PHYSICAL THERAPY IN ONCOLOGY Flashcards
carcinoma affects…
soft tissue
a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.
Sarcoma affects…
Connective tissue and bone:
Sarcoma is an uncommon group of cancers which arise in the bones, and connective tissue such as fat and muscle
Leukemia affects….
hematopoietic cells:
a malignant progressive disease in which the bone marrow and other blood-forming organs produce increased numbers of immature or abnormal leukocyte (WBC)
Lymphoma affects…
Lymphoma is the name for a group of blood cancers that develop in the lymphatic system
TNM staging
Tumor, Node, Metastasis
SIGNS AND SYMPTOMS:
- Pallor
- Easy bruising
- Pain that wakes from sleeping
- Lymphadenopathy
- Fatigue
- Unintentional weight loss
Peripheral blood smear
A blood smear is a blood test used to look for abnormalities in blood cells
During this week, anti-emetics are given, typically feel reasonably well
Chemo week
drug that is effective against vomiting and nausea
During this week, chemo is taking effect, mouth sores, nausea, low counts/energy. Will be admitted if febrile
Neutropenic week
abnormally low level of neutrophils (WBC)
Oncology mediports:
restrictions?
- Subcutaneus, venous access
- No restrictions
after removal of oncology mediport
avoid excessive stretch and weight bearing for 2 weeks
oncology mediports
Vinka-alkaloids
- Chemothrapy agents
- Vincristine
- Vinblastine
- Vinorelibine
____________ are used in chemotherapy for cancer. They are a class of cell cycle–specific cytotoxic drugs that work by inhibiting the ability of cancer cells to divide: Acting upon tubulin, they prevent it from forming into microtubules, a necessary component for cellular division.
Vinca alkaloids
Vinca-Alkaloids side effects
Peripheral neuropathy:
- Long nerves in the body: finger flexors and dorsiflexors
- Diminished reflexes
- Muscle cramping
- Pain/hypersensitivity
- Paralysis
“Patient may not tell doctors about side effects”
The anthracyclines are among the most effective anticancer treatments ever developed and are effective against more types of cancer than any other class of chemotherapeutic agents. Their main adverse effect is _________, which considerably limits their usefulness
cardiotoxicity:
Cardiomyopathy and CHF
Monitor HR closely, asymptomatic
Anthracycline antibiotics examples:
- Doxorubicin
- Danorubicin
- Epirubicin
- Idarubicin
Since cancer cells, in general, proliferate faster and with less error-correcting than healthy cells, cancer cells are more sensitive to DNA damage—such as being alkylated. _________ agents are used to treat several cancers. However, they are also toxic to normal cells (cytotoxic), particularly cells that divide frequently, such as those in the gastrointestinal tract, bone marrow, testicles and ovaries, which can cause loss of fertility. Most of the ___________ agents are also carcinogenic.
Alkylating
Side effects of Alkylating agents (Busalfan)
-
Pulmonary Fibrosis
- Low O2 Sat
- Do not use supplemental oxygen (makes pulmonari fibrosis worse)
Busulfan is used for:
- Preparing the body for a hematopoietic stem cell transplant in combination with another medicine (cyclophosphamide) in patients with chronic myelogenous leukemia.
- It may also be used for other conditions as determined by your doctor.
Platinum Based chemothrapy agents:
- Cisplatin
- Carboplatin
- Nedaplatin
Side effects of Platinum-Based chemothrapy agents
(Cisplatin Carboplatin Nedaplatin)
Hearing Loss, Vestibular Involvement
The main dose-limiting side effect of cancer treatment with platinum compounds is
neurotoxicity
which causes peripheral neuropathies including polyneuropathy
hearing loss, vestibular involvement
peripheral neuropathies during chemotherapy treatment include:
- Loss of Achilles tendon reflex
- Sensory impairments
- Numbness
- Parasthesia
- Weakness/muscle atrophy
- Loss of fine motor skills
- Gait disturbance with tripping and falls
peripheral neuropathies during chemotherapy treatment develop at which phase of the tx?
any phase of treatment
progression of peripheral neuropathy
(SE from chemotherapy)
- Cramping
- Pain
- Weakness
- Numbness
- Paralysis
what is referred as the “chemo brain”
- Mental “cloudiness”
- Typically rapid onset
- Can be short term or long term
- Exact cause is unknown
During “chemo brain” period, mental “cloudiness” can include the following impairments:
- Lapses in memory
- “spacing out” and difficulty concentrating
- Multitasking becomes difficult
- Increased processing time
- Word recall
Distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.
