week 3 Flashcards
1
Q
cancer is the [] killer of children in the US
pediatric CA
A
1
- 1/5 won’t survive –> when they do, 2/3 suffer long term effects
- 12+ types, 100s of subtypes
today, 90% of kids with most common cancers survive
2
Q
what type of cancer has highest survival rate for childhood cancer
pediatric CA
A
- ALL: acute lymphoblastic leukemia
3
Q
efficacy/survival rates have [], but side effects are []
pediatric CA
A
- survival rates have improved, but side effects are increasingly damaging
- secondary cancer, heart/lung damage, infertility, chronic hepatitis, alterations in growth and development, impaired cognitive abilities, psychosocial impact
- 2/3 of survivors experience at least 1 side effect
4
Q
pediatric vs adult cancer
pediatric CA
A
5
Q
most common childhood cancer diagnosis
pediatric CA
A
- leukemia
- 28% of childhood cancers
- cancer of the bone marrow and blood
- most start in early (precursor) forms of white blood cells
- symptoms: pallor, fatigue, bruising/bleeding, fever, bone/joint pain in different joint
- most common types: acute lymphoblastic leukemia (93% survival rate), acute myeloid leukemia (75% survival rate)
6
Q
medical treatment “road map” for childhood cancer
pediatric CA
example
A
- induction: 4 weeks, to put into remission
- consolidation: 4-8 weeks, treatment into spine
- interim maintenance: 6-8 weeks, “rest” phase
- delayed intensification: 8 weeks, reduces hiding cells
- maintenance: 2-3 years
- allows the team to know meds, side effects to expect
7
Q
brain and CNS tumors in childhood cancer
pediatric CA
A
- 26% of childhood cancers
- variable treatment plans due to variable tumors/types
- most tumors start in lower parts of brain (cerebellum, brain stem)
- symptoms: HA, NV, visual changes, dizziness, seizures, ataxia, weakness
8
Q
red flags for cancer in young child
pediatric CA
A
- increased fussiness or irritability
- mildly pale
- bruising/bleeding/nosebleeds
- leg pain –> refusal to walk, wanting to be carried
- regression in developmental skills
- screening: regression of skills, change in mobility, difficulty keeping up with peers, increase in clumsiness, tripping or falling, walking or moving differently
9
Q
red flags for cancer in older child
pediatric CA
A
- complaints of fatigue and tiredness
- change in eating habits
- weight loss
- night sweats
- bone/joint pain
- fever and respiratory symptoms
- screening in adolescents/YA: trouble running/jumping/stairs, walking differently, feeling more tired or exhausted, change in activity levels, tingling or numbness in hands or feet, tripping or falling
more like adult S&S
10
Q
chemotherapy side in children
pediatric CA
A
- chemo: peripheral neuropathy –> distal deficits
- steroids: steroid mypathy –> proximal deficits
- cardiac effects, fatigue, avascular necrosis, orthopedic procedures
11
Q
radiation side effects in children
pediatric CA
A
- skin burns, blistering, reddness –> can produce ROM deficits (painful to move)
- fatuge, pain
- joint contracture
- osteoporisi
- cardiac and vascular disease
12
Q
peripheral neuropathy in children
pediatric CA
A
- common, under-diganosed
- 83% of children treated for non-CNS cancers with vincristine have clinically or sub-clinically significant peripheral neuropathy
- clinical findsings: strength deficits, impaired DTRs, impaired sensation, poor balance
- functional imapcts: foot drop (tib ant), gait compensations, imapired balance, impaired proprioception
permanent in adults
at 3 months post treatment, 30% improvement
13
Q
cancer-related fatigue in children
pediatric CA
A
- persistent, distressing, subjective sense of physical/emotional/cognitive exhaustion that is not proportional to recent activity
- no relief with rest or nap
- prevalence ranges 59-100%
- execise in small doses
14
Q
cancer long-term side effects in children
pediatric CA
A
- compaired to siblings, adult survivors of childhood cancer are more likely to experience issues related to general health, mental health, functional impairments, activity limitations
15
Q
role of PT in childhood cancer
pediatric CA
A
- minimize impairments and maximuze activity in age-appropriate life roles in home, school, and community
- cancer impacts child’s entire life, not just body
- occurs during critical developmental periods – can alter course of development
16
Q
PT intervention in childhood cancer
what does the literature say
pediatric CA
A
- safe and feasible
- improvements demonstrated in fatigue, strength, CP endurance, balance
- positive effects on QOL, activity levels, physical function
- supportive of need for comprehensive, proactive models of pediatric oncology rehab
- lab count considerations: patients with cancer always have low platelets/blood counts, so instead of letting numbers dictate, use S&S to dictate PT/treatment
17
Q
orthoses for pediatric cancer
pediatric CA
A
- for ease of walking, increased participation, willingness to exercise
18
Q
considerations for PT evaluation in childhood cancer
pediatric CA
A
- activity and participation
