1
Q
three most common types of cancer for males and females
A
male prostate 27 % , lung, colon/rectum
females breast 29% lung, colon/rectum
2
Q
who were the most likely race to get cancer
A
blacks
3
Q
what leads to the decline in prostate CA
A
the detection of the prostate antigen believed to be a huge link to prostate CA.
4
Q
probability of developing breast CA for women and probability of developing prostate CA for men
A
Women is 1 in 8 and men is 1 in 7
5
Q
survival rates for CA
A
women is stage 0 100 stage 1 100 stage 2 92 stage 3 stage4 72 stage 5 22 stages for men for survival stage 0 100 stage 1 96 stage 2 84 stage 3 52 stage 4 24
6
Q
how different types of CA are there
A
over 200
7
Q
how to grade the size of the CA
A
t = tumor n = nodule m= metasis
Stage I: T≤2cm, N=0, M=0
Stage II: T>2-5, N=any, M=0 or T=any, N=large#, M=0
Stage IV: Any T; Any N; M=1 (metastatic-terminal, not curable)
8
Q
common sites for CA to spread to
A
brain liver lungs are the most common of spreading
9
Q
common signs of CA
A
pain, discomfort
fatigue difficulty sleeping
shortness of breath
swelling/lymphedema
failure to improve
w/P.Tdifficulty w/ADLs (i.e.-work, household chores, family responsibilities
10
Q
CA risk factors
A
Genetics
Diet and Exercise
BMI
alcohol
UV exposure
Tobacco Cigarette Cigar Second hand smoke Smokeless
11
Q
Typical causes of skin CA
A
Most common cancer… UV/Sun exposure (severe sunburns as a child) Light skin Family history (1st degree relative) # of moles (50-100+) Types of moles Previous h/o skin CA Occupational exposures
12
Q
Most common types of skin CA
A
Non-melanoma
Basal Cell Carcinoma (BCC) most common type of skin CA sun exposure (head, neck, trunk, arm, back of hands) fair skin > dark skin grows slowly and rarely spreads
Squamous Cell Carcinoma (SCC) Second most common type Sun exposure (ear rim, face, neck, trunks, arm, lips)
13
Q
Most deadly form of CA and what is the deadliest and what is the number one reason for it
A
Melanoma
presents as a mole or new dark spot
deadliest form of skin CA
8,500+ Americans die every year (1 person every hour)
5 yr survival 91%
Localized 98% (84% of people are diagnosed)
Regional 62%
International Prevalence of Indoor Tanning – A Systematic Review and Meta-Analysis.” – JAMA Dermatol. 2014;150(4):390-400
Number of skin cancer cases due to tanning is higher than number of lung cancer cases due to smoking. In US alone, 419,254 cases of skin cancer can be attributed to indoor tanning. Out of this number, 6,199 are melanoma cases
14
Q
what are the ABCDE’s for screening for moles
A
asymmetry - one half doesn’t match the other half
border- the edges are notched or ragged
color- the edges varied shades are black or brown
diameter- greater than 6 mm
evolving- change in size shape or color
15
Q
treatment options for removing the mole
A
Freezing (liquid nitrogen) Laser therapy Photodynamic therapy (PDT) Curettage and electrodessication Mohs surgery Excisional surgery Radiation therapy Chemotherapy Biological therapy (interferon and interleukin-2
16
Q
What is the probability of developing prostate CA.
what people are at risk for developing prostate CA??
what are the treatment options??
A
Risk – 1 in 7 men will be dx’d 15% of men will develop increases w/age (median age dx: 66 yo) Race (African Americans > chance than Caucasian) family hx 1 relative with h/o prostate CA = 2x risk factor 2+ relatives “ = 4x “ diet & lifestyle (obesity) social and environmental factors
Treatment Watch and wait Radical prostatectomy Radiation therapy (external beam radiation or brachytherapy) Chemotherapy Clinical Trials Diet modification
17
Q
Cervical and Ovarian CA what casues them and how are they detected??
