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oncology Flashcards

(52 cards)

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1
Q

what is cancer

A

abnormal cells within a tissue which proliferate in an uncontrolled manner

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1
Q

cancer prevalance

A

1 in 6
50%
~2 mmill diagonisis per year

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2
Q

semantics

A

names for the type of cell or organ it startsin

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3
Q

why are some cancers more common than others

A

certain cell types more likely to aquire mutations- cells which proliferate rapidly–> endothelial cells, fibroblasts, smooth ms cells, sites of exposureto carcinogens

skin
lung
breast
colorectal

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4
Q

curable by surgery alone

A

melanoma
pancreatic cancer
early stage lung or colo
renal cell carcinoma
breast - if early

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5
Q

physiologic result of oncologic intreventions

A

Impaired range of motion
 Lymphedema
 Impaired organ function
 Fibrosis of tissue
 Pulmonary/Cardiac Dysfunction
 Cognitive change  Radiation-induced
cognitive decline

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6
Q

recommendations for interventions

A

Return to usual activity as soon as
possible after surgery
 Maintain exercise
 Increase slowly
 Pay attention to body signals

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7
Q

PT tc lymphedema

A

patient education
complete decongestive therapy

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8
Q

risk of lymphedema

A

Stronger Risk Factor
Extent of surgery
Obesity

Weak Risk Factor
Number of lymph
nodes removed

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9
Q

systemic therapy purpose

A

cure –> eliminate cancer that might have escaped site of origin - adjuvant –> following first line of tx

control –> decreasing size to make surgery easier

neoadjuvant –> before the primary tx

palliative –> control disease that is metastatic

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10
Q

traditional chemotherapy

A

The use of chemical agents to treat or
to control disease
 Most drugs interfere with the synthesis
or function of DNA
 Low Therapeutic Index  Toxic
Dose50/Effective Dose50
 Use repeatedly

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11
Q

physiologic result of systemic therapy**

A

Bone marrow suppression  RBC, WBC,
platelets
 Anemia, neutropenia, thrombocytopenia
 Cardiotoxicity
 Pulmonary impairment
 Peripheral Neuropathy
 Sarcopenia
 Cognitive Dysfunction
 Endocrine Changes
 Bone Loss

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12
Q

symptom challenges of acute therapy

A

fatigue
nasuea
deconditionoing
infection

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13
Q

functional end result

A

Loss of muscle mass
 Decreased strength
 Less endurance
 Overall decline 
physiologic reserve
 Less able to tolerate
additional therapy
Cancer
Speeds
up this
Process

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14
Q

cancer tc impacts that improve w rehab and exercise

A

Fitness
 Strength
 Functional Ability
 Cancer Related Fatigue
 Range of Motion
 Lymphedema
 Weight gain
 Sarcopenia

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15
Q

effects of exercise in leukemia patients

A

Muscular endurance increased
 Fatigue decreased
 Depression decreased
 It was safe
Battaglini et al 2009

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16
Q

side effects before, after, and during treatment - exercise

A

Exercise post therapy associated w/ reduced:
 Fatigue
 Shortness of breath
 Pain
 Depression
 Exercise 6 months latter associated w/ reduced:
 Sleep disturbance
 Memory problems
 Fatigue

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17
Q

benefits of exercise during tc: physiologic

A

Increased lean tissue mass
 Increased VO2 max
 Decreased resting heart rate
 Improved training distance
 Increased upper and lower body strength
 Improved flexibility
 Higher physical functioning scores

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18
Q

QoL benefits of exercise during tx

A

Decreased fatigue
 Decreased nausea
 Improved sleep patterns
 Lower pain perception
 Less emotional and psychological distress
 Lower depression and anxiety

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19
Q

exercise caution!!

A

Anemia: hemoglobin < 7 g/dL
 Fever ≥ 38 C
 Elevated blood pressure >200 SBP or >110 DBP
 Rapid heart rate >120bpm
 Desirable Ranges:
 Systolic >95 and < 180
 Resting HR >50 and < 120
 Careful use of resistance bands w/
thrombocytopenia & lymphedema

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20
Q

persistent effects

Study These Flashcards
A

Began during chemotherapy, often worsen &
don’t necessarily go away

21
Q

late effects

Study These Flashcards
A

develop montsh to years after tx

cardiomyopathies
arrythmias
lung parenchyma change resulting from radiation –> fibrosis

22
Q

persistent effect: cancer related fatigue

Study These Flashcards
A
  • Most distressing
    symptom associated
    with cancer & its
    treatment
  • Experienced by 70-
    100%
  • Can last months to
    years
23
Q

cancer related fatigue

Study These Flashcards
A

Persistent subjective sense of exhaustion
related to cancer or cancer treatment that
interferes with usual function

Not relieved by rest or sleep
 Does not correspond to level of exertion
 More severe and distressing
 Disproportionate level of fatigue

