WEEK 2 NOTES: ONCOLOGY

¶ What is Cancer?
o A disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body
o Can start almost anywhere in the body
o Two Main Categories
1. Hematologic (blood) cancers: cancers of blood cells
a. leukemia, lymphoma, and multiple myeloma
2. Solid tumor cancers: cancers of any of the other body organs or tissues
a. breast, prostate, lung, and colorectal cancers
¶ Tumors
o Mutations to DNA molecules
o Uncontrolled cell division causing new growth
¶ Types of Tumors:
o Benign: Non-cancerous, slow growing, low rate of recurrence.
o Malignant: Cancerous, rapid in growth, invade surrounding tissues, spread to other areas in the body.
¶ Types of Cancer
o described by where it originates
o Carcinoma
 Skin or tissues that line or cover internal organs. At least 80% of all cancers are carcinomas.
o Sarcoma
 Bone, cartilage, fat, muscle, blood vessels, connective/supportive tissues
o Leukemia
 Blood-forming tissues (bone marrow)
o Lymphoma and Multiple Myeloma
 Cells of the immune system
o Central Nervous System
 Tissues of the brain, spinal cord
¶ Metastatic Disease
o Same name and type of cancer as the original growth
o Most common sites of metastatic disease include lungs, liver, and bone
o Treatment depends on:
 Type
 Size
 Location
 Number of metastatic tumors
¶ Stages of Cancer
o Staging is the process of finding out how advanced a person’s cancer is, including the amount of cancer in the body
and where it is located
o Important for determining which treatment is needed
o Common staging systems:
 TMN staging system (Refer to Exhibit 24.1 in Smith-Gabai & Holm textbook p. 491)
o Roman numeral system
¶ Oncology statistics
o Cancer is the second leading cause of death in the US: 1 in 2 men, 1 in 3 women
o Most common Cancers
 Female: Breast, lung, colon & rectum, uterine, thyroid
 Male: prostate, lung, colon & rectum, urinary/bladder, melanoma
o Survival rates are increasing, and death rates are declining
 Due to early detection, improved diagnosis, and treatment
o Cancer treatment costs the US $137.4 billion per year

¶ Cancer Risk factors & Disparities

MODIFIABLE NON-MODIFIABLE DISPARITIES
• Tobacco • Genetics • Race/ethnicity
• Alcohol • Age • Disability
• Diet • Ionizing Radiation • Gender identity
 • Physical activity • Geographic location
• Obesity • Income
• Environmental exposure • Education
• Age
• Sexual orientation
• National origin

¶ Cancer treatment
o Principles of Cancer Care
o Understand the disease process
o Return/restore quality of life
o Provide care along the cancer continuum
o Provide a collaborative/holistic approach to treatment
¶ Continuum of Care
o Pretreatment: Recently diagnosed, no treatment initiated
o Active care: Actively receiving treatment with the intent to cure the disease
o Maintenance: Receiving long-term maintenance chemotherapy, hormonal, or other therapy to keep a disease in
remission/ under control
o Post care/ remission: Finished with all treatment and considered disease free
o Palliative: Receiving palliative treatment for an incurable form of cancer
¶ Treatment
o Goals of treatment:
 Cure the patient using single or combined modalities
 Improve the quality of the patient’s life if the cancer is not curable
o Types of treatment:
 Surgery
 Chemotherapy
 Radiation
 BMT/PBSCT (Peripheral blood stem cell transplant)
 Hormone therapy and immunotherapy
 Surgery

Treatment Use Side Effects

Prevention Pain
Diagnosis Fatigue/poor endurance
Staging Risk of infection
Treatment Edema
Reconstruction Blood clots/pulmonary embolisms
Palliation Change in functional status
Cosmetic changes

Chemotherapy
¶ Treatment Use
o Systemic treatment used to treat cancer that has metastasized
o Goals
 Curative intent
 Control
 Palliative
o Adjuvant: chemo given after surgery VS neoadjuvant: chemo before surgery to shrink the tumor
o Infusion, injection, oral, topical
¶ Side Effects
o Short Term:
 Hair loss, neuropathy, nausea, swelling, and fatigue
o Long Term:
 Increased risk of developing a second cancer, peripheral neuropathies, high risk for infections, fatigue,
cognitive deficits

Note: Risk for developing these long-term side effects increases when chemo is combined with other treatments such as
radiation therapy
Radiation
¶ Treatment Use
o Uses high-energy particles or waves to destroy or damage cancer cells
 X-rays
 Gamma rays
 Electron beams
 Protons
o Considered a localized treatment approach
o EBRT, Brachytherapy, Systemic RT
¶ Side Effects
o Long Term Effects
 May cause learning and coordination problems especially in very young children
 Whole Brain Radiation
 Fatigue
 Skin changes/ fragility/fibrosis
 Nausea
 May cause second cancer to form in treated area years after treatment
Hormone therapy
¶ Uses hormones to slow or stop cancer cell growth
Immunotherapy
¶ Use a person’s immune system to fight cancer
Stem Cell/ Bone Marrow Transplant
¶ This restores blood-forming cells destroyed by high-dose chemotherapy or radiation

Complementary and alternative (CAM) treatments

¶ Increase in complementary and alternative treatments for side effects related to cancer
o Decrease in pain and anxiety with Massage, Reflexology, and Acupressure (Calcagni et al, 2019)
o Prayer is the most common use of CAM in China and Western areas (Kuo et al., 2018)
o Can improve hopelessness with individuals who have breast cancer (Akuyz, 2019)
¶ The National Center for Complementary and Alternative Medicine (NCCAM) 5 categories of CAM:
1. Alternative medical systems (I.e. naturopathy)
2. Body-mind interventions (I.e. prayers)
3. Biologically based therapist (I.e. herbs)
4. Manipulative and Body-based treatments (I.e. massage)
5. Energy treatments (I.e. reiki)

