Cancer

1. Cancer KNR 365

2. Definition • Class of malignant diseases in which cells proliferate in an unrestricted manner, usually forming a tumor • Austin, 2001 • Tumor: new cells that have no function • Benign tumor: remains at site of origin • Malignant tumor: has potential to spread to other tissues • Carter & VanAndel, 2011

3. Definition • Broad set of diseases that share the characteristic of having abnormal cells that divide without control • Porter & burlingame, 200, p.33 • If spreading is not controlled, it can result in death • Cancer Facts & Figures, 2011

4. What does prevalence mean? • How common a disease or condition is • MedicineNet.com • % of population that is affected with a particular disease • Mirriam-Webster

5. Prevalence • Cancer prevalence is defined as the total number of people living with cancer at any point in time. It includes people diagnosed with cancer in the past as well those who were recently diagnosed. • Cancer prevalence is affected both by the incidence of a cancer and by how long people normally live with the disease, but it is not a measure of cancer occurrence. This number is the cancer incidence, which is the number of people newly diagnosed with cancer in a given time period (usually a year). • For example, lung cancer is the second most common cancer in both men and women, but lung cancer prevalence is not as high as that of some less common cancers. This is because people with lung cancer tend not to live as long after diagnosis. • American Cancer Society

6. Prevalence • 11.7 million living with cancer • 5 year survival 68% • Cancer Facts & Figures, 2011 • 1,596,670 new cases projected to occur in 2011 • 571,950 deaths projected for 2011 • Siegel, Ward, Brawley & Jemal, 2011 • 1 out of 8 deaths world wide is from cancer • Carter & VanAndel, 2011

7. Prevalence • Lifetime risk of developing cancer • 1 out of 2 men • 1 out of 3 women

8. Prevalence - Estimate in US,2008American Cancer Society

9. What is etiology? • Cause of a disease or disorder • Austin, 2001 • Cause or origin • Factors that produce or predispose toward a certain disease or disorder • MedicineNet.com

10. Etiology • Caused by multiple mutations of genes that control cell division • Normal cells grow in coordinated manner, cancer cells multiply out-of-control • Destroy adjacent normal cells and tissues • Spread to other body parts • Metastases are secondary cancers that develop at a new site • Carter & VanAndel, 2011

11. Etiology --- Risk Factors • Behavioral (Controlled by person) • Smoking, diet, sun exposure, physical activity • Biological • Age, gender, race, skin complexion • Environmental • 2nd hand smoke, radon, exposure to pesticides • Genetic • Multiple family members • Porter & burlingame, 2006 • Carter & VanAndel, 2011

12. Etiology • More than ½ of all cancers are preventable • Carter & VanAndel, 2011 • All cancers caused by cigarette smoking and heavy use of alcohol could be prevented completely • Importance of screening • More treatable if detected early • Cancer Facts & Figures, 2011

13. Etiology • Risk of cancer diagnosis increases with age • Carter & VanAndel, 2011 • 78% of all people 55 years & older • Cancer Facts & Figures, 2011

14. Diagnostic Criteria • Diagnosed by • Imaging (CT scans, MRI scans, PET scans, x-rays) • Laboratory tests • Biopsy • Surgical removal of tumor • Porter & burlingame, 2001

15. Diagnostic Criteria • Staging describes extent and spread of disease and helps determine prognosis & treatment • TNM system • T = size and extent of primary tumor • T0, T1, T2, T3, T4 • N = absence or presence of regional spread in the lymph nodes (N0, N1, N2, N3) • M = absence or presence of distant metastatic spread (M0, M1) • See page 35, Porter & burlingame, 2008)

16. Diagnostic Criteria • In stu • Localized • Regional • Distant • Unknown • See Porter & burlingame, 2006, p.35

17. Diagnostic Criteria • Identified by primary organ and site of origin • Epithelioma: skin cancer • Carcinoma: glandular cancer • Sarcoma: muscle, fibrous tissue, tendon, bone cancer • Lymphoma: lymph tissue cancer • Leukemia: white blood cells • Highest childhood cancer • Carter & VanAndel, 2011 • Porter & burlingame, 2006

18. Symptoms or Characteristics7 Warning Signs • Unusual bleeding or discharge • Lump or thickening in or under skin tissue • Change in size or color of wart or mole • Sores that do not heal • Change in bowel or bladder habits • Chronic hoarseness or nagging cough • Chronic indigestion or difficulty swallowing

19. What is prognosis? • Forecast of the probable course and outcome • of a disorder • Austin, 2001 • Expected course, chance of recovery • MedicineNet.com

20. Prognosis • Depends on: • Type • Stage • Treatment options available • Overall health • Some live decades after • Others short life expectancy • Porter & burlingame, 2006 • See my earlier stats

