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Safety Considerations with Anti-Neoplastic Treatments - Coggle Diagram
Safety Considerations with Anti-Neoplastic Treatments
Hematological Compromise
Myelosupperssion secondary to Corticosteroids
increased risk for infection
compromised metabolic function
altered physiologic response to exercise
Anemia
Reduced exercise tolerance and endurance
Fatigue, dizziness, hemodynamic instability
Low intensity exercise to improve blood counts
Use precaution for those with extreme anemia (hemoglobin <8)
During exercise, there is a need to monitor
hemodynamic status
exertional status
patient symptoms (chest pain, lightheadedness, inappropriate dyspnea)
Thrombocytopenia
Platelet count < 10,000kcells/uL
SIGNIFICANT risk for spontaneous hemorrhage
receive prophylactic transfusion
Platelet count < 20,000 kcells/uL
genreal activity is restricted to walking and ADLs
Platelet count > 20,000 kcells/uL
light exercise with close symptoms monitoring
Maintain BP < 170/100
screen for symptoms of bleeding (bruising and bleeding around gums)
Platelet count > 30,000 kcells/uL
moderate exercise and light resistive training
Neutropenia
absolute neutrophul count < 500 mc/L
usually occurs 3-7 days after chemotherapy
Increased risk for infection
no typical signs of infection
fever is often the first sign of infection
no need for barrier precautions (gown, shield) unless risk from PT is excessive
reduce exposure (public spaces) for rehab
Rehab is NOT contraindicated
self-limited by fatigue, malaise, dizziness, lethargy
Precautions for blood count levels
conditions NOT associated with acute care transfer
hemoglobin levels
absolute neutrophil and platelet counts
Conditions associated with acute care transfer
male gender
creatinine > 1.3
hematopoietic stem cell transplantation
Cardiopulmonary Toxicity
Chemotherapy Drugs
Anthracyclines
may result in significant and irreversible changes in cardiac function (primarily reduced left ventricular function)
compromised long-term cardiac function
reduced ejection fraction
Low intensity exercise during chemotherapy cycles may be protective against cardiotoxicity, but care is needed to monitor for symptoms of cardiopulmonary edema (and differentiate between lymphedema)
Trastuzumab (breast cancer)
common symptoms include
systemic edema
shortness of breath
dyspnea
lung congestion
Bleomycin and methotrexate
commonly lead to
pulmonary compromise
pulmonary inflammation
pulmonary fibrosis
Chest wall radiation is progressive
30-35 Gy exposure increases risk for heart damage
structurally changes
myocardium
coronary arteries
valves
conduction system
6-12 months after radiation, complications include
diastolic dysfunction
blood flow abnormalities
nearly 50% of patients demonstrate cardiac-related comorbidity that compromises function 20-30 years after completion of treatment
Neurotoxicity
Common Drugs Causing chemotherapy induced peripheral neuropathy
taxane-based chemotherapy
platinum-based chemotherapy
Presentation
distal extremities
Stocking/glove pattern of sensory loss
progressive loss with additive chemo cycles
severe cases include motor involvement
Timecourse
tend to abate after treatment completion
May impact proprioception and sensation up to 5 years after treatment completion
Implications
Impacts balance, gait and mobility
falls are 2-3x more likely
Rehab
Get a baseline for sensation, strength, and balance prior to chemo
comprehensive falls prevention program should be implemented proactively
Lymphedema
Usually follows lynphadenectomy or radiation therapy
Accompanying risks associated with sudden onset lymphedema
DVT
cancer reoccurence
infection
Exercise
does NOT exacerbate the condition (under controlled circumstances
Use compression garments early, in the subclinical phase, and during exercise is recommended
prevents fluid accumulation in the limbs during exercise
precautions
avoid unnecessary strain and injury to limb
Watch out for
redness
eryhtema
pain
new swelling
refer for extensive medical management if these present
cellulitis (common and requires antibiotic therapy prior to rehab intervention
Frailty
Associated with
falls
higher risk post cancer treatment (esp. in lung and prostate cancer
hospitalizations
increased mortality
high prevalence of balance and walking problems after non-Hodgkin's lymphoma, breast, prostate, and lung cancer
Associated with poorer rehab outcomes and functional gains
Assessment
Use the Comprehensive Geriatric Assessment to stratify patients into high and low risk based on a battery of tests.
Can ID functional decline
Delaying frailty
Focus on optimizing nutrition and muscle mass, balance, and functional training
Osseous Fragility
Advanced Cacners
Risks from Bone Marrow Transplant
typically undertaken after chemo and radiation have failed
patients are cytopenic at time of transplant and remain so for weeks
history of antineoplastic agents usually results in other complications
exercise
mediates better performance at discharge
results in shorter duration of anemia, thrombocytopenia, and length of hospitalization