity prevention
  • Phys activity
  • tobacco prevention+cessation
  • environmental exposure including sun protection
  • participating in screenings
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26
Q

Staging of Cx

What is Staging used for?

A

Process to describe extent of disease

  • aids in Tx planning
  • Predicts clinical prognosis
  • Compares results of tx
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27
Q

2 types of staging in terms of clinical vs. disease state

A

Clinical staging vs. Pathologic staging

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28
Q

Types of Staging

A
  • I-IV
  • TNM
  • Grades
  • In situ-distant spread
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29
Q

Staging Cx

A

See pics for ENTIRE CHART

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30
Q

Staging Cx I-IV

Stage 0

A

In situ, pre-malignant

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31
Q

Staging Cx: I-IV

Stage I

A
  • <2 cm
  • LIMTd to LOCAL site therefore easily resectable
  • *BEST CHANCE OF SURVIVAL– 70-90%
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32
Q

Staging Cx: I-IV

Stage II

A
  • 2-4/5cm
  • Invasion to organ OR adjacent tissue
  • Microinvasion to lymphatic system
  • Resectable BUT uncertain of clear margins
  • Survival rate ~50%
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33
Q

Staging Cx: I-IV

Stage III

A
  • 5 cm
  • Invasion INTO lymphatic system
  • Operable but not resectable
  • Survival ~20-25%
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34
Q

Staging Cx: I-IV

Stage IV

A
  • 10cm
  • Metastatic lesions (regional OR distant)
  • Inoperable for resection
  • *Survival 5%
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35
Q

MOST commonly used system for Staging

Particularly for Solid Tumors

A

TNM

  • T=Tumor size
  • N=absence of presence of Lymph Nodes
  • M=absence or presence of Metastases
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36
Q

TNM Staging

T=Tumor size

A

Tumor size

  • Tx: primary tumor cannot be assessed
  • T0: NO evidence of primary tumor
  • T1-T4: Progressive INC in tumor size
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37
Q

TNM Staging

N= regional Lymph Node involvement

A

N=Lymph Node involvment

  • Nx: nodes cannot be assessed
  • N0: No metastases to local lymph nodes
  • N1-3: Progressive involvement to regional lymph nodes
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38
Q

TNM Staging

M=presence of distant Metastases

A

M=distant Metastases

  • Mx: presence of distant mets cannot be assessed
  • M0: No distant metastases
  • M1: Presence of distant metastases
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39
Q

Grades of Tumor or Cx

Explain…

A
  • Provides measure of differentiation
  • Information on size, shape, rate of cell division
    • ​indicates Aggressiveness
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40
Q

Grades of Tumor or Cx

3:

A
  • LOW: Better predictive and prognostic outcome
  • INTERMEDIATE
  • HIGH: Poor cellular differentiation, likely to metastasize EARLY
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41
Q

In Situ to Distant Spread

Broken down into 5 categories

A
  • In-Situ
  • Local spread
  • Regional spread
  • Distant spread
  • Carcinomatosis
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42
Q

In situ to Distant spread

In-situ

A

Orig layer of cells which are contained w/in tissue

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43
Q

In situ to Distant spread

Local spread

A
  • Penetration OUTSIDE orig layer of tissue
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44
Q

In situ to Distant spread

Regional spread

A
  • Spread to nearby tissue or lymph nodes in area of origin
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45
Q

In situ to Distant spread

Distant spread

A
  • Spread to other organs or areas of body
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46
Q

In situ to Distant spread

Carcinomatosis

A
  • WIDESPREAD end-stage disease
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47
Q

Mechanisms of Metastasis

Primary Disease

A
  • cells CAN BE ID’d from primary organ
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48
Q

Mechs of Metastasis

When does Metastases occur?

A
  • occurrs when cells break from primary tumor and travel by circulatory OR lymphatic system to DISTANT AREAS of the body
  • tumor cells become trapped in the capillaries of distant organs
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49
Q

Metastases occurs in other ways:

A
  • Growth extension and invasion into adjacent tissue
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50
Q

Metastasis is often to body areas of _________

Examples?

