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Exercise Prescription In Cancer Populations > Treatments, Toxicities and CRF > Flashcards

Treatments, Toxicities and CRF Flashcards

1
Q

What are the primary treatments for cancer?

A

Surgery, radiation, chemotherapy and other(hormone and immuno)

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2
Q

What is the aim of surgery?

A

Remove the cancerous cells

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3
Q

What grade of tumors is surgery typically very successful at treating?

A

Lower grades

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4
Q

How does surgery benefit the patient?

A

Reduces bulk of disease and allows for chemo to be more effective

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5
Q

What type of emergency would result in surgery for a cancer patient?

A

Oncological emergencies

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6
Q

How does surgery improve the quality of life for cancer patients?

A

Relief of pain
Reconstruction promoting “normal” structure
Rehabilitation

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7
Q

Can surgery be done preventatively for cancer patients?

A

Yes, to remove organ or growth which could become malignant(based off of family hx, gene presence etc..)

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8
Q

How does radiotherapy work?

A

Charged particles or photons(x rays, gamma rays) are administered to the cancerous site to destroy the malignant cancer cells

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9
Q

What cells does radiation therapy target?

A

All! Will kill all cells

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10
Q

What types of radiation are there?

A

external beam and internal

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11
Q

What types of internal radiation are there?

A

systemic(oral), IMRT, 3D Conformal etc…

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12
Q

What stages of cancer is radiation most beneficial for?

A

3 or 4( but can be used for all)

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13
Q

What are chemotherapy drugs?

A

Anti-tumor drugs that target malignant tumor cells

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14
Q

What would be a research objective regarding chemotherapy?

A

To be able to target cancer cells to be destroyed while preserving healthy/normal cells

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15
Q

How do chemotherapy drugs work?

A

Alter the cell life cycle and stop growth

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16
Q

What categories of chemotherapy drugs are there?

A

Alkylating agents, antimetabolites, anti-tumor antibiotics(anthracyclines) and mitotic inhibitors(alkaloids)

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17
Q

What part of the cell cycle does an alkylating agent target?

A

All phases. Directly damages the DNA.

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18
Q

What part of the cell cycle does an antimetabolite target?

A

S phase specifically. Interferes w/ DNA and RNA by substituting themselves in its place

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19
Q

What part of the cell cycle does an Anthracycline target?

A

All phases. Interfere w/ enzymes involved in DNA replication

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20
Q

What part of the cell cycle does a Mitotic Inhibitor target?

A

Mitosis. Stop mitosis or inhibit enzymes needed for protein synthesis.

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21
Q

What structure do alkylating agents damage?

A

Bone marrow

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22
Q

What is a known side effect of an alkylating agent?

A

Peripheral neuropathy

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23
Q

What are examples of an alkylating agent?

A

cytoxan, temodar and platinum drugs

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24
Q

What is an example of an antimetabolite?

A

5-FU, Xeloda, Floxuridine and Gemzar

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25
Q

What is the main side effect of anthracyclines?

A

extremely cardiotoxic

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26
Q

What are examples of anthracyclines?

A

doxorubicin and daunorubicin

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27
Q

What is a known side effect of mitotic inhibitors?

A

Peripheral neuropathy

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28
Q

What are examples of mitotic inhibitors?

A

Taxol, Taxotere, Velban and Oncovin

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29
Q

Other treatments include

A

Immunotherapies, hormonal therapies, bone marrow and blood stem cell transplantation

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30
Q

How does immunotherapy work?

A

Activates own immune system to fight disease. MAB(monoclonal antibodies) block activation of known receptors to limit cell gene expansion and cell proliferation

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31
Q

Is hormonal therapy gender specific?

A

Yes, and based on the type of cancer which is induced by hormones

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32
Q

What is an example of male hormonal therapy and the coinciding cancer?

A

Androgren deprivation therapy for prostate cancer

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33
Q

What is an example of female hormonal therapy and the coinciding caner?

A

Estrogen blocking therapy for breast cancer

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34
Q

What is a possible side-effect with hormonal therapies?

A

Inducing physical changes associated with the hormone. Example: Females may have induced menses d/t estrogen blocking therapy

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35
Q

How is treatment determined?

A

TNM classification, Tumor grade, Pathologic classification and Personal factors(age, co-morbidities, tolerance of side effects and patient, family and physician opinion)

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36
Q

What age would likely be more tolerable to aggressive treatments?

A

Younger age groups

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37
Q

What is cardiotoxicity in terms of chemotherapy?

