Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
Main con of current cancer treatments mainstays
|
Both chemotherapy and radiation therapy are nonspecific
Balance of elimination of cancer cells and tolerance of toxicities Targeted therapies are being developed but have limited application in the most common tumor types |
|
|
Palliative Care Definition
|
Aims to relieve the suffering and improve quality of life for patients with severe illness and their families
Provided by an interdisciplinary team and offered with other medical treatment For advanced, often terminal illness |
|
|
Spectrum of Palliative Care services at UAB
|
Supportive Care - Outpatient services, survivorship clinics, etc. Sx and Pain managment, weight changes and affective isssues
Hospice Care - OUtpatient Palliative Care, Clinics, and Hospice - Symptom managment ALso inpatient palliative care services |
|
|
Traditional Model of Carej
|
Curative Care from diagnosis to dying - disease specific, restorative
Palliative Care from dying to death - supportative, symptom oriented Changes from curative to palliative as disease progresses |
|
|
Integrated Model of Care
|
Blend of curative and supportive care. At diagnosis it is MOSTLY curative care with less palliative. At dying/death it is mostly palliative care and less curative
Also takes into account helping bereavement period after death for family and caregivers |
|
|
Cancer incidence in population 65 and older
|
60% of all incidence, 70% of all cancer mortality
Increases in survival occur for "all cancers" in groups 75 and older strangely but still lags behind younger populations |
|
|
Physiologic changes with Aging esp with respect to cancer
|
Increased toxicity with cancer treatment
Diminished homeostatic reserve and restorative capacity Seen in all organ systems and may limit treatment options |
|
|
Cancer trials patient pops and indicatation
|
Trials select for healthier and more functional individuals, findings may not be generalizable
Older adults are esp. under-represented in cancer clinical trials |
|
|
Elderly lady with breast cancer treatment options, what else do we need to know about her to take care of her
|
Options: surgical resection, adjuvant chemo, radiation therapy, estrogen blockade (esp if ER+)
Need to know: physiologic changes with aging, medical co-morbidity, frailty and social resources |
|
|
GI Changes with Aging, treatment implications
|
Decrease in salivary flow and impaired swallowing initiation
Decrease in gastric acid output, impaired mucosal protective mechanisms, decreased intestinal motility and absorption IMPAIRED HEPATIC DRUG CLEARANCE Treatment implications a) increased mucositis b) decreased mucosal absorption of meds c) Constipation d) Increased risk of aspiration |
|
|
Mucositis interventions, Constipation interventions
|
Mucositis intervention - basic oral care, ice chips, PALIFERMIN (recombinant kertatinocyte growth factor), pain managment
Constipation interventions - Mostly an issue with VINCA ALKYLOIDS or OPOID PAIN MEDs. Take bowel history, prescribe a bowl regimen (stool softener and stimulant, fiber DOES NOT work) |
|
|
Hematologic Changes with Aging, treatment implications
|
Decrease Hbg concentration, bone marrow cellularity and function
Impaired PMN, lymphocyte and monocyte function Changes in plasma levels of proteins Implications: Decreased marrow reserve, increased anemia risk (fatigue follows), thrombocytopenia risk (bleeding), febrile neutropenia and complications risk |
|
|
Anemia interventions
|
Manage anemia and maintain Hgb, administoer EPO, use PEGFILGRASTIM and FILGRASTIM, screen for B12 def, use daily Ferrous sulphate or liquid form
|
|
|
Musculoskeletal changes with aging, treatment implications
|
Loss of muscle mass and strength, decrease bone mass, reduced cartilage healing, increased postural sway
Implications: Risk of cachexia, falls and fractures, loss of lean body mass Decline in mobility and functional status |
|
|
Treatment for musculoskeletal changes in elderly
|
Encourage exercise
Reduce bone loss associated with cancer treatment - assess bone mineral density, Ca++ and Vit D supplements, consider bisphosphonate therapy |
|
|
CNS changes in aging, Implications
|
Increase neuronal loss, impaired memory and cognition, slowed reactions. Sensory impairments (vision, hearing, olfaction), decreased peripheral nerve myelin
Implications Increased delirium risk, threats to decision-making and ability to give informed consents, increased peripheral neuropathy |
|
|
Treating CNS changes in elderly
|
Reduce delirium risk - screen, correct dehydration, monitor for fevers and infections, orient regularly
Assess for pain and treat appropriately, provide written instructions, partner with family and caregivers |
|
|
Functional Status Evaluation
|
Activities of daily living (ADLs) - dependence in ANY ADL indicates minimal functional reserve
Instrumental activities of daily living (IADL's) - dependence in 1 or more of IADL increases risk of mortality and chemotherapy toxicity |
|
|
Medical comorbidity of lowered functional status
|
May limit treatment options, increased importance of communciation, polypharmacy and increased likelihood of drug-drug interactions
|
|
|
Nutritional Status changes in older pts
|
May be more compromised increasing treatment tox and decreasing response rate. Treatments may exacerbate nutritional compromise. Assess routinely
|
|
|
Psychosocial Issues with aging
|
More depresssion
Living conditions Caregivers Income Access to transportation Access to food |
|
|
Routine Geriatric Assessment role, why it's not done
|
Can assist in identification of age related vulnerabilities that may impact cancer treatment
Addressing these improves both treatment tolerance AND survival Not done: time and resource intensive, NO REVENUE GENERATED |