A
Ovarian CA (3%) -- 1 in 73 risk Epithelial (85-90% carcinomas) Germ cell (2%) Stromal (1%) **most deaths – female reproductive system
Cervical CA – successfully treatable
Squamous cell carcinoma
Adenocarcinoma (85-90%)
**abnormal PAP smear – early detection
18
Q
Treatment options for Ovarian CA
A
Surgery Radiation therapy Chemotherapy Targeted therapy Hormone therapy
19
Q
October is Breast Cancer Awareness Month.
On average, a mammography detects a tumor that
has been present for ______ years.
A
6-8 years
20
Q
On average, a palpable lump is detected after
_____ years
A
8-10 years
21
Q
Common forms of breast CA
non-invasive carcinoma vs
invasive carcinoma -
A
Non-invasive (intraepithelial) – Stage 0 a. (DCIS) Ductal Carcinoma in situ b. (LCIS) Lobular Carcinoma in situ Invasive a. Infiltrating Ductal Carcinoma b. Infiltrating Lobular Carcinoma
22
Q
Ductal Carcinoma in situ (DCIS)
what is this also known as and is this type of CA harmful??
A
aka intraductal carcinoma most common form of non-invasive BC pre-cancerous condition confined to milk ducts 5 year survival rate is ≈100% > risk of recurrence/developing new CA *15-30% come back as invasive CA
23
Q
ways to detect noninvasive ductual CA.
A
No physical signs or symptoms
small % present w/palpable lump or nipple discharge
mammography findings: microcalcifications
Fine needle aspiration biopsy: small needle removes
cells from suspected site to be further analyzed
Core needle biopsy: large needle inserted via a small incision site made to accommodate size of needle in order to obtain a larger tissue sample to be analyzed
24
Q
most common form of invasive breast CA
A
most common form of invasive BC (80%)
started in milk ducts of breast and has spread to surrounding tissue
25
Lobular Carcinoma in situ (LCIS)
```
pre-cancerous condition
confined to lobules (milk glands)
30% have bilateral involvement
25% will develop BC in their lifetime
No physical signs or symptoms
(-) mammography findings
dx by biopsy
```
26
Lobular breast CA
10-15% of invasive BC
| starts in lobules and spreads to surrounding tissues
27
What happens when they remove the breast tissue
removal of breast tissue & some or all of the axillary lymph nodes
pectoralis major is spared
pectoralis minor may or may not be removed to allow easier
access to axilla for dissection
lymphedema risk
28
Simple (Total) Mastectomy
removes entire breast including nipple and areola
chest wall muscles spared & NO axillary dissection
0% risk of lymphedema as no nodes are removed
prophylatic mastectomies
Extended Simple Mastectomy: involves 1-2 lymph nodes. Considered MRM & give lymphedema precautions
29
Lumpectomy
removal of tumor & small or large margin of surrounding breast tissue
sentinel node or axillary dissection
risk for lymphedema
30
Sentinel Lymph Node Biopsies (SLNB)
Lymphoscintigraphy: blue dye & radioactive colloid
injection that maps lymphatic flow
bluest & hottest node where cancer will pass through if going to spread; main drainage route
Benefits: pain
parasthesia
risk for lymphedema
31
Axillary Lymph Node Dissection (ALND)
Varies, 25-30+ lymph nodes in each axilla
Level I: removal of nodes that lie b/t lats dorsi & lateral border of pec minor
Level II: Level I & mid-axillary nodes, located deep to pec minor
Level III: Levels I, II & those in axilla, located medial to pec minor & below costoclavicular ligament
32
breast reconstruction surgery things to think about
Considerations:
immediate vs. delayed
pending adjuvant tx (radiation therapy)
minimize further surgical interventions
psychological
33
Prosthesis (Breast Forms)
non-surgical option
available in a variety of shapes, sizes, & materials
silicone gel, foam, fiberfill interior
weighted or non-weighted
ready made or custom made ($100 - $3,000+)
34
Saline (Saltwater) or Silicone Gel
KNOW THIS SLIDE
what are some precautions to take
least amount of surgery
tissue expander (balloon type device) inserted under pectoralis muscle
3-6 mo period, saline injected via expander port to stretch skin in prep for permanent implant
6-12+ months commitment
precautions
expanders susceptible to microtears
