1MA
REVAKI
Physiotherapy in internal diseases
ONCOLOGICAL REHABILITATION – E. VAN BREDA, T. VAN SOOM
YORICK VAN HULST
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
1 INHOUDSOPGAVE
2 HC 1 – Oncological Rehabilitation – T. van Soom .................................................................... 2
2.1 Introduction ............................................................................................................................. 2
2.2 Morbidities in cancer............................................................................................................... 2
2.2.1 Psychological and psycho-social related ......................................................................... 3
2.2.2 Physiological related........................................................................................................ 6
2.3 Metabolism in cancer ............................................................................................................ 13
2.3.1 Molecular metabolism .................................................................................................. 13
2.3.2 Energy expenditure (EE) ................................................................................................ 16
2.3.3 Effects of cancer and chemotherapy on energy balance in terms of resting energy
expenditure ................................................................................................................................... 19
2.4 Cancer Rehabilitation ............................................................................................................ 20
2.4.1 Mandatory articles on cancer rehabilitation ................................................................. 20
3 HC2 – Oncological Rehabilitation – E. van Breda................................................................... 21
3.1 History of Cancer ................................................................................................................... 21
3.2 Cancer Rehabilitation ............................................................................................................ 22
3.2.1 Quality of life (QOL) ....................................................................................................... 22
3.2.2 Rehabilitation Goal(s) .................................................................................................... 22
3.3 Common rehabilitation problems in cancer patients ........................................................... 23
3.3.1 Chemotherapy induced side effects .............................................................................. 23
3.3.2 Radiotherapy induced side affects ................................................................................ 24
3.3.3 Fatigue ........................................................................................................................... 24
3.3.4 Myopathies .................................................................................................................... 25
3.3.5 Neuropathies & plexopathies ........................................................................................ 25
3.3.6 Others ............................................................................................................................ 25
3.4 Nutrition ................................................................................................................................ 25
3.4.1 Under-nutrition ............................................................................................................. 25
3.4.2 Sarcopenia ..................................................................................................................... 27
3.4.3 Cachexia......................................................................................................................... 29
3.4.4 Wasting/starvation ........................................................................................................ 30
3.5 End conclusions ..................................................................................................................... 32
1
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2 HC 1 – ONCOLOGICAL REHABILITATION – T. VAN SOOM
2.1 INTRODUCTION
Kanker gevallen in algemeen wordt groter.
1 op de 3 gevallen ontwikkeld een tumor.
Kanker doden zijn aan het verminderen.
2.2 MORBIDITIES IN CANCER
Treatment statistics (Overall cancer, all stages combined):
- Surgery: 44.8%
- Radiotherapy: 27.3%
- Chemotherapy: 28.4%
Cancer and -treatment related morbidities; 2 categories:
Er zijn verschillende type behandelingen tegen kanker.
De meest voorkomende zijn:
• Operatie: 44,8%
• Radiotherapie: 27,3%
• Chemotherapie: 28,4%
Dit lijkt weinig, maar dit zijn alle kankerpatiënten van alles bij elkaar.
In agressieve stages zie je chemotherapie, bij lagere stages niet.
De behandeling heeft erg veel impact op QoL:
Cancer en behandeling related morbidities, 2 categorieën:
• Psychologische en psycho-sociale related
• Fysiologisch related
Beide categorieën laten wat overlap zien van morbidities
2
, Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2.2.1 Psychological and psycho-social related
2.2.1.1 Body image and intimacy
Factors that might influence Body image:
(Visible) scars, hair loss, physical appearance, discoloration of the skin,…
Due to:
Treatment; e.g. surgery, irradiation, chemotherapy, hormonal therapy, etc.
Negative impact on:
(a.o. self-esteem affecting) Emotional and physical intimacy
What can you do as physiotherapist?
- Identification
- Treatment
Factoren dat body image doet beïnvloeden:
Haaruitval, littekens, discolorations..
Negatieve impact op:
Deze veranderingen gaan hand in hand met de behandelingen. Ze kunnen een negatief effect hebben
op body image en self esteem
Lack of emotional support heeft drastisch effect op QoL.
