Oncology: Special Topics In Oncolgoy Rehabilitation Flashcards
What is Dietz’s phase of cancer rehab?
This theory describes the goals of rehab based on the pts goals for cancer tx in phases of preventative, restorative, supportive, and palliative care
What is involved in preventative care in the Dietz’s phases of cancer rehab?
Focus on reducing chance of developing impairments
Begins immediately with cancer dx and continues throughout treatment
What is involved in restorative care in the Dietz’s phases of cancer rehab?
Address the functional impairments for people living with and beyond cancer
Aims to resume max functioning with minimal residual side effects
What is involved in supportive care in the Dietz’s phases of cancer rehab?
Centers on optimizing fxn and performance status during disease progression and further treatment
Aims to reduce decline in fxn and QOL
What is involved in palliative care in the Dietz’s phases of cancer rehab?
Emphasizes maintenance of QOL in the setting of terminal disease
Is supportive care in Dietz’s phases of cancer rehab curative or life prolonging?
Life prolonging
When does prehabilitation occur?
Bw dx and initiation of tx
What is the aim of prehabilitation?
To optimize physical and psychological status to reduce incidence and severity of future impairments
Is prehabilitation uni or multimodal?
Can be either
What things may be included in prehabilitation?
Exercise, nutrition, and psychological intervention
Why is psychological intervention included in prehabilitation?
To address any preexisting psych issues and to provide the pt with coping strategies to get through dx and tx
What is the prospective surveillance model?
A model for breast cancer that involves actively monitoring for early signs of impairment to try to catch them before they become something serious
What is involved in active monitoring in the prospective surveillance model?
An initial eval at dx to get a pts baseline
Then follow up visits every 3 months to get for any potential toxicities and side effects that could use rehab
What is the focus of palliative care?
Focus is on QOL
What are the various roles of the team in palliative care?
Symptom management
Spiritual care
Decision making
Care coordination
What symptoms do we manage in palliative care?
Pain, fatigue, SOB, nausea, and psych distress
What is involved in the decision making role in palliative care?
Discussing with the pt and family what their goals are and how they align with available medical treatment
Deciding whether they want to go through with a certain treatment
What is involved in care coordination in palliative care?
Continuity of care bw disciplines
Alignment of goals with treatment
Minimizing unnecessary treatment
Can palliative care be done during active treatment?
Yes!
When does palliative care get involved?
At diagnosis
What is a key distinction between palliative care and hospice care?
Palliative care can be happening at the same time as curative care, while hospice care begins when the pt is no longer wanting curative care
T/f: palliative care is appropriate for any serious illness
True
Is hospice or palliative care concurrent with curative, restorative, and life-prolonging therapies?
Palliative care
What is the aim of hospice care?
Dying with dignity
What is hospice care?
Palliative care for those with terminal illness
T/f: hospice care is interdisciplinary care addressing all aspects of suffering for both the pt and family
True
Is hospice care home or facility based?
Can be either, but the qualifications for facility based hospice care are very strict
What are the qualifications for hospice care?
Pt is in their last weeks to months of life (<6 months)
Pt elects to forego life- prolonging , disease-modifying treatment
What are some unique characteristics of rehab at the end of life?
We are more willing to accept a refusal
Balance fxn and participation with comfort and preserving some strength
Focus on pain control (less accepting of even small amounts of pain)
Anticipation of decline/“bad days”
What are two big benefits of rehab at the end of life?
QOL is maintained longer
There are higher fxnal capacities at the end of life
What plays an important role in cancer prevention and limiting side effects of cancer treatment and promoting improved heath among cancer survivors?
Exercise!
Who are classified as cancer survivors?
Anyone ever diagnosed with cancer
T/f: sedentary lifestyle is a risk factor for several of the most common types of cancers
True
How many minutes of moderate to vigorous physical activity (PA) at least 5 days/week reduces risk of breast, colorectal, liver, and lung cancer?
30-60 minutes
T/f: there is evidence that meeting the PA guidelines improves several symptoms associated with cancer survivorship
True
There is strong evidence that _____ exercise does not exacerbate lymphedema
Resistive
There is moderately strong evidence that aerobic PA improves what?
Sleep
There is moderately strong evidence that resistive PA improves what?
Bone quality
What are the benefits of exercise to cancer survivors?
Reduced CRF, improved health related QOL, improved physical function, reduced anxiety, reduced depression
What is the frequency for aerobic exercise in cancer survivors?
3-5 days/week
What is the intensity of aerobic exercise for cancer survivors?
Moderate (RPE 12-13) or
Vigorous (RPE 14-17) NOT FOR CRF
What is the time for aerobic exercise for cancer survivors?
75 min/week of vigorous intensity OR
150 min/week of moderate intensity OR
An equivalent combo of the 2
What is the type of aerobic exercise for cancer survivors?
Prolonged rhythmic activities using large Ms groups like walking, cycling, swimming
What is the frequency of resistance exercise for cancer survivors?
2-3 days/week
What is the intensity of resistance exercise for cancer survivors?
Start with low resistance (<30% 1 RM) and progress with the smallest increments possible (ie 1 pound at a time)
What is the time of resistance exercise for cancer survivors?
At least 1 set of 8-12
What is the type of resistance exercise for cancer survivors?
Free weights
Resistance machines
WB functional tasks targeting all major Ms groups
T/f: the guidelines for aerobic exercise for cancer survivors the same as for any other older adult
True
What is different about the guidelines for resistance exercise for cancer survivors than for other older adults?
It starts lower and progresses slower
What are the goals of exercise in relation to cancer?
To prolong life, decrease symptoms, and decrease risk
What is involved in exercise screening for cancer survivors?
Detailed cancer related hx to determine what tissues may be involved
Other comorbidities
Cardiac screen
Pulmonary screen
Cognitive screen
Neuro screen
Balance screen
Fxnal screen
How can we adapt exercise for CRF?
Keep RPE <4/10
How can we adapt exercise during/after RXT/chemo?
Ask for lab values and follow lab values guidelines for exercise from the APTA
What do we have to be sure of when a pt have bone metastasis or bone lesions?
Their WB status