CANCER RELATED FATIGUE (CRF)
__________ biopsy is a surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system. Sentinel node biopsy is used most commonly in evaluating breast cancer and melanoma.
Sentinel node
Breast cancer tx considerations
- Metastases to bone and brain
- Axillary lymph node dissection
- Flexion restrictions
- Cording/Axillary Web Syndrome
Gynecologic Cancers treatment considerations
Retroperitoneal Lymph Node Dissection (RPLND) often performed
Trismus refers to
reduced opening of the jaws caused by spasm of the muscles of mastication, or may generally refer to all causes of limited mouth opening
Head and Neck cancer tx considerations
- Restrictions in neck ROM post-op
- Trismus
lung cancer metastasizes to
bone and brain
lung cancer tx considerations
- Pulmonary health
- Oxygen saturation levels
- Positioning
Leukemia & Lymphoma high risk of
Avascular Necrosis
How do pediatric cancer affect development?
-
Developmental delays
- Parent education is extremely important
Primary Bone Tumors Metastasizes to
lung
primary bone tumors peaks at
growth spurts
Brain Tumors tx considerations:
- May be inoperable
- Level of function changes very quickly
- Ommaya reservoir
- Steroids and anti-convulsant
Most men die ______ prostate cancer, not from it
with
Colorectal, Pancreatic & Gastrointestinal tx considerations
- Large scale surgeries needed,
- early mobilization is key
the “big 3” in cancer treatment
- chemotherapy
- surgery
- radiation
General chemotherapy side effects include
- Nausea
- Mucositis (“mouth sores”)
- Low blood counts:
- Neutropenia (abnormally low level of neutrophils, WBC)
radiation therapy can be given up to
10 years after treatment
radiation side effects
-
FIBROSIS:
- Skin: lack of glands and follicles, sensation, pliability
- Organs
Hematopoietic stem cells are replaced with new ones from a donor
“BONE MARROW TRANSPLANT
sources of stem cell transplant:
- Peripheral Blood
- Cord Blood
- Bone Marrow
Cushingoid Symptoms
syngenic
genetically matched twin
Systems effected in a transplanted immune system
- Skin
- Liver
- Gut
a collection of signs and symptoms due to prolonged exposure to cortisol
Cushing’s syndrome
steroids used for cancer treatment prevent increased…
intra-cranial pressure
Bone Pain
- Platelets and HgB are produced in the bone marrow
- Activity has no effect
- No risk of fracture or damage
When to proceed to PT treatment session:
- Lower extremity DVT with IVC filter
- Platelets > 20, HgB > 8
- Bone pain from increasing counts
- Hydration prior to or following chemotherapy
When to modify to PT treatment session:
- Platelets 10-20, HgB 7-8 with special orders
- Symptomatic
- External VP shunt
delay or hold PT session?
- Active chemotherapy infusion
- Active blood or platelet transfusion
- A-Line in place
delay
delay or hold PT session if…?
- Following radiation
- Following dialysis
- DVT (without IVC filter)
- PEG-asparaginase
hold
come back in a few days
Pretreatmnet of patients with cancer:
- Strengthening and conditioning
- Education on potential treatment related activity and participation limitations
cancer cells division progression
METASTASES
- Cancer cells travel to a remote area via
- Blood vessels
- Lymph vessels
Axillary web syndrome (AWS), also known as cording, sometimes develops as a side effect of
sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Both procedures involve removing just a few (SLNB) or many (ALND) of the axillary, or underarm, lymph nodes. Most people with breast cancer need to have at least one of these surgeries. Scar tissue from surgery to the chest area to remove the cancer itself also can contribute to cording .
An Ommaya reservoir is an
intraventricular catheter system that can be used for the aspiration of cerebrospinal fluid or for the delivery of drugs (e.g. chemotherapy) into the cerebrospinal fluid. It consists of a catheter in one lateral ventricle attached to a reservoir implanted under the scalp.
Cancer pain management:
-
Pt education:
- Life style change: nutrition & sleep cycle
- Activity management: no aggressive exercise or activity when pain is severe
- Physical exercise: strenghthening, endurance, stretching
- Mind-body therapy: yoga, relaxation therapy
- Passive interventions: massage, TENS, hydrotherapy, myofascial release
cancer PT treatment during active care phase
Address specific impairments, episodes of care inpatient and outpatient
cancer PT treatment during palliation phase
- Focus on patient/family goals.
- Improve quality of life.
- Maximize functional skills.
- Durable medical equipment needs
cancer PT treatment during Post care/ Maintenence phase
- Address specific impairments and conditioning.
- Return to activity and participation based on patient’s goals.