A

High blood flow

  • Lungs
  • Liver
  • Brain and CNS
  • Lymphatic system
  • Skeletal system
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51
Q

Pts found w/ and w/out metastases

A
  • 30% pts found w/ metastases on Dx
  • 30-40% pts w/ hidden mets @ Dx
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52
Q

Eval of Metastases

Methods:

A
  • Radiograph
  • Bone scans
  • CT
  • MRI
    • *particularly for spinal involvement
  • PET scan
    • ​*for cells that metabolize glucose unusually fast
  • Lab tests
    • Ca* lvls
    • Serum markers
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53
Q

Eval of Mets

*PET scans

what should you know??

A

BEST to eval loc and size of mets in pts w/ advanced mets disease

54
Q

Brain Mets

A

30% of all brain tumors

55
Q

Brain Mets

Common Cx’s that metastasize to brain

A

Lung

Breast

Melanoma

Kidney

56
Q

Brain mets

prognosis

A

3-6mos

57
Q

Brain Mets

S/S

A
  • HA
  • nausea/vom
  • fatigue
  • seizures
  • confusion
  • diff concentrating
  • falls
  • double vision
  • other neuro deficits
58
Q

Brain Mets

Leptomeningeal Disease

what is this?

A
  • Spread INTO meninges and CSF
  • Often FROM:
    • ​Breast cx, lung cx, melanoma
59
Q

Approx ____________ of all cx will metastasize to BONE

A

50%

60
Q

Bone Mets

Common Cx’s

A

see chart

61
Q

Bone Mets

S/S

A
  • PAIN
  • swelling
  • palpable mass
  • sensory and/or motor changes
  • functional changes
  • Gait disturbs
  • Fx
  • Systemic sx’s
62
Q

Metastatic Bone Dis

what is COMMON?

A

PAIN @ NIGHT

63
Q

Metastatic Bone Disease

OsteoLYTIC Mets

A
  • Cx cells cause bone DESTRUCTION
    • ​renal cell cx
    • lung cx (NON SMALL CELL)
    • melanoma
    • thyroid cx
64
Q

Metastatic Bone Dis

OsteoBLASTIC mets

A
  • Cx cells cause BONE FORMATION
    • ​prostate cx
    • lung cx (SMALL CELL)
65
Q

This Lung Cx is osteoLYTIC

A

NON-small cell

66
Q

This Lung Cx is osteoBLASTIC

A

SMALL-cell

67
Q

Metastatic bone disease

Mixed (osteolytic + blastic)

A
  • causes bone destruction AND formation
    • ​Breast Cx *****
68
Q

This type of Cx is MIX of osteolytic and osteoblastic

A

Breast Cx

69
Q

Evaluation of Fx Risk

Mirel’s Scoring System (see pics)

What else are we looking for?

A
  • Immobility vs. ambulation/limtd WB
  • compression fx’s and cord compression
  • Tx:
    • ​Sx
    • Radiation
    • Protected WB
70
Q

Lung Mets

Lung tumors originate where ?

A

OUTSIDE lung tissue

71
Q

Lung Mets

Tumors commonly metastasize from:

A
  • Primary breast
  • Primary bone
  • Primary renal
  • Primary colorectal
  • Primary testicular cx’s
72
Q

Lung Mets

Tx

A

depends on primary tumor AND prognosis

73
Q

Lung Mets

Sx’s

A

SOB

Hemoptysis–coughing up blood

dry, persistent cough

74
Q

Lung Mets

PT implications

A
  • Asses/monitor HR
  • PulseOX
  • RPE–Borg
75
Q

Tx of Cx’s

Various tx’s

A
  • Sx
  • Chemo
  • Radiation
  • Biologic therapies
  • Hemapoietic Stem Cell Transplant
  • Supportive Tx; complementary vs alternative therapies
  • Tx may be in Combination
    • ​Adjuvant vs. Neoadjuvant
76
Q

Tx of Cx

Factors in determining Tx:

A
  • Type/Stage of Cx
  • Gen health of Pt
  • QOL
  • Effectiveness of Tx
  • Financial strains
  • Social supports
77
Q

MOST COMMON TYPE OF Cx Tx

A

Surgery!!!