: avoid direct STM / soft tissue work
: if necessary, apply gentle techniques to soften tissue
avoid strengthening,“bulking up” of pec/ant chest wall muscle
35
Autologous Reconstruction
tissue from another area of body to create a breast
implant can be used underneath own tissue
free flap: tissue is harvested & vasculature is severed microsurgical techniques reconnect free flap to new vasculature in chest
pedicle flap: tissue is tunneled under skin to create a breast maintaining original vasculature
36
TRAM Flap (think abs to boobs) what is the pros and cons
popular reconstruction choice
abdominal flap can only be utilized for 1 procedure
unilateral mastectomy
double mastectomy simultaneously
Pro
“tummy tuck”
tissue feels like a natural breast
Con
little to no sensation in new breasts
long horizontal abdominal scar (hipbone to hipbone)
newly created belly button
permanent abdominal weakness
Also it is important for PT's to work on scar mobilization techniques and posture is huge here because after these procedures the pt is pulled forward and they need to work on straightening up the spine.
37
DIEP Flap
deep inferior epigastric perforator”
only skin, fat, & blood vessels are removed from lower abdomen
in a free flap procedure; no muscle removed
microsurgery is required to reattach vasculature to tissue flap
```
Pro
faster recovery due to no muscle removed
less abdominal wall discomfort
less risk of abdominal weakness
“tummy tuck”
```
38
Latissimus Dorsi Flap what are the pros and cons
a section of skin, fat, and lats dorsi is tunneled under the skin to
the anterior chest to create a breast
blood vessels remain intact for most part, however microvascular
reattachment may be needed
commonly used with an implant
Pro
relatively easy reconstruction procedure
results in few complications
Con
skin color and texture differentiation between back and chest
may present w/posterior trunk weakness
asymmetry of back
muscle contraction of lats may present as muscle contraction in breast
39
GAP Flap
gluteal artery perforatory”
section of skin, fat, and buttock muscle is transplanted to create a new breast
implant may or may not be needed
not a commonly utilized reconstruction technique
S-GAP or I-GAP
Pro
scar on buttock covered by “crease” (I-GAP)
no muscle removed (S-GAP)
no sensation loss (S-GAP)
Con
long reconstruction time
high complexity leading to high failure rate due to poor vascularization
tissue failure requires surgical removal
loss of sensation (I-GAP)
40
Nipple & Areola Reconstruction describe the procedure
can utilize tissue from labia, inside of thigh, or a number of other places to create nipple
performed >2 months after final reconstruction is done after all healing & swelling has occurred
newly formed nipple/areola can be tattooed to color the tissue
41
chemotherapy
Systemic therapy
Chemo enters bloodstream to affect whole body
Non-specific cell selectiveness
affects rapidly dividing healthy cells (e.g. hair, intestines)
Prevents cell growth & replication through disruption of cell division; inhibits DNA / RNA
Neoadjuvant: pre-surgery w/goal to remove less tissue by shrinking cancer
Adjuvant Chemotherapy: post-surgery w/goal to ensure remaining any remaining cancer cells are eliminated
42
Chemotherapy Regimen
```
Combination therapy (q3wks)
2-3 chemo medications given at same time
Decreased risk of recurrence of cancer
Decreased drug resistance
Optimal combo delivery kills cancer cells
```
Dose Dense Therapy (DDT) (q2wks)
Decreased time interval b/t chemo doses = condensed scheduled
Potential for increased side effects due to decreased recovery time (e.g. anemia, neutropenia)
43
Chemotherapy Delivery & Dosage
Individually tailored to each patient
Specific cancer
Stage of cancer
Other health status & treatments received
Always recommended w/lymph node involvement
More aggressive w/pre-menopausal women
Never recommended w/DCIS
Delivery:
Several cycles w/set recovery periods
3-6 month duration
IV aka infusion, injection, catheters/ports implanted, oral
44
CHEMO: Alkylating agents dont have to know them all by name but what are some of there side effects??