A

Direct damage to the heart

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38
Q

Cardiotoxicity may include inflammation of the sac surrounding the heart, what is this called?

A

Pericarditis

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39
Q

How may cardiotoxicity present its self in a measurable form?

A

EKG abnormalities

40
Q

Inflammation of the vasculature could lead to…

A

Vascular dilation, increased capillary permeability and interstitial edema. Resulting in increased HR, decreased SV and therefore decreased CO.

41
Q

Does cardiotoxicity effect blood perfusion at the tissue?

A

Yes, by reducing perfusion

42
Q

What is a possible result of pulmonary toxicity from cancer treatments?

A

pulmonary fibrosis. The lobes of the lungs will not expand as freely, resulting in less oxygen availability for tissues.

43
Q

Certain cancer treatments can alter muscle integrity. What system would this effect?

A

muscoskeletal

44
Q

Loss of muscle force is a common side effect. Due to what?

A

Cancer cachexia(wasting)

45
Q

When looking at the sarcomere, what is a possible side effect of cancer treatment?

A

disorganization of proteins in the myofibril

46
Q

Protein synthesis is an essential part of repair. What is the effect of cancer treatment on protein synthesis?

A

Decreased protein synthesis

47
Q

What is myelosuppresion?

A

Injury to the cells in the bone marrow, effecting the immune system

48
Q

What is leukopenia? What system is this toxicity related to?

A

Leukopenia is a reduction in WBC count. This toxicity is related to immune system toxicity

49
Q

What is anemia and what are the effects on nutrient delivery?

A

Reduced hemoglobin content in the blood results in decreased oxygen saturation and less availability for cellular uptake

50
Q

What is lymphocytopenia?

A

Reduced WBC production in the lymph system resulting in compromised immune system

51
Q

What is thrombocytopenia?

A

A reduced number of platelets in the blood resulting in impaired healing

52
Q

Intestinal fibrosis is a possible toxicity to the GI system. Why is it toxic?

A

Tissue of the GI system is damaged and loses function. This results in reduced surface area for nutrient absorption and therefore less nutrients to the cells in need.

53
Q

If a patient is suffering from increased intestinal motility, why is this an issue?

A

Increased intestinal motility likely results in diarrhea. Diarrhea results in dehydration and reduced nutrient uptake.

54
Q

How would altered GI tissue effect absorption of nutrients?

A

Impeded or altered portions of the GI block absorption and therefore reduce the efficiency of the GI system to absorb nutrients and disperse them throughout the blood stream

55
Q

Malfunction of the thyroid would be a toxicity to which system?

A

Neuroendrocrine

56
Q

How may neuroendocrine toxicity effect growth hormone release?

A

Abnormalities in release of GH can result in growth problems

57
Q

CNS issues as a result of treatment would effect what systems?

A

Neuroendocrine

58
Q

Peripheral neuropathy is a side effect of certain chemotherapy drugs. What is it and what system is it effecting?

A

Peripheral neuropathy is numbing or weakness of the periphery(arms/hands and legs/feet). This is classified as neuroendocrine toxicity.

59
Q

Decreased coordination falls under which toxicity classisfication?

A

Neuroendocrine

60
Q

Hepatic toxicity can present itself in multiple ways. What are they? What is the result of these toxicities?

A

Hepatic fibrosis and cytotoxic lesions can reduce the liver’s function of cleaning waste products and storing glycogen.

61
Q

Radiation and chemo can can dermatologic toxicity. What are they?

A

Alopecia or hair loss

Skin lesions

62
Q

What major long term decrements are there for cancer treatment? What can attenuate these?

A

Reduced cardiac function(increased HR, decreased SV) pulmonary function(decreased O2), motor function(neuropathy) and muscular strength(cachexia). Exercise is proven to attenuate these decrements

63
Q

Recent incisions and sutures would be a special consideration for which type of treatment?

A

Surgical

64
Q

What can be surgically implanted for ease of access? What considerations are needed for this?

A

Port, need to watch ROM and pain w/ movement

65
Q

Surgery can result in a change of body___? What results?

A

Image. Pt may no longer feel desirable.

66
Q

Pts undergoing surgery may have extreme ____. They may also be holding water, what is this called?

A

Fatigue. Edema.

67
Q

Radiation patients have special considerations in regard to their skin. Why?

A

Acute and chronic skin reactions to radiation. Need to be mindful of what are is touching for exercises as well as the clothing being worn.

68
Q

Leukopenia is a special consideration for those undergoing radiation, what is it and why is it a consideration?