21. Course of Treatment • Chemotherapy • Radiation • Surgery • And others (see Porter & burlingame, 2006, p. 35-36) • Destroy or remove cancer cells

22. Effect on Physical, Cognitive, Social, & Emotional Functioning • Surgery: tumor & surrounding tissues removed • Chemotherapy: loss of white cells permit infections, reduced platelets are risk for bleeding, hair loss, memory problems, plus similar to radiation • Radiation: nausea, vomiting, weakness, profuse sweating, loss of appetite, weight loss, fatigue, pain • Others: fear, insomnia, etc. • Carter & VanAndel, 2011

23. Secondary Conditions • Depression • Anxiety • Carter & VanAndel, 2011

24. Predominate Age & Developmental Implications • As note previously more with older adults • Deal with mortality • Youth • Frequent hospitalizations • Regular follow-ups for years • Over protective parents

25. What are contraindications? • Something that makes something inadvisable • Merriam-Webster

26. Typical Contraindications or Limitations • Ultrasound • Standard massage • Medical screening for exercise programs • Not exercise 24 hours after chemotherapy

27. Pharmacology Assignment Resource • Typical medicine • Most common drugs • Side effects • Impact on functioning • Contraindications for participation in recreation & leisure • E.g., hydrate well while on x medication • Olson, 2011, Chapter 8 • WebMD

28. Adaptive or Assistive Equipment • Artificial larynx • Switches • Communication devices • Walkers • Canes • Wigs • Modification of activities (see p. 37) • Depending on cancer and impact on functioning

29. Biopsychosocial Impact of Disability Assignment Resource • Family • Activity of Daily Living • Social Interaction • Self Identity • Work • Health Status • Quality of Life • Porter & burlingame, 2006, p.35 • Anticipated Findings of RT Assessment • Carter & VanAndel, 2011 • Fear of death • Anticipation of pain • Side effects of medications • Feelings of insecurity • Dependency • Disrupted social relationships • Others?

30. Therapeutic Recreation Interventions Assignment Resources • Client needs appropriate for TR • Goals & objectives • Possible interventions • Evidence-based practice programs • TR assessments • Contraindications/precautions for TR services • Accommodations for effects of medication • Porter & burlingame, 2006, p.37

31. Client Needs Appropriate for TR & Possible Interventions

32. Client Needs Appropriate for TR & Possible Interventions

33. Client Needs Appropriate for TRCarter & VanAndel, 2011 • Diversion • Promote health & well-being • Manage grief, depression, and end-of-life issues • Social involvement & continued peer & family support • Self determination • Relaxation • Stress management • Pain control • Physical activity • Self-esteem • Cognitive stimulation • Expressive experiences • Coping strategies • Positive self-image

34. Possible InterventionsCarter & VanAndel, 2011 • Journaling and expressive arts • Guided imagery & muscle relaxation • Nature & outdoor experiences (spiritual health) • Leisure education • Problem-solving, coping strategies • Medical play for kids • Humor • Animal-assisted therapy • Diet & exercise • Bedside activities • Health & wellness for family members

35. Example of goals & objectives • To increase engagement in home leisure activities • After discussion on personal leisure resources, client will complete a timeline for 1 day, as judged appropriate by CTRS. • YOUR TURN

36. Evidence-based Practice Programs • Voelkl, J.E. (2008)."I love pumpkins": The role of therapeutic recreation in oncology. Therapeutic Recreation Journal, 42(4), 228-235. • Alsobrooks, A. K., Owen, J., Groff, D., Battaglini, C. L., Evans, E., & Brustad, R. (2010).Promoting physical and psychosocial health behavior changes in breast cancer survivors through a community-based workshop: Process and impact evaluation. American Journal of Recreation Therapy, 9(4): 39-46.

37. Evidence-based Practice Programs • Stricker, C. T., Drake, D., Hoyer, K. & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. Oncology Nursing Forum 31(5), 963-976. (OT Seeker) • Wood, M. J., Molassiotis, A., & Payne, S. (2011). What research evidence is there for the use of art therapy in the management of symptoms in adults with cancer? A systematic review. Psycho-Oncology,20(2), 135-145. (OT Seeker)

38. TR Assessments • Leisure Interest Measure • Leisurescope Plus • Leisure Assessment Inventory • Porter & burlingame, 2006, p.478 • OTHERS?

39. Therapeutic Recreation Interventions Contraindications/precautions for TR Services Accommodations for effects of medication • If cognitive impairments, may need to talk with family • Insure physician OK for physical activities • Observe for depression • Observe for pain • Others? • Keep out of sun due to sun sensitivity from medications • Have water available due to mouth dryness • Others?