```
Alkylating agents
Platinum-based antineoplastic drugs
Antimetabolites
Anti-tumor antibiotics
Topoisomerase inhibitors
Mitotic inhibitors
Corticosteroids
```
45
Platinum agents side effects
Disrupts & damages DNA (similar to alkylating agents)
Cisplatin (Platinol)
Carboplatin (Paraplatin)
Oxaliplatin (Eloxatin)
Side effects
Fatigue, nausea, vomiting, low WBC / RBC / platelet, kidney damage, hair loss, loss of appetite, nerve damage/peripheral neuropathy
46
Chemo anti-metabolites and side effects all of these are really pretty similar
```
Interfere w/DNA & RNA growth, substituting normal building blocks; damage cells during S-phase
5-fluorouracil (5-FU)
6-mercaptopurine (6-MP)
Capecitabine (Xeloda)
Gemcitabine (Gemzar)
Methotrexate (Rheumatrex)
```
Side effects
nausea, vomiting, loss of appetite, dehydration, hand-foot syndrome, include lowered blood counts, mouth/throat sores, diarrhea, joint pain, swelling, rash, irregular periods, low WBC, anemia
47
CHEMO: Anti-tumor antibiotics
```
Anthracyclines interfere with enzymes associated w/DNA replication
Doxorubicin (Adriamycin)
Epirubicin (Ellence)
Daunorubicin (Cerubidine)
Idarubicin (Idamycin)
Mitomycin-C (Mutamycin)
Actinomycin-D
Mitoxantrone (Novantrone)
Bleomycin (Blenoxane)
```
Side effects
cardiotoxicity, leukemia, nausea, vomiting, hair loss, loss of appetite, stomach pain, diarrhea, difficulty swallowing, skin sensitivity, rash, nail changes, lowered blood counts, fatigue, mouth sores, irregular periods, hand-foot syndrome
48
CHEMO: Mitotic inhibitors
Plant alkaloids; stop mitosis & inhibit enzymes from making protein required for cell reproduction
Taxanes: Paclitaxel (Taxol), Docetaxel (Taxotere)
Vinca Alkaloids: Vinorelbine (Navelbine), Vinblastine (Velban), Vincristine (Oncovin), Vindestine (Eldisine)
Epothilones: Ixabepilone (Ixempra)
Estramustine (Emcyt)
Side effects
muscle aches, weakness, vomiting, infection, mouth sores, diarrhea, hair loss, peripheral neuropathy, bone marrow suppression, allergic reactions, irregular periods
49
CHEMO: Corticosteroids what do they do and what are the side effects
Natural hormone & hormone-like drug used to kill cancer and/or slow tumor growth
Anti-emetics: used to alleviate/prevent nausea & vomiting
Prevents severe allergic reactions
Prednisone
Methylprednisolone (Solumedrol)
Dexamethasone (Decadron)
Side effects
weight gain, delayed wound healing, osteoporosis
50
Other types of CA Drugs (not all inclusive)
Drugs & biological tx used to treat cancer, but not considered chemotherapy
Target different properties specific to CA cells; less serious side effects
Targeted therapies: can be part of main tx, after tx to maintain remission or decrease chance of recurrence
Hormonal therapy: hormone-like drugs that change action or production of female/male hormones to prevent cancer cells from using hormone to grow
Anti-estrogen: compete with estrogen to bind to estrogen receptors
Tamoxifen, Fulvestrant
Side effects: hot flashes, nausea, fatigue
Aromatase Inhibitors: stop production of estrogen in post-menopausal women; less estrogen available to stimulate growth of hormone-receptor-positive breast cancer cells
Arimidex, Aromasin, Femara
Side effects: cardiotoxicity, osteoporosis, bone fx, joint pain/stiffness
51
Chemo Side Effects know just the main ones
```
pain, discomfort
cancer-related fatigue(main)
weakness
neutropenia(main)
nausea & vomiting
leukopenia(main)
cardiotoxicity(main)
mouth and throat sores
nail changes
weight changes
thrombocytopenia
taste and smell changes
vaginal dryness
menopause & assoc. symptoms
fertility issues
incontinence
hair loss
anemia
constipation & diarrhea
indigestion
vision/eye problems
osteopenia/osteoporosis
feelings of depression & anxiety(main)
infection(main)
chemo fog (main)
decreased mental sharpness
swelling/lymphedema (main)
chemo-induced peripheral neuropathy (CIPN (main)
```
52
Radiation Therapy (high dose of radiation therapy) describe the purpose of it.