24
therapy for cancer related fatigue - exercise
~25% reduction in fatigue in cancer survivors randomized to the exercise group
25
direct mechanism of hoe exercise improves fatigue
Muscle strength & endurance  Cardiopulmonary fitness  Dampened Inflammatory response  Improved insulin function
26
indirect mechanism of how exercise improves fatigue
Diminished anxiety and depression  Improved sleep  Improved cognition
27
how exercise improves survival
Breast Cancer: 30% lower risk of morality  Prostate Cancer: 30% lower risk  Colo-rectal Cancer: 50% lower risk  Brain Tumors: 36% lower risk
28
why does exercise reduce cancer recurrance and mrotality
Decreased circulating hormone levels  Decreased inflammation  Improved insulin sensitivity  Promotes weight loss/controls weight gain  Helps maintain weight loss
29
PA among cancer survivors
76.8% without cancer DID NOT meet recommendations of 150 min/week  95.5% cancer survivors DID NOT meet recommendations
30
ACSM rountable guidelines on exercise - breast cancer
Aerobic fitness is improved (2010&2019)  Muscular Strength improved (2010&2019)  Physical Function improved post therapy (2010&2019)  Exercise is safe (2010&2019)  Anxiety (2019)  Depression (2019)  Fatigue (2019)  Lymphedema (2019) Evidence Category A: Breast Cancer category B Fatigue levels decline (2010)  Quality of life improves (2010)  Depression & Anxiety declines (2010)  Body size & composition improves (2010)  Bone Health (2019)  Sleep (2019
31
gaps in the literature related to exercise
Falls  Cardiotoxicity  Peripheral Neuropathy  Cognitive Function  Nausea  Pain  Sexual Function  Treatment Tolerance
32
what is exercise based oncology rehab
Use of physical therapy and exercise modalities to improve or maintain function, ameliorate or prevent side effects of cancer/cancer therapy, and improve fitness and strengt
33
increased emphasis on PT
Focus on specific impairments Encouraging exercise without assessing and treating physical impairments can cause problems  Skills to deal with many cancer related side effects: ROM, lymphedema, balance, strength, fatigue  Training in exercise assessments and interventions  PT evaluation  insurance reimbursement
34
patient with cancer are different
Limited prognosis Extensive medical co-morbidity High degree of pain Psychosocial distress Dynamic disease process Side effects of antineoplastic therapy Unique goals of care
35
Exercise post therapy associated w/ reduced:
 Fatigue  Shortness of breath  Pain  Depression
36
exercise 6 months latter associated with reduced
sleep disturbance memory problems fatigue
37
physiological benefits of exercise during tx
Increased lean tissue mass Increased VO2 max Decreased resting heart rate Improved training distance Increased upper and lower body strength Improved flexibility Higher physical functioning scores
38
benefits of exercise during tx: qol
Decreased fatigue Decreased nausea Improved sleep patterns Lower pain perception Less emotional and psychological distress Lower depression and anxiety
39
treating cancer related fatigue
Physical Activity * Walking program throughout treatment tends to decrease CRF Mock 2007 * Aerobic training *  blood flow *  hemoglobin * Strength training *  muscle enzymes * Enlarges muscle fibers * Too much of a good thing? * Gentle moderate exercise decreased inflammation * Overly aggressive exercise increases inflammation
40
neoplasm
“new growth”- not necessarily cancerben
41
benign
innocuous, harmless to host unless large enough to compress or obstruct surrounding tissue
42
malignant
Aggressive, if left untreated will invade other organs and result in death
43
remission
Operationally defined according to diagnosis, usually associated with being free of symptoms
44
cure
No evidence of disease and same life expectancy as person who was never diagnosed
45
medical tx
Multimodal! Strategies include: * Surgery * Chemotherapy * Radiation Therapy * Immunotherapy * Hormonal Therapy
46
persistent effects
began during chemotherapy, often worsen & don’t necessary go away
47
late effects
develop months to years after treatment
48
thrombocytopenia
Low Platelet Counts * Bruising * Malaise and fatigue * Nosebleeds * Bleeding gums * Blood filled bullae in mucous membranes * Continuous bleeding
49
neutropenia
low levels of neutrophils' Immune system compromise from cancer therapies increase the risk for infection ANC (absolute neutrophil count) * the precursors of the WBC’s * found in the bone marrow * A more accurate measure of infection risk
50
what we do prevention
Hand Washing! Encourage good pulmonary toileting Encourage hygiene Encourage ambulation Mask and gown Food restrictions? Live plant restrictions? Kitty litter?
51
hemoglobin values
10-12: - Aerobic Exercise as tolerated 8-10: - Ambulation and ADL's as tolerated - Monitor for lightheadedness, chest pain, SOB, weakness <8: - Limited activity - Patients will become more symptomatic with activity and have lower tolerance for exercise

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