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PCNP Theory 3 2023 > Week 8 Oncology in Primary Care > Flashcards

Week 8 Oncology in Primary Care Flashcards

1
Q

What does it mean to be cured of cancer?
In remission?

A

Means when the patient hasn’t had cancer in 5 year time span

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2
Q

Top 6 cancer deaths in 2023 (combined M+W)

A
  1. Lung and bronchus (top for M+W)
  2. Colorectum
  3. Pancreas
  4. Breast
  5. Prostate
  6. Liver and intrahepatic bile duct

Lung and bronchus d/t smoking boom in 1960s-1980s

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3
Q

Top 3 Estimated new cancer cases (women)

A
  1. Breast
  2. Lung
  3. Colon and rectum
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4
Q

Top 3 estimated cancer cases (Male)

A
  1. Prostate
  2. Lung and bronchus
  3. Colon and rectum
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5
Q

Most people diagnosed with cancer are above how old?

A

55

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6
Q

SDOH in context of cancer care
Factors

7 L’s

A
  • Low income
  • Low health literacy
  • Long travel distance to screening sites
  • Lack health insurance
  • Lack of good transportation to facility
  • Leave (no medical leave)
  • Lack of access to clean water/air

7 L’s

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7
Q

Optimal Cancer Care across continuum
Steps of Cancer care (6 steps)

A
  1. Prevention and risk reduction
  2. Screening
  3. Diagnosis
  4. Treatment
  5. Survivorship
  6. EoL care
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8
Q

Which level of prevention is most optimal for cancer?

A

Primary prevention
- aka prevent the problem from happening in the 1st place
- Reduce modifiable risk factors

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9
Q

Which level of prevention is cancer screening?

A

Secondary
- You are detecting disease in early, asymptomatic, or preclinical state to eliminate potential impact

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10
Q

Risks of screening

A
  • Bleeding from invasive tests (colonoscopy)
  • False (+)
  • False (-)
  • DX cancer not treatable or treatment not improve QoL
  • SDOH in screening
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11
Q

Other components in screening appointment

what else do you gather from pt/give to pt

A
  • Complete health history (FMHx + PMHx)
    • Genetic testing
  • Provide evidence-based + age-appropriate screening
  • PE - look for s/s
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12
Q

Signs/symptoms of cancer presence
TEST QUESTION

A
  • May be asymptomatic
  • Mass or lesion, skin changes
  • Lymphadenopathy
  • Bone pain
  • Bowel/Bladder changes
  • Unintentional weight loss
  • Fever
  • Cough, SOB
  • Fatigue
  • Abnormal bleeding
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13
Q

Special considerations of screening in older adults

A
  • Clinical trails usually don’t include older adults
  • Use individualized approach when using recommendations/guidelines
  • Consider life expectancy, comorbidities, functional status, + pt’s goals/values
  • Underscreening vs overscreening (don’t do mammograms on dementia pts)
  • Consider lag time between cancer screening and its benefits; harms of screening are more immediate
  • Life expectancy of at least 10 yrs is necesary to derive a survival benefit for breast or colorectal cancers
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14
Q

Choosing wisely recommendation in cancer screening

A
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15
Q

Cancer pathology descriptors

A
  • Histological info
    • to tailor txs; need to know cancer type
  • Biomarker testing/genomic profiling
    • Unique pattern of biomarkers/tumor markers - also to tailor prognostic info + tx
  • Biopsy to assess malignant cells: Needle, endoscopic, surgical
  • Tissue exam vs. Cytologic exam
  • Timing: frozen section (udring surgery) vs pathology (more accurate - takes longer)
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16
Q

Purpose of biomarker testing

A

Looks for genes, proteins to help ID cancer type + tx options
surveillance cancer with these too

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17
Q

Types of Cancer biomarkers

A
  • Circulating tumor markers (not diagnostic)
  • Tumor tissue markers (usually from tumor tissue itself)
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18
Q

Purposes of circulating tumor markers
Frequency of measurement?

A
  • Estimate prognosis
  • Determine stage of cancer
  • Detect cancer that remains after tx or that has returned
  • Assess how well tx is working
  • Monitor whether treatment has stopped working
  • Measured serially during cancer tx
  • Checked to retect possible recurrence
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19
Q

Cancer Grading system

A

Description of a tumor based on how abnormal the tumor cells and tumor tissues appear microscopically
GX: Grade cannot be assessed
G1: Well differentiated (low grade)
G2: Moderately differentiated (intermediate)
G3: Poorly differentiated (high)
G4: Undifferentiated (high)

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20
Q

Cancel cell
Differentiated vs undifferentiated

A

Well-differentiated: close to normal cells
Undifferentiated: abnormal looking cells

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21
Q

Cancer staging system

A

Helps to describe the extent of the cancer
TNM staging
T = size and extent of primary tumor
N = number of regional lymph nodes w/cancer
M = metastasis

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22
Q

Curative treatment for which cancer stage(s)?