Use of high-dose, high-energy beam to damage cancer cells
localized treatment of tumor
Damage cell’s DNA
Non-cell specific; damages normal, healthy cells
Neo-adjuvant and/or adjuvant treatment; accelerated schedule
53
Radiation oncologist
Radiation physicist
Radiation therapist
What does each member of the radiation team do?
Radiation oncologist – designs & monitors radiation therapy intervention type
Radiation physicist / dosimetrist – calculates radiation therapy dosage & delivery
Radiation therapist – performs set-up and delivers daily radiation therapy treatments
54
Radiation Therapy Methods
External beam radiation (linear accelerator)
Radiation from external source
Internal radiation therapy (brachytherapy)
Radiation source implanted in nearby surrounding tissue of tumor site or inside actual tumor
Radioactive ‘implant’ can be left for any length of time; radiation depletes as time passes
Combination therapy – external & internal radiation therapy
Used in conjunction with each other
55
Radiation Therapy Methods
External beam radiation (linear accelerator)
Frequency: 5 days wk, 1-10 weeks
Dependent on size, type, location, co-morbidities, adjuvant therapies
```
Expectation
Delivery is painless
15-30 min set-up of machine
Actual radiation takes a few minutes only
Simulation (initial visit 30 mins)
Tattoos
```
56
Radiation Therapy Methods
Internal radiation therapy (brachytherapy)
Implants (needle like tubes inserted in an OR)
Seeds, pellets, wire give off radiation for weeks to month
Sometimes stay in private hospital room due to care required w/implants; limit contact
Precautions
distance from children or pregnant women
radiation badge for healthcare professionals
57
Additional Radiation Therapy Methods
Three-Dimensional Conformal Radiation Therapy
Digital simulator integrates treatment machines & planning computers to create 3-D image
Improved accuracy in choosing and shaping beams to avoid healthy tissue and conform to tumor site
Treatment of choice for CAs that cannot be felt or seen
Intensity-Modulated Radiation Therapy (IMRT)
Uniform, homogenous, doses of radiation; prevents hot spots
Used in tumors closely situated to critical tissues; spares healthy tissue
Treatment of choice for prostate, lung, H&N, some breast & GI tumors
Image-guided radiation therapy (IGRT)
Use imaging to locate tumor immediately before radiation dose
More accurate delivery of radiation to tumor
Stereotactic body radiotherapy (SBRT)
Delivery of high dose radiation to small targets
1-5 treatment sessions
Treatment of choice for early-stage lung tumors (90% cure)
58
Radiation Therapy Side Effects
```
pain, soreness
fatigue, weakness
hair loss (site dependent)
neutropenia
skin sensitivity
flaky, peeling skin, redness
blisters, itching
radiation ‘burns’
soft tissue fibrosis
hyperpigmentation / scarring
telangiectasis
wounds / abscess / infections
edema / Lymphedema
nausea & vomiting
bowel & bladder changes, diarrhea
```
59
Radiation Therapy Skin Care Guidelines
minimize sun exposure
wear loose-fitting clothing
avoid skin irritation from rubbing (e.g. underarm, bra-line)
use recommended lotion / cream as per radiation therapy team
avoid shaving / waxing in targeted area
60
Potential side effects of chemo or radiation or surgery
cording, muscle weakness, ROM loss. lymphedema, and fatique CRF
61
what is a scar lolz?