- ADLs, school, after school activities, recreational activities, peer and sibling interactions, age appropriate play, family community outings
- gaite analysis, function task and movement, developmental screen, QOL measures, patient specific functional scale (PSFS), AMPAC
- impairments
- ROM deficits, sensory impairments, muscle weakness, balance deficits, poor endurance or fatigue, motor planing and coordination, pain, gait deviation, motor skills and functional mobility
- MMT, ROM, SLB, PBS, light touch, pediatric modified total neuropathy scale, 2 or 6 minute walk test, 10 m walk test, TUG, TUDS, modified ashworth
19
Q
final thoughts on childhood cancer
pediatric CA
A
- children and adolescents with cancer often have high rehab needs and potential
- create an active partnership with families to determine priorities and model of care for rehab
- providing education to promote self-management and lifestyle strategies is key to optimal outcomes
22
Q
quantifying toxicity
A
- national cancer institute (NCI) common terminology criteria for adverse events (CTCAE)
- 1 - mild
- 2 - moderate
- 3 - severe
- 4 - disabling/life-threatening
- 5 - death
- people don’t want to talk about toxicity and have to stop “cure”
23
Q
myelosuppression
common treatment-related side effects
A
- suppressing everything in myeloid line
- white blood - focus on neutrophils, immune deficient
- platelets –> bleeding risk
- red blood cells –> anemia
- most common dose-limiting toxicity
- onset depends on lifespan of blood cells: neutrophils (5.5 days), RBC (20-190 days), monocytes (1-3 days), platelets (8-9 days)
- drug, dose, and regimen-specific
24
Q
neutropenia
common treatment-related side effects
A
- high risk of contamination/illness (no fresh flower or fruit)
- due to radiation therapy and/or chemo - kills cells that grow at fast rate
- normal neutrophil count is 1,500-8,000 cells/mm^3
- management
- neutropenic precautions: wash hands, minimize exposure from sick people and large crowds
- treatment: boost WBC production
- granulocyte colony-stimulating factor (GC-SF)
- side effect - bone pain
33
Q
taxanes and vinca alkaloids
A
- MOA: interefere with mitosis (M phase)
- taxanes: binds to stabilized microtubules, interfere with disassembly
- vinca alkaloids: inhibit microtubule assembly
- side effects
- peripheral neuropathy - distal to proximal: stocking and glove, motor nerve impairment leading to loss of DTR and ataxia, paralysis (foot and wrist drop), irreversible or minimally reversible
- cardiotoxicity: arrythmias - bradycardia, hypotension, heart failure
34
Q
taxanes
A
paclitaxel, docetaxel, cabzitaxel
of taxanes and vinca alkaloids
35
Q
vinca alkaloids
A
vinblastine, vincristine
of taxanes and vinca alkaloids
36
Q
alkylating agents
A
- MOA: prevent cell division by cross-linking DNA strands (S phase)
- increase bonds between bases to prevent separation and synthesis of DNA
- intra and inter strand cross links
- cell continues to synthesize other cell constituents (RNA, protein) and imblanace occurs –> cell dies (G1/G2 phase)
- side effects
- myelosuppresion: primary dose-limiting toxicity, leukopenia (immune suppression, decreased WBC levels)
- hemorrhagic cystitis: more common in poorly hydrated or patients with renal disease, hematuria
- neurotoxicity: encephalopathy manifested by cerebellar ataxia, mental confusion, complex visual hallucinations
37
Q
alkylating agents
A
cyclophosphamide, ifosfamide
38
Q
anthracycline
A
- the rubicins
- MOA: prevent cell division by intercalation between DNA base pairs (S phase), sits in DNA helix and blocks DNA synthesis –> inhibit DNA replication
- side effects:
- cardiotoxicity: acute (pericarditis, arrhythmias), chronic (congestive cardiomyopathy and HF) –> HR risk increases with escalating dose of doxorubicin
- hand-foot syndrome: erythema, swelling, dysesthesia - painful itching and burning in cold, blistering and desquamation (shedding of skin)
39
Q
anthracylcines
A
rubicins
doxorubicin, adriamycin (red devil)
40
Q
HF risk and doxorubicin
A
risk increases at 550 mg/m2
41
Q
targeted therapy
HER2 monoclonal antibodies
A
- for breast cancer
- human epidermal growth factor receptor 2 (HER 2)
- HER2 is a growth promoting protein - HER2 receptors overexpressed in some breast cancers
- MOA: binds to HER2 receptor preventing receptor activation and slowing growth
42
Q
hormone therapy
A
- block receptor activation –> interrupt cell growth and signaling cascade
- especially in prostate and breast cancer
- anti-estrogen agents: blocks estrogen production, block aromatase (enzyme that catalyzes estrogen formation)
- anti-estrogens: selective estrogen receptor modulator (SERM)
48
Q
bone marrow transplant
A
- process: induction chemo/radiation –> transplant –> engraftment
- autologous/autogenic: transplant cells come from patient themselves
- allogenic: transplant from donor, HLA matching, sibling/family member, matched unrelated donor (MUD)
- side effect - graft vs host disease): donated cells recognize recipients cells as foreign, trigger immune response
