Physiotherapy Role in Geriatric Oncology: Difference between revisions

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== Physiotherapy  Management  ==
== Physiotherapy  Management  ==
 
Physiotherapy intervention  requires assessment of the older adults with cancer, which can be based on neurologic, integumentary, musculoskeletal, comorbidities and geriatric syndromes. The common problem with an older adult with cancer are:
==== '''Common Problems:''' ====
* Impaired bed mobility
• Impaired bed mobility
* Difficulty with transfers
 
* Decreased muscle strength
• Difficulty with transfers
* Decreased ambulation
 
* Decreased ROM, cardiovascular endurance
• Decreased muscle strength
* Impaired balance
 
* Pain etc.
• Decreased ambulation
 
• Decreased ROM, cardiovascular endurance
 
• Impaired balance
 
• Pain


==== '''Physical activity guidelines recommendation for Healthy Older Adults''' ====
==== '''Physical activity guidelines recommendation for Healthy Older Adults''' ====
American College of Sports Medicine and the American Heart Association.moderate recommendation for healthy older adults<ref>Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. P[https://pubmed.ncbi.nlm.nih.gov/17671236/ hysical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.] Circulation. 2007;116(9):1094.</ref>:
American College of Sports Medicine (ACSM) and the American Heart Association (AHA) on physical activity guideline<ref>Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. P[https://pubmed.ncbi.nlm.nih.gov/17671236/ hysical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.] Circulation. 2007;116(9):1094.</ref>:
* Aerobic
* Aerobic exercise
Moderate aerobic for 5-6/10) 5 days/wk, 30 mins/day, bouts of 10 mins each
# Moderate aerobic is recommended for 5 days per week, 30 mins/day, bouts of 10 mins each
 
# Vigorous aerobic exercise is recommended for 3 days per week, continuous for at least 20 mins/day
(vigorous, 7-8/10) 3 days/wk, continuous for at least 20 mins/day
* Strengthening exercise is recommended for at least 2 days/wk, 8-10 exercises to major muscle groups for 10-15 reps  
* Strengthening  
At least 2 days/wk, 8-10 exercises (major mm groups),
 
10-15 reps
* Flexibility/Balance
At least 2 days/wk; for those at risk for falls- include
 
balance


* Flexibility/Balance for at least 2 days/wk; for those at risk for falls it is recommended to include balance.
==== '''Exercise Guidelines for Cancer Survivors''' ====
==== '''Exercise Guidelines for Cancer Survivors''' ====
General Statement
exercus guid for cancer survivors<ref name=":1">Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM. [https://pubmed.ncbi.nlm.nih.gov/20559064/ American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.] Medicine & Science in Sports & Exercise. 2010 Jul 1;42(7):1409-26.</ref>
* Avoid inactivity. Return to normal ADLs as quickly as possible after surgery.
* Individuals with known metastatic bone disease will require modifications to avoid fractures.
* Individuals with cardiac conditions may require modifications and supervision for safety.
Aerobic •Breast/Prostate/Colon/Hematologic/Gynecologic- Same as age-appropriate PAG for Americans
 
•Adult HSCT- OK to exercise everyday; lighter intensity, and lower progression of intensity; avoid
 
overtraining/vigorous ex
 
•Colon- MD permission to engage in contact sports
 
Resistance •Breast- supervised program with very low resistance; watch out for UE symptoms/lymphedema;
 
fracture risk
 
•Prostate- add pelvic floor exercise for radical prostatectomy; fracture risk
 
•Colon- start with low resistance and progress resistance slowly for patients with stoma to avoid
 
herniation
 
•Adult HSCT- resistance training might be more important than aerobic ex
 
•Gynecologic- proceed with caution if patient has lymph node removal or RT


Flexibility •Breast/Prostate/Hematologic/Adult HSCT/Gynecologic- Same as age-appropriate PAG for
American College of Medicine on exercise guidelines for cancer survivors<ref name=":1" /> advice to avoid inactivity, return to normal activities of daily living as quickly as possible. Also on the general statement, a person with metastatic bone disease requires modifications to avoid fractures. And those with cardiac conditions may require modifications and supervision to ensure their safety.
* Aerobic
Individual with breast, prostate,colon, hematologic, gynecologic cancers are to follow ACSM and AHA physical activity guideline(PAG) for their age group
* Resistance exercise
Individual with breast cancer are to be supervised for low resistance exercise.


