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Integ Final > Oncology Rehab > Flashcards

Oncology Rehab Flashcards

1
Q

prevalence:

A

50%

1 in 6

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2
Q

cancer =

A

Abnormal cells within a tissue which proliferate in an uncontrolled manner

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3
Q

Most cancers are named for the type of cell or organ in which they start ➔ ___

A

primary cancer

Breast, Lung, GI
Sarcoma – bone, muscle

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4
Q

Higher stage = ___ prognosis

A

worse

Stage IV = metastatic

If a cancer metastasizes, the new tumor bears the same name as the primary tumor

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5
Q

Cures =

A

Individual Cures — Sure
Rid the world of cancer —Probably Not

Heterogeneous

complex and varied nature of cancer, which makes finding a universal cure challenging

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6
Q

oncology challenge =

A

Cancer is common➔ ~2 million diagnosis per year in the US

Cancer is heterogeneous

> 17 million survivors and growing

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7
Q

___ survivors in vermont

A

~40,000

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8
Q

what causes cancer?

A

Tobacco smoking (35%)

Nutrition, Physical Inactivity, Obesity (40%)

Environmental & Industrial Exposures

Drug-induced (secondary neoplasms)

Viruses (EBV, Hepatitis B & C, HIV, HPV)

Genetic predisposition

Age

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9
Q

Why are some cancers more common than the others?

A

Certain cell types more likely to acquire mutations

Cells which proliferate rapidly ➔ endothelial cells, fibroblasts, smooth ms cells

Sites of exposure to carcinogens

Skin
Lung
Breast
Colorectal

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10
Q

age-adjusted death rates top 2 leading causes:

A

heart disease - 23.4%

cancer - 22%

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11
Q

estimated new cancer cases - male

A

Prostate 19%
Lung/Bronchus 14%
Colon/rectum 9%
Urinary/Bladder 7%
Melanoma 6%
NH Lymphoma 5%
Kidney 5%

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12
Q

estimated new cancer cases - female

A

Breast 30%
Lung/Bronchus 13%
Colon/rectum 7%
Uterus 7%
Thyroid 5%
NH Lymphoma 4%
Melanoma 4%

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13
Q

estimated US cancer deaths - male

A

Lung/bronchus 26%
Prostate 9%
Colon/rectum 8%
Pancreas 7%
Liver/bile duct 6%
Leukemia 4%
Esophagus 4%

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14
Q

estimated US cancer deaths - female

A

Lung/bronchus 25%
Breast 14%
Colon/rectum 8%
Pancreas 7%
Ovary 5%
Leukemia 4%
Uterus 4%

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15
Q

concepts for decision making:

A

Multi modality treatment ➔ most but not all

Extent of disease

Type of cancer ➔ even within the same organ

Responsiveness to radiation or chemotherapy

Pathologic characteristics ➔ extent of mutation

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16
Q

stages:

A

0 = carcinoma in situ - early form

1 = localized

2 = early locally advanced

3 = late locally advanced

4 = metastasized

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17
Q

small cell lung cancer (SCLC)

A

10-15% of lung cancers

classically, 3 subtypes

usually centrally located

more aggressive

staged as limited or extensive disease

treatment usually chemotherapy with or without radiation

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18
Q

non-small cell lung cancer (NSCLC)

A

85-90% of lung cancers

many subtypes

centrally or peripherally located

can be fast or slow growing

stages using TNM staging

treatment is surgical, medical, or radiation

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19
Q

Seminoma testicular cancer

A

Localized: 70% present at stage 1

Mets: typically lymph nodes

Prognosis: extremely radiosensitive

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20
Q

Non-Seminoma testicular cancer

A

Regional: 60% present at stage II or III

Mets: typically hematogenous

Prognosis: relatively radioresistant; poorer prognosis

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21
Q

treatment options: local control

A

Surgery➔ tumor removal for a variety of reasons

Radiation therapy ➔ adjuvant or neoadjuvant

22
Q

curable by surgery alone:

A

Melanoma
Pancreatic Cancer
Early Stage Lung or Colon
Renal Cell Carcinoma

Breast Cancer ➔ if early & with certain characteristics

23
Q

result of surgical and radiation interventions:

A

Impaired range of motion

Lymphedema

Impaired organ function

Fibrosis of tissue

Pulmonary/Cardiac Dysfunction

Cognitive change ➔ Radiation-induced cognitive decline

24
Q

recommendations:

A

Return to usual activity as soon as possible after surgery

Maintain exercise

Increase slowly

Pay attention to body signals

25
Q

Lymphedema

A

arms
legs
neck

Physical Therapy Treatment: - Exercise
- Patient Education
- Complete Decongestive Therapy

26
Q

Risk of lymphedema:

