Oncology Rehab Flashcards
prevalence:
50%
1 in 6
cancer =
Abnormal cells within a tissue which proliferate in an uncontrolled manner
Most cancers are named for the type of cell or organ in which they start ➔ ___
primary cancer
Breast, Lung, GI
Sarcoma – bone, muscle
Higher stage = ___ prognosis
worse
Stage IV = metastatic
If a cancer metastasizes, the new tumor bears the same name as the primary tumor
Cures =
Individual Cures — Sure
Rid the world of cancer —Probably Not
Heterogeneous
complex and varied nature of cancer, which makes finding a universal cure challenging
oncology challenge =
Cancer is common➔ ~2 million diagnosis per year in the US
Cancer is heterogeneous
> 17 million survivors and growing
___ survivors in vermont
~40,000
what causes cancer?
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
Why are some cancers more common than the others?
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
age-adjusted death rates top 2 leading causes:
heart disease - 23.4%
cancer - 22%
estimated new cancer cases - male
Prostate 19%
Lung/Bronchus 14%
Colon/rectum 9%
Urinary/Bladder 7%
Melanoma 6%
NH Lymphoma 5%
Kidney 5%
estimated new cancer cases - female
Breast 30%
Lung/Bronchus 13%
Colon/rectum 7%
Uterus 7%
Thyroid 5%
NH Lymphoma 4%
Melanoma 4%
estimated US cancer deaths - male
Lung/bronchus 26%
Prostate 9%
Colon/rectum 8%
Pancreas 7%
Liver/bile duct 6%
Leukemia 4%
Esophagus 4%
estimated US cancer deaths - female
Lung/bronchus 25%
Breast 14%
Colon/rectum 8%
Pancreas 7%
Ovary 5%
Leukemia 4%
Uterus 4%
concepts for decision making:
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
stages:
0 = carcinoma in situ - early form
1 = localized
2 = early locally advanced
3 = late locally advanced
4 = metastasized
small cell lung cancer (SCLC)
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
non-small cell lung cancer (NSCLC)
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
Seminoma testicular cancer
Localized: 70% present at stage 1
Mets: typically lymph nodes
Prognosis: extremely radiosensitive
Non-Seminoma testicular cancer
Regional: 60% present at stage II or III
Mets: typically hematogenous
Prognosis: relatively radioresistant; poorer prognosis
treatment options: local control
Surgery➔ tumor removal for a variety of reasons
Radiation therapy ➔ adjuvant or neoadjuvant
curable by surgery alone:
Melanoma
Pancreatic Cancer
Early Stage Lung or Colon
Renal Cell Carcinoma
Breast Cancer ➔ if early & with certain characteristics
result of surgical and radiation interventions:
Impaired range of motion
Lymphedema
Impaired organ function
Fibrosis of tissue
Pulmonary/Cardiac Dysfunction
Cognitive change ➔ Radiation-induced cognitive decline
recommendations:
Return to usual activity as soon as possible after surgery
Maintain exercise
Increase slowly
Pay attention to body signals
Lymphedema
arms
legs
neck
Physical Therapy Treatment: - Exercise
- Patient Education
- Complete Decongestive Therapy
Risk of lymphedema:
Stronger Risk Factor:
Extent of surgery
Obesity
Weak Risk Factor - Number of lymph nodes removed
CAUTION:
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
PT interventions: post surgery and radiation
Break up fibrotic tissue
ADL
Limb Volume
Improving urinary incontinence
Improve range of motion
QoL
Cure➔
Eliminate cancer that might have escaped site of origin
Adjuvant ➔ following first-line of treatment
Control➔
Decreasing size to make surgery easier
Neoadjuvant➔ before the primary treatment
Palliative ➔
Control disease that is metastatic
chemotherapy cocktail:
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
physiologic result of systemic therapy:
Bone marrow suppression ➔ RBC, WBC, platelets
*Anemia, neutropenia, thrombocytopenia
Cardiotoxicity
Pulmonary impairment
Peripheral Neuropathy
Sarcopenia
Cognitive Dysfunction
Endocrine Changes
Bone Loss
chemotherapy translation to activity tolerance:
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
symptom challenges of acute therapy:
Fatigue
Nausea/Vomiting
Deconditioning
Infection
functional end result:
Loss of muscle mass
Decreased strength
Less endurance
Overall decline ➔ physiologic reserve
Less able to tolerate additional therapy
**cancer speeds up this process
cancer treatment impacts that improve with rehab and exercise:
Fitness
Strength
Functional Ability
Cancer Related Fatigue
Range of Motion
Lymphedema
Weight gain
Sarcopenia
effects of exercise in leukemia patients:
Muscular endurance increased
Fatigue decreased
Depression decreased
It was safe
**reduces side effects
Exercise post therapy associated w/ reduced:
Fatigue
Shortness of breath
Pain
Depression
Exercise 6 months latter associated w/ reduced:
Sleep disturbance
Memory problems
Fatigue
physiologic benefits of exercise during treatment:
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
QOL benefits of exercise during treatment:
Decreased fatigue
Decreased nausea
Improved sleep patterns
Lower pain perception
Less emotional and psychological distress
Lower depression and anxiety
exercise caution:
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
Persistent effects:
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
Late effects:
Develop months to years after treatment
Cardiomyopathies
Arrythmias
Lung parenchyma change resulting from radiation ➔ fibrosis
cancer-related-fatigue
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
exercise improves fatigue: direct mechanism
Muscle strength & endurance
Cardiopulmonary fitness
Dampened Inflammatory response
Improved insulin function
exercise improves fatigue: indirect mechanism
Diminished anxiety and depression
Improved sleep
Improved cognition
exercise improves survival:
Breast Cancer: 30% lower risk of morality
Prostate Cancer: 30% lower risk
Colo-rectal Cancer: 50% lower risk
Brain Tumors: 36% lower risk
why does exercise reduce cancer recurrence and mortality?
Decreased circulating hormone levels
Decreased inflammation
Improved insulin sensitivity
Promotes weight loss/controls weight gain
Helps maintain weight loss
physical activity among cancer survivors:
76.8% without cancer DID NOT meet recommendations of 150 min/week
95.5% cancer survivors DID NOT meet recommendations
limitations of FITT principles:
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