Americans
Individual with prostate cancer are encouraged to add pelvic floor exercise after undergoing radical prostatectomy.


•Colon- avoid excessive abdominal pressure for patients with ostomy
Individual with colon cancer are to start with low resistance and progress resistance slowly  to avoid herniation
* Flexibility
Individual with Breast/Prostate/Hematologic cancer are to exercise at  at PAG guideline.


== Prevention  ==
== Prevention  ==
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== Resources    ==
== Resources    ==


add appropriate resources here
[https://www.mskcc.org/sites/default/files/node/19501/documents/pt-therapy-considerations-geriatric-pt-aquino-and-espiritu.pdf Geriatric Cancer Rehabilitation]




Revision as of 13:34, 17 July 2020

Original Editor - Tolulope Adeniji
Top Contributors - Tolulope Adeniji, Kim Jackson, Vidya Acharya, Chelsea Mclene and Areeba RajaThis article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (Template:18/Template:07/Template:2020)

Overview of Geriatric Oncology[edit | edit source]

Geriatric oncology is a special area that deals with issues surrounding assessmeny and management of older adults with cancer.Due to ageing process that is complex, most newly diagnosed cancers are among this population[1]. And it is essential to understand the baseline health status of a patient before making treatment decisions. Generally, a geriatric assessment is supposed to be a comprehensive evaluation that includes medical, psychosocial, and functional problems in older patients with cancer[1]. Geriatric oncology should includes specific areas such as identification of vulnerability, predicting survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice. The information on this write up will elaborates on how physiotherapy contributes to geriatric oncology practice.

Epidemiology[edit | edit source]

Ageing is an indirect risk factor for cancer and one reason for this can be linked to increase exposure to carcinogenic substances in greater time that could predispose such individual to genetic changes and eventually tumor[2] Cancer is highly prevalent among the older adults and the incidence and mortality of cancer increases with age. However, at very old age, >90 years, cancer prevalence decreases.[3] Aside the ageing being risk factors of cancer, gender is also associated with some certain cancer. Among common cancer in older adults, incidence of the following cancer are high among male gender: prostate, lung, and bowel cancers, while, breast, lung, bowel, stomach, and uterine cancer are of higher incident in female gender[4]

Aetiology[edit | edit source]

The underlying causes of cancer among older adults can be explain based on the biology of ancer and impact of ageing. These can be explain under the following heading:

  • Molecular Changes
  • Cellular Changes
  • Tumorogenesis: A Simplified Model
  • Physiologic Changes

For more information on the above biology of cancer and ageing kindly see follow this link [aging.html|https://www.hopkinsmedicine.org/gec/series/cancer_aging.html#biology]

Assessment and Investigations[edit | edit source]

Geriatric assessment and investigations is an essential process to evaluate if an older adult is fit, vulnerable, or frail. The assessment encompass age-related conditions that should be investigate within the period of cancer treatment. One important of this is that it will guide care to best management line.