78
Q

Cx Tx

Sx

A
  • Determined by:
    • Cx type
    • Cx location
    • Pts functional status
79
Q

Cx Tx

Sx GOALS:

A
  • Biopsy—–only definitive way to dx cx
  • Removal of tumor
    • complete resection or tumor debulking
  • Correction of life threatening condition
  • Pain relief and palliation
80
Q

Chemotherapy

More useful for tx of what???

A

WIDESPREAD or Metastatic disease

**SYSTEMIC (whole body) Tx

81
Q

Chemotherapy

A
  • WIDESPREAD or METASTATIC DIS
  • Affects cell DNA synthesis
  • SINGLE agent or COMBO therapy
  • Delivery
    • PO
    • subcutaneously
    • IM
    • IV
    • injection
    • wafers
  • Single dose or Multiple doses in rounds to min. SEs
  • Affects tissue w/ high rate of cell division
    • ​GI
    • Hair
82
Q

Cx Tx

Chemotherapy GOALS

A
  • DESTROY or SHRINK tumors
  • Slow progression of dis.
  • Palliation
  • Reduction of tumor size to allow for sx resection
83
Q

Common Chemotherapy agents

A
  • Cisplatin
  • Ifosfamide
  • Cytarabine
  • Methotrexate****
  • Doxorubicin
  • Vincristine****
  • Tamoxifen
  • B-interferon
84
Q

Cx Tx

Radiation

MORE USEFUL TO WHAT

A

LOCALIZED lesions

85
Q

Cx Tx

Radiation

A
  • LOCALIZED lesions
  • destroys cells by damaging DNA to impair cell replication
  • attempt to minimize damage to healthy tissue
  • affects tissues w/ high rate cell division
    • ​skin
    • GI
    • hair
  • **Hyperfractionation
    • ​SMALLER doses @ HIGHER freq
86
Q

Cx Tx

Radiation

GOALS:

A
  • DESTROY or SHRINK tumors
  • Curative OR Palliative
  • Reduction in tumor size to allow for complete sx resection OR reduced amt of sx intervention
87
Q

Types of Radiation

A
  • Teletherapy–external beam radiation
  • Sealed source–brachytherapy (radioactive implants)
  • Intensity Modulated Radiation Therapy–IMRT
    • ​3D beams
  • Cyberknife—robotic/precision mapping
88
Q

Biologic Therapies (Targeted Therapies)

4 types

A
  1. Monoclonal antibodies
  2. Small molecules
  3. Antiangiogenic Therapy
  4. Hormonal Therapy
89
Q

Biologic Therapies (Targeted Therapies)

Monoclonal antibodies

A
  • Pharmaceutical antibodies that specifically act against particular antigen
  • Marks the cells so that other components from bodys own immune system will attack it
  • Antibodies can be carriers for chemotherapies—minimizes SE’s
90
Q

Biologic Therapies (Targeted Therapies)

Small Mc’s

A

BLOCK enzymes and receptors to PREVENT growth and proliferation

91
Q

Biologic Therapies (Targeted Therapies)

Antiangiogenic Therapy

A

BLOCKS formation of new blood vessels supplying the tumor

92
Q

Biologic Therapies (Targeted Therapies)

Hormonal Therapy

A

BLOCKS hormone receptors for hormone that supplies tumor

93
Q

Hemopoietic Stem Cell Transplant

Used for Tx of what ?