A

Reduced WBC=Reduced immune function

69
Q

Dehydration is a special consideration for radiation pts. What can you do to combat this?

A

schedule freq. water breaks

70
Q

A combination of fragile skin and ___ could result in skin damage or even tearing.

A

edema

71
Q

Chemotherapy can cause alterations to blood. What are they and why are they considerations?

A

leukopenia and thrombocytopenia. Reduced WBC and platelets. Reduced immune system function and impaired healing.

72
Q

Chemotherapy can be delivered via ___. These should be considered when selecting exercises for the client.

A

port

73
Q

Chemotherapy can result in being susceptible to ____ of the skin. Mindful programming will avoid too much pressure being placed on the skin.

A

bruising.

74
Q

All cancer patients have special considerations regardless of the type of treatment. What are these?

A

Careful wording to not trigger a bad emotion and sensitivity to difficult situations

75
Q

What are the most common symptoms for cx pts? (there are 6)

A

lymphedema, pain, body image changes, muscle weakness, depression/anxiety and fatigue

76
Q

What percentage of cx pts experience fatigue?

A

72-95%

77
Q

How does CRF differentiate from normal fatigue?

A

CRF is different in that it occurs without exertion.

78
Q

What is a concise definition of fatigue?

A

Energy expenditure outstrips the restorative process

79
Q

Describe CRF

A

severe, chronic, spread widely, unrelieved by rest, impairs ADL and unrelated to activity

80
Q

How long can CRF persist?

A

months or years following treatment

81
Q

How could CRF effect a patient?

A

physically, psychosocially and economically

82
Q

What are two fatigue theories?

A

Depletion of energy yielding substances (depletion to maintain blood glucose) and Accumulation of metabolites

83
Q

What is the Otto Warburg Effect?

A

Cancer cells have an unusually high rate of glycolysis, even under aerobic conditions. Leads to accumulation of metabolites

84
Q

What is PFK? How does it fit in glycolysis?

A

PFK is phosphofructokinase. It is an enzyme which is the rate limiting step in glycolysis.

85
Q

Trace the accumulation of metabolites from start to resulting CRF

A

Lactic acid dissociates hydrogren ions
This inhibits PFK, can displace Ca from troponin, stimulate pain receptors, inhibit binding of o2 and hemoglobin, inhibit fatty acid release

86
Q

How does displacement of Ca from Troponin result in CRF?

A

Reduce muscle contraction resulting in weakness and increased fatigue.

87
Q

How may dissociation of hydrogen ions effect blood pH?

A

reduced pH, leading to acidosis

88
Q

Normal cell metabolism utilizes the mitochondria when oxygen is present to oxidize glucose. How about when oxygen is not present?

A

in the absence of oxygen, glucose is converted into lactate

89
Q

Increased lactate accumulation is a result of ___.

A

Increased use of glucose in the presences of oxygen.

90
Q

What is the term to describe use of glucose in the presence of oxygen?

A

aerobic glycolysis

91
Q

What alterations can take place in terms of cardiotoxicity?

A 
increased time to peak filling of the LV
Decreased RV/LV ejection fractions
Abnormal LV contractility
Reduced cardiac output
=lower o2 saturation and nutrient delivery
92
Q

What alterations can take place in terms of pulmonary toxicity?

A

SOB
Reduced total lung capacity
Reduced vital capacity
Reduced inspiratory capacity
Reduced intake of O2, decreased removal of CO2
Decreased submaximal/maximal exercise O2 consumption

93
Q

What alterations can take place in terms of muscle degeneration?

A

Cx cachexia can result from decreased protein synthesis and increased atrophy
Destruction of skeletal and adipose tissues
Increased muscular weakness(lower strength/lower time to fatigue)

94
Q

Myelosuppression is a result of ____. What results can be expected?

A

Inhibition of bone marrow function. Decreased O2 carrying capacity, decreased RBC(anemia) and increased workload placed on the heart

95
Q

GI toxicity can result in what physiologic alterations?

A

Altered metabolism and decreased nutrient, electrolyte and fluid uptake

96
Q

Hepatotoxicity and nephrotoxicity can result in what physiologic alterations?

A

Damage to liver and kidneys
Interfere w/ metabolic functions(liver)
Interference in energy production, hydration and waste removal(kidney)
Blood glucose maintenance(liver)

97
Q

What psychological factors can become present in cx patients?

A 
Decreased attention/cognition
Chemo-related cognitive impairment (chemobrain)
Depression and anxiety
Change in social patterns
Change in body image

Exercise Prescription In Cancer Populations (4 decks)

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