BO7 407 Chasse - rehabsummit.com · 5 Chemotherapy long term side effects Infertility Early...
Transcript of BO7 407 Chasse - rehabsummit.com · 5 Chemotherapy long term side effects Infertility Early...
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To comply with professional boards/associations standards:• I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.
Session 407: Rehab’s Role in Cancer SurvivorshipDebora Chasse, DPT, WCS, CLT‐LANA
Leading the Way in Continuing Education and Professional Development. www.Vyne.com
Learning Objectives
1. Describe how surgical procedures for cancer affect patients both physically and psychosocially.
2. Determine the short and long‐term effects of cancer treatments such as radiation and chemotherapy on patients’ functional levels
3. Investigate treatment modalities to alleviate the short and long‐term effects of cancer treatments and help patients improve functional strength and mobility.
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Cancer is characterized by the uncontrolled growth and spread of abnormal cells. If the spread
is not controlled, death will occur.
New cancer cases predicted in 2017 in the U.S.
Female
Breast 252.710 30%
Lung 105,510 12%
Colon 64,010 8%
Uterine 61,380 7%
Thyroid 42,470 5%
Skin (M) 39,940 4%
Male
Prostate 161,360 19%
Lung 116,990 14%
Colon 71,420 9%
Bladder 60,490 7%
Skin 52,170 6%
Kidney 40,610 5%
Excess body weight
Physical inactivity
Excess alcohol consumption
Poor nutrition
Excess sun exposure
Over 50 years old (87% of all cancers)
The World Cancer Research Fund estimates that 20% of all cancers in US are caused by a
combination of:
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Cancer Staging TMN to assess cancer growth and spread
Extent of the primary tumor (T)
Absence or presence of regional lymph node involvement (N)
Absence or presence of distance metastases (M)
Staging
0 in situ
I early
IV most advanced
Removal of the tumor and surrounding tissue.
Removal of associated lymph nodes
Radiation to the affected site
Chemotherapy prior or following surgery
Hormone therapy if appropriate
Breast reconstruction
Breast cancer treatment
Risks & complications following breast cancer surgery
Bleeding
Infection
Seroma/hematoma
Reaction to meds
Permanent scarring
Shoulder pain/stiffness
Pain
Loss/altered sensation
Wound healing problems
Lymphedema
Anesthetic risks such as confusion, transient fatigue, muscle aches,vomiting.
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Icepacks (indirect) for pain relief
Prescribed exercises to improve mobility, slowly
Proprioception stimulation
Use affected arm for ADL’s
Elevate your arm above your heart 45 mins 3‐5 times/day. While pumping hand 15‐25 times, flexing elbow 15‐25 times for lymph flow.
Deep breathing ex to prevent pneumonia and increase lymph flow.
Self care after surgery
Goal‐beams of intense energy to kill cancer cells.
Cardiac and pulmonary toxicity
Difficulty swallowing, cough, shortness of breath
Burns, tissue damage
Lymphedema
Effects of radiation treatment on post‐mastectomy patients
Goal: destroy breast cancer cells through a drug delivered into a vein or as a pill.
Destroys WBC, RBC, platelets
Neuropathy‐numbness, pain, burning, tingling, temperature sensitivity, weakness in extremities.
Chemo brain‐short term memory/concentration
Hair loss, fatigue, loss of appetite, nausea/vomiting, constipation/diarrhea, mouth sores, skin/nail changes.
Risk of infection due to decrease WBC.
Effects of chemotherapy on postmastectomy patients
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Chemotherapy long term side effects
Infertility
Early menopause
Osteoporosis
Heart damage
Leukemia (cancer of blood cells
Fear, sadness, isolation
Psychological Effects ofCancer Treatment
Shock/disbelief
Fear/uncertainty
Guilt
Grief/sadness
Anxiety
Depression
Anger/frustration
Feelings of isolation
Vulnerability/helplessness
Focus on what you can change
Each persons cancer journey is unique and individualized.
Talk about your feelings.
