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Mincer Final Exam- 4 > Cancer Rehab > Flashcards

Cancer Rehab Flashcards

1
Q

What are the four phases of cancer treatment?

A
  1. Curative Care
  2. Supportive Care
  3. Rehabilitative care
  4. Palliative Care
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2
Q

What is the general role of PT in Curative Care?

A

Curative Care- ablation of neoplastic disease PT contributes to physical, psychological preparation for medical intervention through education and physical exercise.

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3
Q

What is the general role of PT in Supportive Care?

A

Supportive Care- implies static or declining health status Primary goals:

  1. Maintenance of optimal function
  2. Amelioration of symptoms
  3. Prevention of secondary impairments and disabilities
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4
Q

What is the general role of PT in Rehabilitative Care?

A

Restoration of function Prevention/minimization of secondary disability

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5
Q

What is the general role of PT in Palliative Care?

A

Goal is amelioration of symptoms Patient preferences can safely drive treatment decisions

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6
Q

How does exercise, in general, benefit the patient with cancer?

A
  • Prevents complications.
  • Improves the pts quality of life
  • Enhances function

The most common PT intervention when treating these pts are:

  • Strengthening
  • HEP
  • Flexibility, &
  • Pt education.
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7
Q

List some benefits of exercise for cancer pt/s? (12)

What is improved? P2HEWS- V

What is Decreased/ Reduced? FANDS

A
  • Improved Physical functioning
  • Improved Physical activity
  • Improved Hgb concentration
  • Improved Exercise capacity
  • Improved Weight control
  • Improved Self esteem
  • V02 max (increased)

________________________

  • Reduction in Fatigue
  • Reduction in Anxiety
  • Reduction in Nausea
  • Less Depression
  • Decreased Signs and symptoms of distress
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8
Q

What is more beneficial in recovery of ROM: early or delayed implementation of post-op exercise?

A

Early

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9
Q

What is one precaution that has to be observed during early intervention especially with breast cancer patients and how can it be avoided?

A

Early exercise intervention especially in the UE might increase the amount of drainage. To avoid it ROM exercises are maintained below 90 degrees.

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10
Q

What is the role of exercise in cancer detection?

A

PTs can be involved in any point of the ‘Conceptual Framework’

  • Pre-diagnosis (prevention and detection)
  • Post-diagnosis (treatment of cancer, and after treatment of cancer, as well as palliative care)

Also from screencast:

  • Theoretically, acute and/or chronic PA may directly influence cancer detection by affecting the sensitivity and/or specificity of screening tests (eg, mammography, prostate specific antigen, fecal occult blood).
  • Second, PA may indirectly affect detection by facilitating adherence to cancer screening behaviors, thereby resulting in earlier detection.

Courneya & Friedenreich, 2007

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11
Q

What is the role of exercise in cancer prevention? PA and Cancer prevention:

A
  • PA is more effective after cancer treatment period
  • PA may help cancer survivors expedite recovery from the acute effects of treatments
  • Meta-analysis have observed that the effects of PA interventions may be larger in the survivorship time period compared with the treatment period.
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12
Q

Describe one good approach to detection, intervention and prevention.

A

Patients with breast cancer undergo a multimodal approach to disease management that extends across the time frame of at least 1 year. Evidence suggests that physical impairments and functional limitations are associated with every treatment modality introduced throughout that continuum. Therefore, this need for ongoing assessment and treatment when necessary warrants a prospective clinical approach that provides advice and guidance for return to full function and promotes early detection and intervention for other potential impairments known to be associated with cancer treatment.

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13
Q
  • Name 4 Circulatory System Risk factors associated with exercise in Cancer M-CAT
A
  • Myocardial Infarct
  • Cardiomyopathies
  • Anemia
  • Thrombocytopenia
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14
Q

Other risk factors associated with exercise in Cancer LIP

A
  • Lymphedema
  • Immune system can be affected
  • Pathological fx
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15
Q

Explain the inverted “J” relationship between exercise and immune system in cancer pts.

