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What are the primary goals in oncology rehabilitation?
Improve quality of life
Maintain independence
Reduce side effects of cancer/treatments
Maintain and gain physical/mental wellness throughout survivorship
What are the therapist roles in oncology rehabilitation?
Address the following:
Pain, swelling, weakness, fatigue, ROM, balance
Neuropathy, lymphedema, axillary cording, radiation fibrosis
Functional independence
Pre-Op/Tx baseline assessments
Swallowing, chewing food
Multitasking, memory, safety awareness, medication management
Body image and general coping
DME recommendation
Melphalan
Medication that requires pt to chew ice 30 minutes prior to chemo infusion, during, and 2 hours after completion
Busulfan
Medication that crosses the blood brain barrier and causes seizures or seizure like symptoms. You are unable to work with pt during infusion. Pharmacokinetic studies drawn at specific times are required.
Thiotepa
Medication that seeps out of skin, requiring pt to shower at least 4 times a day. Encourage pt to wear hospital provided clothing. PPE considerations
Ribavirin
Medication that is Aerosol only: do not enter room when medication is running. Patient must remain in room for duration of treatment then use PPE
Etoposide
Medication that can cause hypotension if administered too quickly
Benadryl
Medication that is commonly given before infusion. Patient may become sleepy or have affected balance.
Corticosteroids
Medication that increases risk of muscle atrophy (especially proximally & avascular necrosis)
Midodrine
Medication that is used to manage orthostatic hypotension
Must be cleared for PT
Therapists must see patient within 1-59 minutes after the pt has taken med
Takes about 30-40 minutes to take effect
Keep HOB > 30 deg
If a patient is taking _________ and OT/PT is on the schedule, therapist must see the patient 1-59 minutes after the medication is given.
Midodrine
Ommaya Reservoir
Soft plastic dome the size of a quarter
Treats CNS cancers
Prevents CNS cancers
Treat Hydrocephalus
Drain/test CSF
Usually never removed
Considerations for the Ommaya Reservoir
For 6 weeks…
No heavy contact to head
No contact sports/high intensity activity
Gentle ADLs with head grooming
Clinical manifestations of Axillary Web Syndrome
Web of thick, rope-like structures called “cords”
May not be visible/felt but pt will report “pain and tightness”
Possible result of Sentinel Lymph Node Biopsy or Axillary Lymph Node Dissection (more common)
Caused by trauma to the connective tissue that encases bundles of blood vessels, lymph vessels, and nerves.
What does Axillary Web Syndrome result in?
Inflammation, scarring, and hardening of tissue
Decrease in ROM and function
Increase in pain
Therapist roles for Axillary Web Syndrome
Education
PROM/AAROM/AROM (UE, trunk)
Nerve glides
Manual therapy (may hear popping)
Myofascial release
Soft tissue mobilizations
Cord manipulation
Joint mobilizations
Scraping
Moist heat (avoid if patient has lymphedema)
Specialized lymphedema therapy
Anti-inflammatory medications
Cancer related fatigue
Feeling of debilitating tiredness or total lack of energy that lasts for days, weeks, or moths; more severe, lasts longer, limits ADLs/IADLs
T/F: You can fix Cancer Related Fatigue by sleeping
False; this will make it worse
Etiological factors of Cancer Related Fatigue
Cancer & cancer treatment (medications and/or radiation, etc)
Anemia
Poor duration or quality of sleep
Inactivity
Poor nutrition
Low mood
Clinical manifestations of Cancer Related Fatigue
Pain
Fatigue (least likely to be treated by providers)
Nausea/vomitting
Therapist Roles for Cancer Related Fatigue
Assessment of fatigue’s influence of patient’s daily
Education
Energy conservation techniques
Physical activity guidance
Cognitive behavioral therapy
Stress management and relaxation technique
Nutritional counseling
Social support and coping skills
Symptom management
Goal setting and monitoring
Chemo-Brain
Cancer treatment side effect
Clinical Manifestations of Chemo-Brain
Changes in thinking and cognitive function (mild to severe)
Forgetfulness (short term memory)
Slower thinking
Difficulty concentrating
Periods of mental fogginess
Rehabilitation Professional’s roles for Chemo-Brain
“Brain training” games: crosswords, matching games, puzzles etc.
Cognitive strategies: OT and Speech therapy (routine, memory aids, & environmental modifications
Depression and anxiety management
Validate patient’s concerns (provide early education)
Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Removes tumors that are visible in the abdomen and uses heated chemotherapy into the abdomen to kill remaining cancer cells
What type of cancer is targeted with HIPEC?
Abdominal cancers, cancers of the appendix, colon, or stomach.
Rehabilitation professionals’ implications for HIPEC
Preoperative Assessment and Optimization
Postoperative rehabilitation to address weakness reduced ROM, and functional limitations
Pain management
Psychosocial support
Functional restoration to improve physical function, endurance, balance, and mobility.
Education and home management
Basic Mechanisms of Chimeric Antigen Receptor (CAR) T Cell Therapy
Modifies T cells to recognize and attack cancer
T cell collection → 5 weeks for cell modification
Hospital admission: intensive chemotherapy (to weaken immune system to aid modified T cells
Modified T cells are multiplied and infused to patient
Remain in hospital for at least 3-4 weeks (with no complications or infections)
What types of cancer is targeted by CAR T Cell therapy?
Leukemias, lymphomas, and Multiple Myeloma
Rehabilitation professionals’ implications for CAR T Cell therapy?
Psychological support
Symptom management (pain/fatigue/nausea management)
Family support and education
Post-treatment transition and follow up
Basic mechanisms of the Whipple procedure
When cancer originates in the head of the pancreas, it is removed along with the gallbladder, common bile duct, and a section of the small intestine.
To reconstruct the digestive tract, a loop of the small intestine is connected to the pancreas, common hepatic duct, and the stomach
What types of cancer are targeted by Whipple procedure?
Pancreatic cancer, bile duct cancer, ampullary cancer
Cytokine Release Syndrome (CRS)
Caused by a large, rapid release of cytokines into the blood from immune cells affected by immunotherapy
When does CRS occur?
Within the 1st week of CAR-T cells
Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) presents after what?
CRS
When does ICANS resolve?
Within 28 days
Which has a short duration, CRS or ICANS?
CRS
Signs and symptoms of CRS?
Fever
Hypotension
Hypoxia
Organ failure
Signs and symptoms of ICANS?
Delirium, confusion, disoriented, decrease level of consciousness
Tremor
Ataxia
Headache
Aphasia (mimics stroke)
Seizure
Coma
Rehabilitation roles for CRS?
Assessment of functional impairments
Development of rehabilitation plans
Mobility training
ADL training
SLP therapy
Psychosocial support
Coordination of care
Rehabilitation roles for ICANS?
Functional assessment
Development of rehabilitation plans
Mobility training
ADL training
Cognitive rehabilitation
SLP therapy
Psychosocial support
Coordination of care