areas of fibrous tissue that replace normal skin (or other tissue) after injury…scarring is a natural part of the healing process
62
process of scar formation
```
Inflammatory Phase (0-5 days)
hemostasis
inflammation
clotting factor
capillary vasodilation
```
```
Proliferative Phase (2 days – 3 weeks)
epithelialization
angiogenesis
granulation tissue formation
randomized collagen deposits
```
Remodeling Phase (3 weeks – 2 years)
Aka Maturation Phase
Randomized collagen deposits are slowly organized
Tensile strength increases for up to 1 yr
Full strength of injured skin is never regained (Only 70-80%)
63
properties of scars
```
Less resistant to UV rays
Poor regeneration of sweat glands
Poor regeneration of hair follicles
Color variations
Poor blood circulation
Uneven appearance & inelastic in nature
```
64
how to test soft tissue
incision fully healed or if careful, prior to complete closure/healing
flat finger pads (small area); flat hand (large surface area)
5 grams of pressure (nickel)
manual mobilization of skin and soft tissue (superficial deep)
light, gentle, traction skin/soft tissue (avoid rubbing)
utilize all directions (ie-clockwise/counterclockwise, diagonals, etc)
65
Scar management techniques and purposes
```
Scar modeling
Soft tissue mobilizations
Myofascial techniques
Visceral manipulation
Craniosacral
```
ROM pain seromas pulmonary functions
strength gait post-surgical edema nerve entrapments
posture cosmesis lymphedema functional movement
66
what creates misalignment of tissue??
fascia
67
technique to myofasical release
superficial deep (5 grams of pressure to start)
move into direction of ease or into direction of restriction
engage skin, soft tissue, fascia
keep hands/fingers relaxed
light, gentle, traction skin/soft tissue
NO rubbing!!!!
utilize all directions (e.g.- up, down, s/s, clock, diagonals…)
Unwinding technique
68
coording - what is it and does it reslove itself
temporary inflammation of lymph vessels resulting in scarring / fibrosis
Axillary Web Syndrome
Sclerosing Lymphangitis
Mondor’s Syndrome
Venous sclerosing
Trunk cording
Palpable cords axilla, elbow, forearm
Reproducible pain w/corresponding edema pattern
self-resolving condition (wksmonths), can be extremely painful with severe functional limitation…with P.T., pain relief & decreased edema within 1-2 treatments
69
what does PT focus on??
Encourage patient to attend PT consistently
```
Focus often is on
Chemo-Induced Peripheral Neuropathy (CIPN)
Cancer-related fatigue (CRF)
Balance / falls
Surgery-related side effects
```
Manual lymphatic drainage (MLD)
70
P.T. related to Radiation Therapy what do you focus on
Schedule PT sessions pre-radiation appts
Skin most fragile immediately after & up to 6 hrs after Rx tx
Hold PT if medically appropriate
Focus often is on
ROM
Edema, lymphedema
Grade pressure of soft tissue mobs during & after Rx tx
Caution when using modalities in treated quadrant
Self-manual lymphatic drainage (MLD)
71
what does PT focus on mainly
```
Posture
Body mechanics
Functional mobility (optimal gains, not just fxn’l)
Cardiopulmonary home exercise program
Lymphatic drainage
Energy Conservation
```
72
All the things we have in our tool bags to treat CA patients with.