A

Inverted J: moderate exercise/activity = enhance immune function; sedentary and strenuous exercise/activity impair immune function

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16
Q

What is the minimal, most critical level of platelets and its significance?

A

<20,000

risk for spontanious bleeding

no exercise.

**Some permit AROM, ADLs, Walking with physician approval

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17
Q

what is the implication for exercise when platelets are >30K?

A

light exercise AROM only walking as tolerated

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18
Q

what is the implication for exercise when platelets are >50K?

A

PREs as tolerated bicycling on flat levels

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19
Q

What is the normal level for platelets?

A

>150K Normal activity

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20
Q

when is thrombocytopenia suspected and what are the limitations to activity?

A

platelets

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21
Q

What is the normal range for WBC?

A

5,000 -10,000 cells/microliter

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22
Q

What if WBC are under 5000 with a fever

A

No exercise

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23
Q

What if WBC are less than 5,000 or over 10,000

A

Light exercise Progress to resistive exercise as tolerated

*according to colored handout from Mincer. According to lab values chart it only lists greater than 5000. WBC info looks weird in that chart.

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24
Q

What does increased level of WBC mean and what is the implication for PT intervention?

A

Leukocytosis, fever, sxs of localized or systemic infection inflammation or trauma thorough hand washing

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25
Q

What does HCT measure?

A

The percentage of RBC in the whole blood (both number and size)

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26
Q

What is the normal percentage for HCT?

A

Male: 40.7 to 50.3%

Female: 36.1 to 44.3%

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27
Q

What is the HCT interval where exercise should be approached with caution?

A

25 - 30 %

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28
Q

What is the critical HCT percentage?

A

<25%

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29
Q

What does high hematocrit mean and what is the condition associated with it?

A

HCT rises when the # of RBCs increases or when the plasma volume is reduced like in dehydration.

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30
Q

What does low HCT mean and name some conditions associated with that?

A

A drop in HCT may reflect anemia, bone loss, bone marrow failure, destruction of RBCs, leukemia, malnutrition, multiple myeloma and/or rheumatoid arthritis.

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31
Q

What are the normal values for Hgb?

A

women - 12-15 g/dL men - 14-16.5 g/dL

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32
Q

What is the accepted HgB value in cancer pts and what kind of exercise is permitted?

A

>10 g/dL - Resistive exercise permitted

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33
Q

What does 8-10 g/dL Hgb mean as far as exercise?

A

light exercise

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34
Q

what is the critical Hgb value / exercise not permitted?

A

> 8 g/dL Hgb

35
Q

How do we generally interpret Hgb readings? high and low

A

Indicator of severity of anemia or polycythemia levels may impact oxygen saturation readings

36
Q

How do we monitor the Hgb level in a cancer patient and what accommodations do we need to make to exercise when a drop is suspected.

A
  • Use oxygen saturation - Monitor pt’s response to tx If low may need to provide longer rest periods; perform exercise/ activities at lower intensity, duration.
37
Q

How does a PT decide that fatigue is cancer related and not a result of other medical problems?

FI2N2D2- SPA2S

A

Fatigue Assessment “Rules Out” other cause for fatigue like:

  • Fever
  • Immobility
  • Infection,
  • Nutritional deficiencies (eg., protein, calories, vitamins)
  • Neurotoxic therapies
  • Depression
  • Dehydration
  • Sleep disturbances
  • Pain
  • Anemia
  • Anxiety
  • Sedating meds (eg., opioids, benzos)
38
Q

What are other characteristics of cancer related fatigue that help us differentiate it?

A
  • Chronic
  • Not relived by rest
  • Not proportional to the level of exertion
  • Interferes with function
39
Q

What should lead a PT to suspect bony metastasis

A

Certain types of cancer have a propensity of metastasizing to the bone. These cancers are;

  • Breast
  • Lung
  • Prostate.
40
Q

What should the response be if bone metastasis is suspected or confirmed?