A
  • Leukemia,
  • MDS (Myelodysplastic Syndrome)
  • Lymphoma
  • Aplastic anemia
94
Q

Hemopoietic Stem Cell Transplant

A
  • leukemia, MDS, lymphoma, aplastic anemia
  • High Dose chemotherapy AND whole body radiation kills cx but creates bone marrow destruction
    • ​Stem Cell transplantation to REBUILD marrow found in bone marrow and circulating blood
  • Autologous–pts own body OR Allogenic–donor
95
Q

Hemopoietic Stem Cell Transplant

GOALS

A
  • Rid body of diseased marrow and replace it w/ fresh healthy functioning marrow
96
Q

Cx Tx

Stem Cell Harvest

MAIN POINTS

A
  • pt given G-CSF to produce high vol of circulating stem cells
  • Collection from BONE MARROW
  • Allogenic (from donor) transplants–> HLA (human leukocyte antigen)
    • ​must be matched***
97
Q

Cx Tx

Supportive Tx: Complementary and Alternative Tx

A
  • Integrative medicine
  • acupuncture
  • reiki
  • hypnosis
  • yoga
  • meditation***
  • massage
  • tai chi
  • Qi gong
98
Q

Tx Outcomes

No Evidence of Disease

NED:

A
  • ALL signs of disease have disappeared after tx from 0-5yrs
99
Q

Tx Outcomes

Durable Remission

A

NED for prolooooonged period

100
Q

Tx Outcomes

Cure:

A

W/out evidence of dis @ 5 yrs POST-Dx

101
Q

Tx Outcomes

What about people who are cured?

A

STILL REMAIN w/ sig limitations and impairs

affects function***

102
Q

Karnofsky Performance Scale

What is it?

A
  • measures ability of cx pts to perform ordinary tasks
  • Can be used to determine:
    • ​prognosis
    • participation in clinical trial
    • measure changes in pt function

HIGHER SCORE==HIGHER lvl of function

LOWER SCORE==LOWER chance of survival

103
Q

Eastern Cooperative Oncology Group Performance Scale

ECOG

what is it??

A
  • Determines HOW a pts disease is PROGRESSING
  • HOW dis affects ADLs
  • Determining ability of pt to tolerate tx
  • Assists in prognosis
104
Q

Progression of Care

4 Steps

A
  1. Preventative
  2. Restorative
  3. Supportive
  4. Palliative
105
Q

Progression of Care

Preventative

PRIMARY PREVENTION

A
  • 1/2 ALL cx deaths could be prevented thru screening tests and healthier lifestyle
  • Epigenetics: Block formation and progression of cx ​
    • Nutrigenetics: change gene sequencing and function AND DNA sequencing w/ foods/beverages
    • Chemo prevention: use of agents to inhibit and reverse cx by eliminating pre-malig cells and blocking progression of norm cells into tumors
      • ​NSAIDs, green/black tea, Vit D/E
    • Cx vaccines: using a persons OWN cx cells that have been inactivated to stimulate immune system to make antibodies which will respond in the event of reoccurrence
      • HPV vaccine
106
Q

Progression of Care

Preventative

SECONDARY PREVENTION

A
  • EARLY detection and QUICK tx to reduce morbidities and mortality
107
Q

Progression of Care

Preventative

TERTIARY PREVENTION

A
  • Sx mgmt
  • limiting comps and preventing disability
  • Active role of PT: GOAL to improve and maintain
108
Q

Role of PT in Prevention

Morano MT, et al

A

See study below

109
Q

Progression of Care

RESTORATIVE

A
  • GOOD oncologic prognosis and functional potential
  • GOAL: MAXIMIZE phys, social, psycho, vocational function
  • Tx: impairment or disability***
  • Active Role of PT: maintain function and prevent further impairment or disability
110
Q

Progression of Care

SUPPORTIVE

A
  • LIMITED oncologic prognosis and functional pot.
  • Focus: on home and family support, QOL
  • Maintaing function thru survivorship and/or progress of disease
  • Active Role of PT: PREVENTION of further impairment or disability
111
Q

Progress of Care

Palliative Care

What is Palliative Care?

A
  • approach that improves the QOL of life of pts and their families facing proble assoc’d w/ life-threatening or serious illness
  • Thru prevention and relief of suffering by means of:
    • ​EARLY ID and impeccable assessment and Tx of pain and other problems, physical, psychosocial and spiritual
112
Q

Progress of Care

Palliative Care

More on Palliative Care

A
  • Curative options EXHAUSTED
  • Regardless of lifespan
  • **Multidisciplinary approach
  • AIMS:
    • ​sx mgmt
    • MIN SEs from dis. or Tx
    • address psychological, social, spiritual concerns
113
Q

Progress of Care

Hospice Care

What is Hospice Care ?