Joint mobilizations
Shoulder, t-spine, scapula, 1st rib, clavicle
Muscle re-organization
Strain counterstrain, trigger point release, myofascial unwinding
Decompression techniques
Spine, ant chest wall, shoulders, postural re-ed
Abdominal breathing
Diaphragmatic, meditation / relaxation (Mind-Body)
73
reasons for lymphedema
Accumulation / stagnation of protein-rich fluid due to impairment of the lymphatic system
```
potential etiology
SLNB / ALND
inguinal dissection
pelvic node dissection
head/neck dissection
radiation
temporary edema due to chemotherapy
hysterectomy
```
74
signs of lympedema
warmth & temperature
redness, streaking, splotchiness
pain
swelling
```
Physician should be contacted to determine if it is
an infection (cellulitis) and if antibiotics is needed.
```
Early symptoms for lymphedema: pressure, tightness, heaviness
75
maintain an even body temperature in somebody with lymphedema how would you do this just think of your mom
Protect the body from sun by wearing
Sunblock of at least 30 spf
UVA / UBA resistant clothing
Monitor body temperatures…avoid extremes
heat, cold
jacuzzi / sauna
Gradual exercise…
76
carrying techniques for patients with lymph edema
```
Minimize heavy lifting / carrying by
alternate the shoulder carrying the purse
use a backpack
observe proper posture/biomechanics
use both arms, lift with legs
exercise
```
Minimize repetitive movement
77
where to inject and take blood pressure readings if B arms present with lympedema??
BP, blood drawings, injections & vaccinations are encouraged to be done in an unaffected quadrant when possible
if both sides of upper body are at risk, medical team should use:
thigh cuff for blood pressure
buttock for vaccinations, injections
78
The ‘multiple hit’ hypothesis
```
Pulmonary function (systemic therapy, radiation)
Cardiac function (DOX, Herceptin, radiation, SMIs
Vascular compliance (DOX, radiation, SMIs)
Skeletal muscle function (decadron, hormone therapy, chemotherapy?, SMIs?)
CV reserve
```
79
what declines with breast CA
VO2peak decline during adjuvant therapy in early breast cancer
80
whats the recommended exercise duration for people
5-7 Days a Week for 30-60 Minutes
81
benefits of exercise
```
strength & flexibility
self-esteem
body image
post-surgical healing
immune function
quality of life
posture
sense of control / weight
endurance
sleep quality
Improve bladder health
Helps build / maintain bone, muscle, & joints
pain & fatigue
risk of certain cancers
feelings of depression & anxiety
risk of co-morbidities
Diabetes
Heart disease
High blood pressure
nausea & vomiting
risk for falls
mortality in prostate CA survivors
```
82
how often to do strength, flexiblity or aerobic exercsises
FLEXIBILITY AEROBIC
5-7 x week
30-60 mins
```
walk
bike
swim
jog
aerobics
dance
```
5-7 x week
warm-up
cool-down
active movements
stretching
yoga
Tai Ch
STRENGTH
3-5-7 x week
repetitions vary
resistance bands
free weights
weight machines
household chores
83
How hard should I be exercising
Moderate intensity aerobic activity
Gradually progress strength training
Avoid labored breathing (comfortable conversation)
60% - 80% maximal heart rate (HRmax)
HRmax = (220 – age) x 0.60 to (220 - age) x 0.80
84
what are some precautions when exercising to look out when exercising with CA patients
```
Pain, night pain
Extreme fatigue
Fever
Chest pain, palpitations
Leg cramps
Rapid weight loss
SOB
Severe diarrhea or vomiting
Disorientation, confusion, dizziness, lightheadedness
Numbness, tingling, burning, swelling
Low blood count
Dehydration
Same day chemotherapy
Within 2-6 hours of radiation
```
85
Benefits of plevic floor exercises
```
Education
Improve bowel and bladder function
Correct poor voiding patterns/behaviors
Decrease pain
Improve ADL and QOL
```
86
some relaxation techniques
```
Meditation
Guided visual imagery
Deep breathing (4x4x8 breathing)
Complementary therapies
Support groups
Journaling
Hobby
Tai Chi
Yoga
EXERCISE
```
oncology SP2
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