A

If bony metastasis is confirmed (by radiograph, CT), caution should be used to prevent a pathological fracture.

  • Unweight the extremity (could assist with bracing, or prescription of assistive devices)
  • Educate the patient on the risk of fx
  • Caution with ROM
  • Notify the care provider
41
Q

What are some S&S that would indicate metastasis to the bone?

A

May present as asymptomatic soft tissue mass bone pain:

  • Deep or localized Increased with activity
  • Decreased tolerance to weight bearing; antalgic gait
  • Does not respond to physical agents
  • Soft tissue swelling
  • Pathologic fractures
  • Hypercalcemia
  • Back or rib cage
42
Q

What is the most common problem affecting cancer survivors?

A
  • Cancer-related fatigue affects 70% to 100% of patients who are actively being treated for cancer or are in the post-treatment recovery phase that varies in time.
  • It is the most common side effect of cancer and cancer treatment
  • Patients can experience cancer-related fatigue years after treatment, regardless of the type of treatment – radiation therapy (XRT), chemotherapy, bone marrow transplantation, stem cell transplantation, etc.
43
Q

Define cancer related fatigue

A

A “persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning”

  • When an individual experiences cancer-related fatigue, additional rest and an improved diet does not impact the subjective level of fatigue. This type of fatigue can impact functional activities, and is associated with activity intolerance.
44
Q

What are the components of the FEWS framework

A
  • Functional
  • Educate
  • Wellness
  • Safety
45
Q

What does Functional stand for in the FEWS framework?

A
  • Optimize the patient’s FUNCTIONAL status (bed mobility, transfers, ambulation, ADLs)
46
Q

What does Educate stand for in the FEWS framework?

A
  • EDUCATE the patient/caregiver (HEP, assistive device, disease mgmt, energy conservation)
47
Q

What does Wellness stand for in the FEWS framework?

A
  • Promote WELLNESS to prevent disease progression and/or the development of co-morbidities (walking program, posture correction, aerobic ex, relaxation techniques)
48
Q

What does Safety stand for in the FEWS framework?

A
  • Stress SAFETY within the patient’s typical environment (skin breakdown, falls, proper use of equipment)
49
Q

When and how do you use FEWS?

A

During goal setting, and specific interventions- can be linked to each component of the framework

50
Q

When do you begin exercises in the course of cancer treatment?

A

When patients begin cancer treatment, continue throughout active treatment and after

51
Q

How do you keep track of fatigue during exercise (and generally)

A

Patients should rate their fatigue on a 0 to 10 scale (or mild, moderate, or severe- 10= so tired you cannot roll over in bed) to track the level of fatigue

52
Q

Give two general guidelines for exercise protocol

A
  • Employ a warm-up and cool-down before and after each session
  • Incorporate flexibility, strengthening, and aerobic exercise
53
Q

Parameters for appropriate intensity of exercise

A
  • Exercise protocol of low to moderate intensity (has + effects) 50% to 70% of max heart rate or
  • RPE of 11-13 on the original Borg scale
  • Avoid exhaustion
54
Q

How do you progress exercise?

A

Based on cardiovascular conditioning in duration of session, frequency of exercise, and intensity

  • From 15 to 30 minutes
  • From 3 to 5 days/week
  • From low to moderate intensity to higher; intensity
  • Should not provoke symptoms
55
Q

Three more general guidelines for exercise protocol

A
  • Aerobic component should be emphasized, although both interval and resistance training are also found to be beneficial
  • If you had to pick your kind, choose aerobic (walking, biking, swimming, etc)
  • Incorporate an exercise diary or log Track fatigue levels as well so they can see the relationship between exercise and fatigue
  • Employ safety at all costs
56
Q

What are the complications following cancer surgery?