The US National Comprehensive Cancer Network (NCCN) and International Society of Geriatric Oncology (SIOG) recommendation for geriatric oncology assessment are to be shoulder on the following  features: functional status, comorbidity, cognition, mental health status, fatigue, social status and support, nutrition, and presence of geriatric syndromes[5]

Oncology Examination

Clinical Manifestations[edit | edit source]

Clinical manifestations of an older adults with cancer is a multi-factorial symptoms. It is an overlap between the following clinial manifestations:

  • Geriatric comordiities (Congestive heart failure, diabetes, hypertension, anemia, depression, COPD etc)
  • Age related deficits in body systems such as increase prevalence of urinary incontinence in urinary system, Presbycusis in sensory system, sarcopenia in musculoskeletal system etc.
  • Geriatric syndrome (combination of one or more of the following: falls, frailty, polyharmacy, delirium, dementia etc

Physiotherapy Management[edit | edit source]

Physiotherapy intervention requires assessment of the older adults with cancer, which can be based on neurologic, integumentary, musculoskeletal, comorbidities and geriatric syndromes. The common problem with an older adult with cancer are:

  • Impaired bed mobility
  • Difficulty with transfers
  • Decreased muscle strength
  • Decreased ambulation
  • Decreased ROM, cardiovascular endurance
  • Impaired balance
  • Pain etc.

Physical activity guidelines recommendation for Healthy Older Adults[edit | edit source]

American College of Sports Medicine (ACSM) and the American Heart Association (AHA) on physical activity guideline[6]:

  • Aerobic exercise
  1. Moderate aerobic is recommended for 5 days per week, 30 mins/day, bouts of 10 mins each
  2. Vigorous aerobic exercise is recommended for 3 days per week, continuous for at least 20 mins/day
  • Strengthening exercise is recommended for at least 2 days/wk, 8-10 exercises to major muscle groups for 10-15 reps
  • Flexibility/Balance for at least 2 days/wk; for those at risk for falls it is recommended to include balance.

Exercise Guidelines for Cancer Survivors[edit | edit source]

exercus guid for cancer survivors[7]

American College of Medicine on exercise guidelines for cancer survivors[7] advice to avoid inactivity, return to normal activities of daily living as quickly as possible. Also on the general statement, a person with metastatic bone disease requires modifications to avoid fractures. And those with cardiac conditions may require modifications and supervision to ensure their safety.

  • Aerobic

Individual with breast, prostate,colon, hematologic, gynecologic cancers are to follow ACSM and AHA physical activity guideline(PAG) for their age group

  • Resistance exercise

Individual with breast cancer are to be supervised for low resistance exercise.

Individual with prostate cancer are encouraged to add pelvic floor exercise after undergoing radical prostatectomy.

Individual with colon cancer are to start with low resistance and progress resistance slowly to avoid herniation

  • Flexibility

Individual with Breast/Prostate/Hematologic cancer are to exercise at at PAG guideline.

Prevention[edit | edit source]

Brief consideration of how this pathology could be prevented and the physiotherapy role in health promotion in relation to prevention of disease or disease progression.

Resources[edit | edit source]

Geriatric Cancer Rehabilitation


References[edit | edit source]

  1. ↑ 1.0 1.1 Loh KP, Soto-Perez-de-Celis E, Hsu T, de Glas NA, Battisti NM, Baldini C, Rodrigues M, Lichtman SM, Wildiers H. What every oncologist should know about geriatric assessment for older patients with cancer: young international society of geriatric oncology position paper. Journal of oncology practice. 2018 Feb;14(2):85-94.
  2. ↑ Swaminathan D, Swaminathan V. Geriatric oncology: problems with under-treatment within this population. Cancer biology & medicine. 2015 Dec;12(4):275.
  3. ↑ Gentner D, Grudin J. The evolution of mental metaphors in psychology: A 90-year retrospective. American Psychologist. 1985 Feb;40(2):181.
  4. ↑ Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Annals of oncology. 2007 Mar 1;18(3):581-92.
  5. ↑ Korc-Grodzicki B, Holmes HM, Shahrokni A. Geriatric assessment for oncologists. Cancer biology & medicine. 2015 Dec;12(4):261.
  6. ↑ Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094.
  7. ↑ 7.0 7.1 Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine & Science in Sports & Exercise. 2010 Jul 1;42(7):1409-26.
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