A

Stage 3 or below

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23
Q

Standard tissue biopsies (GOLD STANDARD) involving…

A

Generally involve invasive procedures to detect a tumor

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24
Q

Local cancer treatment modalities

A

Surgery
Radiation therapy
Interventional procedures

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25
Q

Systemic cancer treatment modalities

A

Chemotherapy: attacks different phases of cell cycle
- Neoadjuvant - given before surgery
- Adjuvant - given after surgery
Hormonal therapy
Targeted therapy
Immunotherapy/biotherapy
- Cytokines
Vaccines

26
Q

Why offer complementary/alternative medicine in oncology

A

Helps pt cope w/stress of cancer

27
Q

Roles of PC NP during oncology treatment

there are many

A
  • Be a case manager
  • Maintain regular contact
  • Be available - for any other issues
  • Have knowledge of community resources + covered services
  • Address ongoing health maintenance needs
  • Provide appropriate pain management
  • Assess for pathologic depression and other psychiatric pathology
  • Be aware of therapeutic options
  • Communicate w/ and support patient
28
Q

What labs should the PC NP monitor?

A

Lab surveillance - mostly determined by cancer team
- CBC w/diff- anemia, neutropenia, thrombocytopenia
- CMP - renal + liver function
- Circulating tumor markers - serially

29
Q

How often and When should the NP perform cardiac monitoring

A

0, 3, 6, 9, and 18 mos (more frequent if (+)Cardiac Hx)
Frequent monitoring for deteriorating LVEF
Radiation to the chest
Bone marrow/stem cell transplant or certain types of chemo

30
Q

Which cardiac condition would an NP permanently discontinue cancer treatment?

A

S/S of CHF

31
Q

Chemo tx AEs

A
  • Hair loss (Rx for wig)
  • Diarrhea
  • Anemia
  • Skin changes
  • N/V
32
Q

Radiation therapy AEs

A

Often dependent on site of radiation
* Mucositis
* Thrush
* Fibrosis
* Diarrhea, proctitis

33
Q

Dangers of Chemo-related Diarrhea (CRD)
What to R/O 1st?

A
  • Serious and potentially life-threatening complication of wide variety of chemo drugs, hospital admission frequently needed for adequate care
  • Can result in treatment delays and diminished compliance → compromise long-term outcomes
  • R/o infectious cause before tx w/anti-diarrheals
  • Refractory CRD → supportive care/discontinuation of tx
34
Q

General principles of N/V s/s

A
  • Consider emetogenicity of the chemotherapy regimen
  • Consider timing: acute, delayed, anticipatory, breakthrough
  • Consider severity: mild, mod, severe, refractory
  • Consider options of route administration
  • Cost and insurance coverage
35
Q

Timing:
Acute
Delayed
Anticipatory
Breakthrough

A

Acute: < 24hrs
Delayed: > 24hrs
Anticipatory: take meds on the way to treatment center
Breakthrough: s/s occuring despite meds

36
Q

Diarrhea non-pharm measures

A

Avoid triggering foods that might aggravate diarrhea and aggressive oral rehydration w/fluids containing salt, water, and sugar
Foods to avoid:
* Milk + dairy products
* Spicy foods
* High fiber and high fat foods
* Some fruit juices: prune, orange

37
Q

Neutropenic fever

Definition

A

A single oral temp of ≥ 101F (38.3C) OR
temp of ≥ 100.4F (38C) sustained over a 1hr period

38
Q

Neutropenia

Definition

A

ANC < 1500 or 1000
Severe neutropenia: ANC < 500

39
Q

Neutropenia fever treatment
Med used

A
  • Empiric abx therapy initiated immediately → infectious workup
  • Admission as needed then diagnostic reassessment
  • MED used: LEVAQUIN
40
Q

Hisk risk pts of Neutropenic fever

A

Inpatient management
* Cr > 2; LFTs > 3x normal limit
* Uncontrolled/progressive disease
* PNA risk
* Comorbidities: age, social/home status
* ANC < 1000
* Fever 101F

41
Q

Low risk pts of Neutropenic fever

A

Outpatient management
* Tx w/Levaquin
* Cr < 2; LFTs < 3x normal limit
* No co-morbid conditions
* Limited duration of neutropenia
* Active and independent

42
Q

Mucositis

Definition

A

Acute/short term oral toxicity realted to chemotherapy self-limited AE of either radiation or chemotherapy
- Can affect entire GI tract