A

Acute complications include:

  • Infection
  • Swelling
  • Pain
  • Hematoma, and
  • Seroma.
  • Numbness of the skin over the breast region is common after partial or full mastectomy.
  • Late sequelae including pain, lymphedema, impaired use of the ipsilateral UE, change in body image and other psychological factors such as anxiety or depression, may impact function and QOL.
57
Q

Describe some aspects of Arm Morbidity following Surgery

A

Arm morbidity- the addition of axillary dissection is associated with increased incidence of long-term arm morbidity, including lymphedema and reduction in shoulder ROM, and the severity of impairment is related to the extent and aggressiveness of the local treatment. Surgical removal of axillary lymph nodes is strongly linked to altered lymphatic function and development of lymphedema.

58
Q

What about pain following cancer treatment?

A
  • May be a consequence of surgery, radiation, or systemic chemotherapeutic drugs.
  • Chronic pain after breast cancer treatment may affect 20% to 75% of women following mastectomy.
  • In younger age, more invasive surgery, and radiation therapy following surgery were found to be significantly related to the development of chronic pain.
59
Q

What is Post Mastectomy Pain Syndrome? (PMPS)

A

A neuropathic pain condition thought to be the result of damage to nerve pathways, presumably during surgery but may be the result of :

  • Radiation induced neuropathy
  • Chemotherapy induced peripheral neuropathy, or
  • Progressive nerve compression.
60
Q

What are the characteristics of pain suggesting metastasis?

A

It is important that PTs realize that pain may be a warning sign for cancer recurrence or metastasis, particularly if the pain is non-relenting and does not respond to treatment.

61
Q

What are the complications of Breast Reconstruction?

A
  • Breast reconstruction procedures are not entirely benign.
  • Complications from implants include;
    • Rupture
    • Capsule contracture,
    • Infection, and
    • Malpositioning.
    • Capsule contracture, which is more likely in the presence of radiation therapy, occurs when scar tissue develops and tightens around the implant, and can result in pain and deformity of the breast mound.
62
Q

Which type of breast reconstruction influence trunk strength the most?

A
  • Trunk Strength- Transverse Abdominal Myocutaneous (TRAM) flaps have been associated with trunk weakness and abdominal wall laxity.
63
Q

Talk about the side effects of radiation therapy

A

Includes both acute and late effects, involving tissues in the field of radiation. Acute effects include;

  • Skin erythema
  • Desquamation
  • Aplastic anemia, and
  • Fatigue, and are typically short-lived, lasting from a few weeks to 6 months.

For the rest of their lives survivors of breast cancer are at risk for late effects, which include;

  • Impaired shoulder mobility due to immobilization, pain, adhesions, lung and/or cardiac toxicity,
  • lymphedema,
  • Brachial plexopathy, and
  • New malignancy.
64
Q

What is the prevalence of lymphedema following surgery and lymphedema following surgery plus radiation

A
  • UE lymphedema is reported in 10% of women following breast surgery alone, and as many as 42% of women who have had surgery plus radiation.
65
Q

Define Lymphedema

A

the accumulation of interstitial fluid, typically protein rich, as a results of impaired lymphatic function.

66
Q

How does lymphedema form?

A

Breast cancer related lymphedema results from damage to lymph nodes and lymphatic pathways through;

  • Surgical removal
  • Fibrosis, or
  • Direct endothelial trauma from irradiation. (Affects UE function and QOL)
67
Q

What is Soft tissue Fibrosis

A
  • Severe, or repeated, tissue injury may lead to an environment in which repair cannot occur by tissue regeneration, and thus repair occurs by fibrosis (replacement with connective tissue).
  • Fibrosis and atrophy of tissues within the field of irradiation are unavoidable complications of radiation therapy.
68
Q

Describe the 1st stage of radiation induced Fibrosis

A
  1. Fibrotic phase- characterized by marked chronic inflammation, increased vascular permeability, and edema formation. Fibroblast proliferation and activation occurs.
69
Q

Describe the 2nd stage of radiation induced Fibrosis

A
  1. During the 2nd phase the damaged tissue is composed primarily of activated fibroblasts in a disorganized extracellular matrix.
70
Q

Describe the 3rd stage of radiation induced Fibrosis

A
  1. During the 3rd fibroatrophic phase, there is loss of parenchymal cells and retraction of the fibrous tissue.
71
Q

Is soft tissue fibrosis reversible?

