Oncology: Special Topics In Oncolgoy Rehabilitation

Question 1

What is Dietz’s phase of cancer rehab?

Answer 1

This theory describes the goals of rehab based on the pts goals for cancer tx in phases of preventative, restorative, supportive, and palliative care

Question 2

What is involved in preventative care in the Dietz’s phases of cancer rehab?

Answer 2

Focus on reducing chance of developing impairments
Begins immediately with cancer dx and continues throughout treatment

Question 3

What is involved in restorative care in the Dietz’s phases of cancer rehab?

Answer 3

Address the functional impairments for people living with and beyond cancer
Aims to resume max functioning with minimal residual side effects

Question 4

What is involved in supportive care in the Dietz’s phases of cancer rehab?

Answer 4

Centers on optimizing fxn and performance status during disease progression and further treatment
Aims to reduce decline in fxn and QOL

Question 5

What is involved in palliative care in the Dietz’s phases of cancer rehab?

Answer 5

Emphasizes maintenance of QOL in the setting of terminal disease

Question 6

Is supportive care in Dietz’s phases of cancer rehab curative or life prolonging?

Answer 6

Life prolonging

Question 7

When does prehabilitation occur?

Answer 7

Bw dx and initiation of tx

Question 8

What is the aim of prehabilitation?

Answer 8

To optimize physical and psychological status to reduce incidence and severity of future impairments

Question 9

Is prehabilitation uni or multimodal?

Answer 9

Can be either

Question 10

What things may be included in prehabilitation?

Answer 10

Exercise, nutrition, and psychological intervention

Question 11

Why is psychological intervention included in prehabilitation?

Answer 11

To address any preexisting psych issues and to provide the pt with coping strategies to get through dx and tx

Question 12

What is the prospective surveillance model?

Answer 12

A model for breast cancer that involves actively monitoring for early signs of impairment to try to catch them before they become something serious

Question 13

What is involved in active monitoring in the prospective surveillance model?

Answer 13

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

Question 14

What is the focus of palliative care?

Answer 14

Focus is on QOL

Question 15

What are the various roles of the team in palliative care?

Answer 15

Symptom management
Spiritual care
Decision making
Care coordination

Question 16

What symptoms do we manage in palliative care?

Answer 16

Pain, fatigue, SOB, nausea, and psych distress

Question 17

What is involved in the decision making role in palliative care?

Answer 17

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

Question 18

What is involved in care coordination in palliative care?

Answer 18

Continuity of care bw disciplines
Alignment of goals with treatment
Minimizing unnecessary treatment

Question 19

Can palliative care be done during active treatment?

Answer 19

Yes!

Question 20

When does palliative care get involved?

Answer 20

At diagnosis

Question 21

What is a key distinction between palliative care and hospice care?

Answer 21

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

Question 22

T/f: palliative care is appropriate for any serious illness

Answer 22

True

Question 23

Is hospice or palliative care concurrent with curative, restorative, and life-prolonging therapies?

Answer 23

Palliative care

Question 24

What is the aim of hospice care?

Answer 24

Dying with dignity

Question 25

What is hospice care?

Answer 25

Palliative care for those with terminal illness

Question 26

T/f: hospice care is interdisciplinary care addressing all aspects of suffering for both the pt and family

Answer 26

True

Question 27

Is hospice care home or facility based?

Answer 27

Can be either, but the qualifications for facility based hospice care are very strict

Question 28

What are the qualifications for hospice care?

Answer 28

Pt is in their last weeks to months of life (<6 months) Pt elects to forego life- prolonging , disease-modifying treatment

Question 29

What are some unique characteristics of rehab at the end of life?

Answer 29

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”

Question 30

What are two big benefits of rehab at the end of life?

Answer 30

QOL is maintained longer There are higher fxnal capacities at the end of life

Question 31

What plays an important role in cancer prevention and limiting side effects of cancer treatment and promoting improved heath among cancer survivors?

Answer 31

Exercise!

Question 32

Who are classified as cancer survivors?

Answer 32

Anyone ever diagnosed with cancer

Question 33

T/f: sedentary lifestyle is a risk factor for several of the most common types of cancers

Answer 33

True

Question 34

How many minutes of moderate to vigorous physical activity (PA) at least 5 days/week reduces risk of breast, colorectal, liver, and lung cancer?

Answer 34

30-60 minutes

Question 35

T/f: there is evidence that meeting the PA guidelines improves several symptoms associated with cancer survivorship

Answer 35

True

Question 36

There is strong evidence that _____ exercise does not exacerbate lymphedema

Answer 36

Resistive

Question 37

There is moderately strong evidence that aerobic PA improves what?

Answer 37

Sleep

Question 38

There is moderately strong evidence that resistive PA improves what?

Answer 38

Bone quality

Question 39

What are the benefits of exercise to cancer survivors?

Answer 39

Reduced CRF, improved health related QOL, improved physical function, reduced anxiety, reduced depression

Question 40

What is the frequency for aerobic exercise in cancer survivors?

Answer 40

3-5 days/week

Question 41

What is the intensity of aerobic exercise for cancer survivors?

Answer 41

Moderate (RPE 12-13) or Vigorous (RPE 14-17) NOT FOR CRF

Question 42

What is the time for aerobic exercise for cancer survivors?

Answer 42

75 min/week of vigorous intensity OR 150 min/week of moderate intensity OR An equivalent combo of the 2

Question 43

What is the type of aerobic exercise for cancer survivors?

Answer 43

Prolonged rhythmic activities using large Ms groups like walking, cycling, swimming

Question 44

What is the frequency of resistance exercise for cancer survivors?

Answer 44

2-3 days/week

Question 45

What is the intensity of resistance exercise for cancer survivors?

Answer 45

Start with low resistance (<30% 1 RM) and progress with the smallest increments possible (ie 1 pound at a time)

Question 46

What is the time of resistance exercise for cancer survivors?

Answer 46

At least 1 set of 8-12

Question 47

What is the type of resistance exercise for cancer survivors?

Answer 47

Free weights Resistance machines WB functional tasks targeting all major Ms groups

Question 48

T/f: the guidelines for aerobic exercise for cancer survivors the same as for any other older adult

Answer 48

True

Question 49

What is different about the guidelines for resistance exercise for cancer survivors than for other older adults?

Answer 49

It starts lower and progresses slower

Question 50

What are the goals of exercise in relation to cancer?

Answer 50

To prolong life, decrease symptoms, and decrease risk

Question 51

What is involved in exercise screening for cancer survivors?

Answer 51

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

Question 52

How can we adapt exercise for CRF?

Answer 52

Keep RPE <4/10

Question 53

How can we adapt exercise during/after RXT/chemo?

Answer 53

Ask for lab values and follow lab values guidelines for exercise from the APTA

Question 54

What do we have to be sure of when a pt have bone metastasis or bone lesions?

Answer 54

Their WB status