A
  • Death is imminent, support and care given for people in the last phase of an incurable dis so they may live as fully and comfortably as possible
114
Q

Progress of Care

Hospice Care

More on Hospice Care

A
  • Focus on QOL rather than length of life
    • ​life expectancy <6mos
  • Family centered
  • AIMS:
    • ​PAIN control
    • MAX activity w/out restricts
    • emotional and psycho. support for pt and fam
115
Q

Medicare Req’s for Hospice Care

A
  • Phys and medical director use clinical judge. to certify pt is terminally ill w/ life expectancy <6mos if dis runs normal course
  • enrolls in Medicare approved hospice
  • PT services included
116
Q

Role of PT in Palliative and Hospice Care

A
  • Improve/maintain LOF**
    • ​pt indep.
    • reduced burden on caregivers
  • Max. comfort
  • Implement pain mgmt
  • Positioning**
    • ​protect skin integrity
    • Max pulm function
  • Energy conserv.
  • Home mods
  • caregiver training/edu.
  • respect goals of pt/fam
117
Q

Effects of PT on Pain and Mood in pts w/ terminal Cx: Pilot RCT

A

See study below

118
Q

What is a Survivor?

A

*someone who has completed active cx tx

119
Q

Healthy People 2020

A
  • INC proportion of Cx survivors who are living 5yrs or longer after Dx
  • Baseline- 66.2% >5yrs survival
  • TARGET: 72.8%
120
Q

Macmillan Cx Support

A
  • Survivor: someone who is living w/ or beyond cx
    • completed initial cx mgmts and has no apparent evidence of active dis.
    • living w/ progressive dis and may be receiving tx but is NOT in terminal phase of illness
    • has had cx in past
  • edu, resources, fundraising
121
Q

Primary Needs of Survivors

A
  • prevention/detection
  • monitor for reoccurrence, spread, 2* cx’s
  • interventions for cx and tx SEs
  • coordination of med. team
  • monitor for delayed or prolonged sx’s
122
Q

Role of PT in Survivorship

A
  • Address Impairments!!!!!
    • ​PAIN
    • dec ROM
    • Balance
    • Weakness
    • Limtd mobility
    • fatigue
    • Posture
123
Q

Cx Rehab: Overview of Current Need, Delivery Models, Lvls of Care

A
  • Impairments + disability reduces QOL, reduces part. in society, INCs healthcare utilization
  • survivors have several issues that must be addressed
  • survivors need continuous ex related edu from EARLY in tx, adapted thru tx and cont’d thru survivorship
  • ACSM cert for Cx exercise!!! GET IT!!!
124
Q

Cx Rehab

Delivery Models

Prospective Surveillance Model

A

Eval @ dx to deterine baseline, enlarged scope to cover wellness and surivorship care, web-based and telemedicine

125
Q

Cx Rehab

Delivery Models

Referral Trigger Model

A

automated referral for certain dx’s like lymph node dissection, imbedded screening during onco appts

126
Q

Cx Rehab

Delivery Models

Established Rehab Care Delivery Pathways

A

impairments and adverse sx’s bring pts to hospital or clinic and pt is referred for tx of functional decline

127
Q

Cx Rehab

Delivery Models

ICF, Disability and Health

A

mapping ICF impairments to outcome based functional measures but little impact on clinical practice

128
Q

Cx Rehab

Delivery Models

Center Based Programs

A

Reconditioning program for pts during and after cx tx

similar to cardiopulm rehab

129
Q

Cx Rehab

Delivery Models

Exercise for Rehab and Fitness

A

Conditioning from dx for aerobic fit, strength/endurance,

mitigates toxicity, optimize function, 2* cx prevention benefit

130
Q
A

Medcon Rehab III (6 decks)

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