A

No

72
Q

Talk about Muscle and Skeletal injury following radiation

A
  • Radiation damage to muscle tissue is thought to be due to vascular damage and subsequent inflammation, ischemia, and fibrosis and the vascular damage may contribute to late muscle atrophy.
73
Q

Talk about Radiation Induced Neuropathy

A

Radiation injury to nerve may be direct or indirect. Indirect injury resulting from radiation induced fibrosis within the nerve itself or in the surrounding tissue, and injury to blood vessels supplying the nerve.

74
Q

Talk about Cardiac & Respiratory complications following Radiation

A

With improved delivery of radiation therapy, incidence of cardiac and pulmonary toxicity has declined. Acute cardiac effects from radiation therapy occurs rarely, as does pneumonitis. However, the risk of cardiac complications is greater in the presence of chemotherapy administration, and radiation of the left breast.

75
Q

What are two additional side effects of radiation treatment?

A
  • Myelosuppression and fatigue, both also side effects of chemotherapy, may be the result of, or exacerbated by radiation therapy.
76
Q

What does Systemic therapies imply?

A
  • Chemotherapy
  • Biologic response modifiers, and
  • Hormone therapy)
77
Q

What are some side effects / complications of chemotherapy? MAIN2 LoT

A

Chemotherapy acts on rapidly dividing cells, destroying cancer cells, but also affecting healthy cells. This action accounts for the frequent and significant side effects including;

  • Mucositis
  • Alopecia; peripheral neuropathy, and myelosuppression
  • Induced anemia
  • Nausea and vomiting
  • Neutropenia
  • Loss of appetite,
  • Thrombocytopenia.
78
Q

What is Myelosupression following systemic therapies?

A

Myelosuppression- basically CBC are adversely affected

79
Q

Talk about Cognitive Dysfunction and Chemo

A

Many breast cancer survivors report impaired concentration and memory during and after chemotherapy. Verbal learning and memory were most impaired ——-chemo brain

It sucks to watch someone fight so hard and then gradually change in their mental function :-( on top of everything else . . .

80
Q

What about Cancer Related Fatigue?

A

Unusually persistent, generalized, out of proportion to exertion, and may not be relieved by rest.

81
Q

What is Chemotherapy Induced Cardiac Toxicity

A

Certain chemotherapeutic drugs directly damage the myocardium, resulting in cardiomyopathy.

82
Q

Talk about Chemotherapy Induced Peripheral Neuropathy (CIPN)

A
  • Small fiber damage may result in painful paresthesias and dysesthesias.
  • Large fiber damage may result in raised vibration and touch thresholds.
  • Muscle weakness may be present but motor disturbances are seen less frequently than sensory alterations.
  • Sensory disturbances often occur in a stocking or glove distribution and include pain, numbness, and tingling.
  • Patients have also been shown to have myalgias, autonomic disturbances, diminished DTRs , decreased fine motor function, and decreased postural stability.
83
Q

Talk about Osteoporosis following Systemic Therapies for Cancer

A
  • Diminished bone mineral density is a well-documented complication following certain systemic therapies for breast cancer.
  • Premature menopause, as a result of a reduction in ovarian function, may be a consequence of the administration of chemotherapy in premenopausal women.
84
Q

What about weight gain and cancer treatment?

A
  • Weight gain during chemotherapy is a common side effect, affecting up to ~60% of women.
  • The weight gain is associated with a change in body composition such that there is weight gain in the presence of lean tissue loss (sarcopenic obesity).
  • Obesity has been positively associated with development of lymphedema.

**some pts may also be put on strong corticosteroids to manage side effects of treatment, which will also cause weight gain and muscle wasting.

Mincer Final Exam- 4 (10 decks)

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