A

Stronger Risk Factor:
Extent of surgery
Obesity

Weak Risk Factor - Number of lymph nodes removed

27
Q

CAUTION:

A

Start low and go slow

Bandaging or Compression garments should be worn during exercise

No BP on ipsilateral arm

Skin Punctures = risk of skin infection

28
Q

PT interventions: post surgery and radiation

A

Break up fibrotic tissue
ADL
Limb Volume
Improving urinary incontinence
Improve range of motion
QoL

29
Q

Cure➔

A

Eliminate cancer that might have escaped site of origin

Adjuvant ➔ following first-line of treatment

30
Q

Control➔

A

Decreasing size to make surgery easier

Neoadjuvant➔ before the primary treatment

31
Q

Palliative ➔

A

Control disease that is metastatic

32
Q

chemotherapy cocktail:

A

Use drugs active against the specific disease

Use drugs with non-overlapping toxicities

Use drugs at optimum doses

Use drugs at regular intervals (cycles) with minimal pauses for recovery from toxicity

33
Q

physiologic result of systemic therapy:

A

Bone marrow suppression ➔ RBC, WBC, platelets
*Anemia, neutropenia, thrombocytopenia

Cardiotoxicity
Pulmonary impairment
Peripheral Neuropathy
Sarcopenia
Cognitive Dysfunction
Endocrine Changes
Bone Loss

34
Q

chemotherapy translation to activity tolerance:

A

CON” group consistently demonstrates higher walking speeds than the “AST” group

Chemotherapy often reduces exercise tolerance due to side effects such as fatigue, muscle weakness, and reduced endurance

35
Q

symptom challenges of acute therapy:

A

Fatigue
Nausea/Vomiting
Deconditioning
Infection

36
Q

functional end result:

A

Loss of muscle mass
Decreased strength
Less endurance

Overall decline ➔ physiologic reserve

Less able to tolerate additional therapy

**cancer speeds up this process

37
Q

cancer treatment impacts that improve with rehab and exercise:

A

Fitness
Strength
Functional Ability
Cancer Related Fatigue
Range of Motion
Lymphedema
Weight gain
Sarcopenia

38
Q

effects of exercise in leukemia patients:

A

Muscular endurance increased

Fatigue decreased

Depression decreased

It was safe

**reduces side effects

39
Q

Exercise post therapy associated w/ reduced:

A

Fatigue
Shortness of breath
Pain
Depression

40
Q

Exercise 6 months latter associated w/ reduced:

A

Sleep disturbance
Memory problems
Fatigue

41
Q

physiologic benefits of exercise during treatment:

A

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

42
Q

QOL benefits of exercise during treatment:

A

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

43
Q

exercise caution:

A

Anemia: hemoglobin < 7 g/dL
Fever ≥ 38 C
Elevated blood pressure >200 SBP or >110 DBP
Rapid heart rate >120bpm
Desirable Ranges:
Systolic >95 and < 180

Resting HR >50 and < 120
Careful use of resistance bands w/ thrombocytopenia & lymphedema

44
Q

Persistent effects:

A

Began during chemotherapy, often worsen & don’t necessarily go away

cancer-related-fatigue

Most distressing symptom associated with cancer & its treatment

Experienced by 70-100%
Can last months to years

45
Q

Late effects:

A

Develop months to years after treatment

Cardiomyopathies
Arrythmias
Lung parenchyma change resulting from radiation ➔ fibrosis

46
Q

cancer-related-fatigue

A

Persistent subjective sense of exhaustion related to cancer or cancer treatment that interferes with usual function

Not relieved by rest or sleep
Does not correspond to level of exertion
More severe and distressing
Disproportionate level of fatigue

47
Q

exercise improves fatigue: direct mechanism

A

Muscle strength & endurance
Cardiopulmonary fitness
Dampened Inflammatory response
Improved insulin function

48
Q

exercise improves fatigue: indirect mechanism

A

Diminished anxiety and depression
Improved sleep
Improved cognition

49
Q

exercise improves survival:

A

Breast Cancer: 30% lower risk of morality
Prostate Cancer: 30% lower risk
Colo-rectal Cancer: 50% lower risk
Brain Tumors: 36% lower risk

50
Q

why does exercise reduce cancer recurrence and mortality?

A

Decreased circulating hormone levels
Decreased inflammation
Improved insulin sensitivity
Promotes weight loss/controls weight gain
Helps maintain weight loss

51
Q

physical activity among cancer survivors:

A

76.8% without cancer DID NOT meet recommendations of 150 min/week

95.5% cancer survivors DID NOT meet recommendations

52
Q

limitations of FITT principles:

A

The majority of available literature is still in the most common cancers, namely, early-stage breast cancer and prostate cancers, which limits the ability to extrapolate their findings to other cancer types or advanced cancers

Integ Final (16 decks)

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