Cancer Related Symptoms & OT Interventions

¶ Cancer Pain : 33-50% of patients with cancer experience pain
INTERVENTIONS
¶ Client-centered with emphasis on engagement in meaningful occupation
¶ Interventions directed at minimizing pain & impact on function
¶ Relaxation techniques
¶ Compensatory strategies
Cancer Related Fatigue (CRF)
¶ Common side effect of treatment
¶ Sudden, does not result from activity or exertion
o Not resolved by sleep or rest
¶ May not end when treatment is completed
¶ Exact etiology unknown

Interventions for CRF

¶ General education
o Energy conservation principles, rest breaks during activity
¶ Assess sleep/wake cycles
¶ Cognitive behavioral strategies
o Coping skills
¶ Environment modification/task simplification
¶ Activity engagement
o Strongest evidence base & reported as most effective non-pharmacological intervention
Cancer Related Cognitive Impairment
**As many as 75% of patients experience cognitive changes during changes
 20-30% experience changes after treatment ends**
¶ Patients may have trouble with:
o Attention
o Processing speed
o Organization (thoughts or tasks)
o Short-term memory
o Word finding
 Sometimes referred to as “brain fog” or “chemo brain,” however is not only caused by chemo
¶ Possible Causes of CRCI
o Chemotherapy Anemia
o Hormone Therapy Fatigue
o Immunotherapy Infection
o Radiation Therapy Menopause
o Stem Cell Transplant Nutritional deficiencies
o Surgery Sleep problems
o Inherited susceptibility Anxiety
o Medications (i.e. pain) Depression
Chemotherapy Induced Peripheral Neuropathy
**Approximately 30-40% of patients receiving neurotoxic chemotherapy will
suffer from CIPN**
¶ Symptoms:
o Numbness/tingling
o pain
o cramping in hands and feet
o loss of tactile and vibratory sensitivity
o balance impairment/increased fall risk
o impaired fine motor coordination
¶ Can present hours or days after infusion and last for months to years after completion of treatment
¶ Presents in a stocking glove distribution
INTERVENTIONS for CIPN
¶ Compensation
o ADL modifications for tasks requiring FMC and grip strength- button hook, elastic laces, Dycem/ jar opener
o Proximal stabilization to improve distal function
o Compensation with vision
o Skin care and safety
o Environmental modification to reduce fall risk
¶ SX Management
o Desensitization with manual techniques, vibration, graded textures
o Sensorimotor activities such as strengthening with putty
o Coordination tasks (teach strategies)
Lymphedema
¶ Condition caused by inadequate draining of the lymphatic fluid
¶ Fluid can be blocked by a tumor, scarring, and inflammation of nodes
¶ Can appear immediately after tx or years later
¶ Upper extremity lymphedema common after breast cancer surgery and radiation
¶ Causes increased swelling, feeling of heaviness, pain, in affected region leading to impairments in B/ADLs
OT ROLE IN MANAGING LYMPHEDEMA
¶ Gentle exercises with diaphragmatic breathing
¶ Compression garments with special lymphedema wrapping techniques
¶ Manual lymphatic drainage
¶ Pneumatic compression
¶ Complete decongestive therapy
¶ OTs should be certified in lymphedema management or trained by someone who is, prior to using ANY of these techniques
How to measure edema
¶ Volumetric Displacement
¶ Circumferential Measure
Pitting edema scale
Special considerations
¶ Vital signs: blood pressure, heart rate, Oxygen saturation
¶ Lab Values: Activities should be modified if outside normal ranges
o Platelets > or = 10 K/mcL
o Hemoglobin > or = 7.0 g/dl
¶ Bone Mets
o Risk for pathological fractures
o Clarify weightbearing restrictions
o No MMT
o No manual or resistance training without clearance
¶ Lymphedema
o No BP, punctures, heat, cold on affected limb
¶ Neuropathy/sensory
o Avoid heat modalities and cold packs
o Teach skin checks
o Fall risk
¶ Psychosocial impact
o Body image, depression, and anxiety

Traditional Home Care, Palliative and Hospice Care

¶ Home Care "Care of Sick"
¶ Palliative offer services that focus on quality of life, pain control, symptom management, and emotional support for patient
and families. 
¶ Hospice is appropriate for clients with life expectancy less than 6 months.
o Patients must decline aggressive curative treatments
What Is a home health aide?
¶ HHA provides basic care in the home
o Bathing
o Dressing
o Home management tasks: laundry, meal prep, cleaning, mail, trash
o Socialization
o Feeding assistance
¶ Follows the treatment plan designed by the healthcare team
¶ Most home health agencies require an OT to design the care plan when a HHA is requested by the patient/family or nurse
case manager
¶ HHA services are covered by Medicare and other insurance payers

Considerations for Patients Receiving Hospice Care

¶ Client-driven: if the client wants a progressive exercise plan, then we will prescribe the safest plan that is appropriate based
on their medical status
¶ Fall prevention: clients become deconditioned and have impaired cognition are at a higher risk for falls
¶ Support the caregiver on issues related body mechanics, and resources to decrease caregiver burnout. Also, include education
on the prognosis of the medical condition if appropriate
¶ Use relaxation to improve client’s sleep cycle and experience recuperative sleep

Common Assessment tools used by OT

¶ Client-centered interview
o COPM
¶ Pain Scale
o Pain Scale 0 -10
o Wong-Baker Faces Pain Scale
¶ Cognition
o MOCA
o SLUMS
o Executive Function Performance Test
¶ ADL assessment tool
¶ Brief Fatigue Inventory