Seek out counseling.
Honor your need for rest, healthy food choices, exercise and recharging time.
Try mind‐body techniques.
Improving your psychological well‐being
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Rest
Exercise
Nutrition
Avoid infection
Laughter
Image health
Minimize stress
Meditation, relaxation, breathing.
Self care recommendations
Goal: to treat BC’s that are sensitive to hormones. It prevents hormones from attaching to cancer cells or by decreasing the production of hormones.
Often used after surgery to reduce cancer regrowth.
Prior to surgery to decrease tumor size.
Prevents metastasis.
Some cancers are fueled by estrogen or progesterone
In the form of medication, surgery or radiation.
Hormone therapy for breast cancer
Hormone therapy side effects
More common:
Hot flashes
Vaginal irritation
Fatigue
Nausea
Joint & muscle pain
Less common
Blood clots in veins
Endometrial or uterine CA
Cataracts
Stroke
Osteoporosis
Heart disease
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What is the rehab role in cancer
Therapy can reverse cancer related disability
Determine QOL goals as well as short and long term outcomes
Spirituality
Physical pleasure
Cognitive function
Life satisfaction
Social participation
Balance
Functional status
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Spirituality
Many people return to God during significant illness.
Gerotranscendence
Morbidity & mortality
Decreased risk of suicide and depression
Spiritual pain can prevent healing.
Physical pleasure
Enjoy beauty
Restfulness
Human touch
Cognitive stimulation
Physical energy
Cognitive function
Memory
Attention
Organization
Information‐processing speed
Loss of independence
Emotional health
Implement cognitive strategies
Task related performance
Create individualized systems to set reminders for meds, appts, home tasks, navigation.
Physical exercise
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Life Satisfaction
Sexual relationships
Exercise decreases cortisol and improves QOL.
Mind body Exercise
Quality of life
Balance
Fall prevention
Home modifications
Adaptations
Balance training
Functional Improvements
Dressing
Bathing
Toileting
Cooking
Organizing day
Balancing checkbook
Caring for children
Improved QOL
Active coping
Yoga practice
Improved mood
Improved sleep
Decrease treatment related side effects.
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Upper extremity function
ADL’s
AROM
Pain
Numbness
Scar tissue
Lymphedema
Exercises
Stretching
Modalities to improve AROM
Strengthening
Increase functional tasks
Adaptation
Lymphedema
Skin care health
Weight modifications
Self MLD and flexitouch
Complete Decongestive Therapy
Visceral Manipulation
Matrix Repatterning
Chemotherapy induced peripheral neuropathy (PN)
Meds that cause PN
Diterpenes
Weakness
Numbness
Tingling
Pain
Causes
Functional disability Housekeeping, tactile
agnosia
Dependence on others
OT for adaptation
Remediation through sensory & functional activities
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Has patient fallen in past 6 mos
Has patient experienced difficulty with ADL’s over past several weeks
Are there new UE flexibility restrictions or pain limiting everyday activities?
Has patient experienced new limitation in leisure or social activities?
Has the patient experienced changes in memory, attention, focus that have impacted participation in routine daily activities
Getting a PT/OT referral
Brief geriatric assessment.
Measure functional status, falls, physical health cognition
Patient Reported Outcomes Measurement Information System (PROMIS) assess QOL, functional status, participation in social activities.
Disabilities of arm, shoulder, hand assessment
Function Independence Measure
Functional Impairment tools
Hospital
Skilled nursing
Rehab and subacute
Home care
Outpatient
Physical therapy
Occupational therapy
Speech therapy
Therapy settings
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Physician
Nurse Practioner
Physician’s Assistant
Social worker Outpatient
Home care
Check to see if insurance covers services
Medicare Part B covers outpatient therapy
Supplemental also covers services
Referrals
Cancer survivors are more likely to report being in fair or poor health
3+ chronic comorbidity conditions
Psychological problems
1+ limitations in ADL’s
Poorer functional status compared with same age adults without cancer.
National Health Interview Survey