43
Q

When does mucositits usually occur in cancer treatment

A

After chemo
~7 days peak, usually healed w/in 10-14d
From radiation, more delayed and cumulative

44
Q

Mucositis staging

A

G0: None
G1: Erythema and soreness
G2: Ulcers; able to eat solid food
G3: Ulcers; but requires liquid diet d/t mucositis
G4: Ulcers; alimentation not possible d/t mucositis

45
Q

Mucositis complications

A

Oral candidiasis
HSV infection
Superimposed bacterial infection

46
Q

Mucositis management

A

Magic mouthwash! (Benadryl + Maalox + Viscous lidocaine)
Mylanta (simethicone)
Many others

47
Q

Fatigue causative factors and treatment in setting of cancer care

A

Causative factors
* Emotional distress
* Anemia
* Sleep disturbance
* Nutrition imbalance
* Activity level
* Metabolic derangements

Treatment
* Increase exercise as tolerated
* Address anxiety, depression - to help w/sleep
* Stress management
* Support groups
* Steroids, stimulants

48
Q

What not to give if pts on immunotherapy?

A

STEROIDS

49
Q

Immunotherapy common SEs

A

Skin: Dermatitis, pruritis
Constitutional: Fevers, chills, fatigue
GI: Diarrhea/colitis
Resp: Pneumonitis

50
Q

Immunotherapy Infrequent SEs

A
  • Hepatitis/liver enzyme abnormalities
  • Endocrinopathies: hypophysitis, thyroiditis, adrenal insufficiency
  • Vitiligo
51
Q

Treatments for Immunotherapy SEs based on grade

A

Grade 1-2
- Supportive care
GRade 3-4
- Steroids (except w/endocrinopathies, which are treated w/HRT and not steroids)
Refractory to steroids
- Infliximab (hepatotoxic, not for pts w/liver disease) or mycophenolate mofetil
- Rechallenging with immunotherapy after discontinuataion if possible

52
Q

When do immunotherapy SEs usually show?

A

10-20wks

53
Q

Spinal cord compression

What is it, what does it signify, and symptoms

A
  • Spinal column metastasis, local spread intramedullary metastasis

Symptoms
* Back pain (EARLY)
* Neurologic defecits in legs

54
Q

Superior Vena Cava Syndrome

What is it, what does it signify, and symptoms

A

Mediastinal tumors
Venous catheters
Symptoms: Think everything head stuffiness
* Neck
* Facial, periocular swelling
* Dyspnea
* Cough
* Head pressure
* Hoarseness
* Nasal congestion
* Syncope

55
Q

Pericardial tamponade

What is it, what does it signify, and symptoms

A

Lymphatic obstruction
Pericardial metastasis
Symptoms:
* Dyspnea
* Orthopnea
* Chest pain
* Weakness

56
Q

Hypercalcemia (in cancer SEs)

What is it, what does it signify, symptoms

A

Bone metastasis
PTH - related protein production
Calcitriol excretion
Symptoms:
* Confusion
* Lethargy
* Sleepiness

Bisphosphonates as prophylactic treatment

57
Q

Tumor Lysis Syndrome (TLS)

What is it, what does it signify, and symptoms

A

Rapid tumor cell destruction from chemo - chemo working too well
Multiple electrolyte abnormalities - acute renal failure
Hyperuricemia
Symptoms:
* Nausea
* Weakness
* Myalgia
* Dark urine
* Arrythmias

58
Q

When to contact oncology team?

AKA REFER

A
  • Difficult symptom management
  • Critical lab values
  • New suspicious findings
  • Oncologic emergencies
59
Q

Cancer survivorship

Definition

A

Any individual who has had cancer from time of DX through reminder of their life

60
Q

Risk factors of cancer survivorship

A

Physical and Psychological effects
* Recurrence of primary cancer or through risks for a second primary cancer - chemotherapy related cancers
* Late effects of treatment
* Chronic complications
* Radiation post-effects
* Premature menopause
* Preipheral neuropathy
* Cognitive slowing
* Lymphedema
* Urinary or bowel problems

61
Q

Late or long term effects of chemotherapy

A
  • Cardiac dysfunction
  • Pulmonary fibrosis
  • Neuropathy
  • Hearing loss
  • Premature menopause, infertility
62
Q

Late or long term effects of Hormonal Therapy

A
  • Tamoxifen - clotting, uterine cancer, hot flashes, vaginal dryness
  • Aromatase inhibitors - Osteoporosis, MSK pain
  • Androgen deprivation (LHRH agonists, anti-androgens GnRH agonists) - hot flashes, osteoporosis, metabolic syndrome breast tenderness, reduced libido/ED, fatigue

PCNP Theory 3 2023 (7 decks)

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