Ook fysieke intimacy heeft effect op de patiënt. Veel hebben twijfels over fysieke appearance.
Erectile dysfunction zijn belangrijk voor de man.
2.2.1.2 Anxiety and distress
Cancer diagnosis might induce emotions of anxiety anddistress:
E.g. Fear, anger, sadness
Normal coping behaviour can evolve towards disorder
What can you do as physiotherapist?
- Identification
- Treatment
Kanker diagnose kan ook emoties van angst en distress induceren:
Angst, agressie, verdriet
Vaak tijdelijk, concentratieproblemen etc.
Normal coping behaviour kan daardoor evolven naar een stoornis.
Negatieve gedachtes kan in een loop van negatieve gedachtes blijven, een distress continuum. In
erge cases kan evolven naar een major depressive disorder
Veel risicofactoren zijn er gevonden.
Functionaliteiten in ADL is een risicofactor. Problemen in sociale isolatie etc.
3
REVAKI
Physiotherapy in internal diseases
ONCOLOGICAL REHABILITATION – E. VAN BREDA, T. VAN SOOM
YORICK VAN HULST
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
1 INHOUDSOPGAVE
2 HC 1 – Oncological Rehabilitation – T. van Soom .................................................................... 2
2.1 Introduction ............................................................................................................................. 2
2.2 Morbidities in cancer............................................................................................................... 2
2.2.1 Psychological and psycho-social related ......................................................................... 3
2.2.2 Physiological related........................................................................................................ 6
2.3 Metabolism in cancer ............................................................................................................ 13
2.3.1 Molecular metabolism .................................................................................................. 13
2.3.2 Energy expenditure (EE) ................................................................................................ 16
2.3.3 Effects of cancer and chemotherapy on energy balance in terms of resting energy
expenditure ................................................................................................................................... 19
2.4 Cancer Rehabilitation ............................................................................................................ 20
2.4.1 Mandatory articles on cancer rehabilitation ................................................................. 20
3 HC2 – Oncological Rehabilitation – E. van Breda................................................................... 21
3.1 History of Cancer ................................................................................................................... 21
3.2 Cancer Rehabilitation ............................................................................................................ 22
3.2.1 Quality of life (QOL) ....................................................................................................... 22
3.2.2 Rehabilitation Goal(s) .................................................................................................... 22
3.3 Common rehabilitation problems in cancer patients ........................................................... 23
3.3.1 Chemotherapy induced side effects .............................................................................. 23
3.3.2 Radiotherapy induced side affects ................................................................................ 24
3.3.3 Fatigue ........................................................................................................................... 24
3.3.4 Myopathies .................................................................................................................... 25
3.3.5 Neuropathies & plexopathies ........................................................................................ 25
3.3.6 Others ............................................................................................................................ 25
3.4 Nutrition ................................................................................................................................ 25
3.4.1 Under-nutrition ............................................................................................................. 25
3.4.2 Sarcopenia ..................................................................................................................... 27
3.4.3 Cachexia......................................................................................................................... 29
3.4.4 Wasting/starvation ........................................................................................................ 30
3.5 End conclusions ..................................................................................................................... 32
1
,Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2 HC 1 – ONCOLOGICAL REHABILITATION – T. VAN SOOM
2.1 INTRODUCTION
Kanker gevallen in algemeen wordt groter.
1 op de 3 gevallen ontwikkeld een tumor.
Kanker doden zijn aan het verminderen.
2.2 MORBIDITIES IN CANCER
Treatment statistics (Overall cancer, all stages combined):
- Surgery: 44.8%
- Radiotherapy: 27.3%
- Chemotherapy: 28.4%
Cancer and -treatment related morbidities; 2 categories:
Er zijn verschillende type behandelingen tegen kanker.
De meest voorkomende zijn:
• Operatie: 44,8%
• Radiotherapie: 27,3%
• Chemotherapie: 28,4%
Dit lijkt weinig, maar dit zijn alle kankerpatiënten van alles bij elkaar.
In agressieve stages zie je chemotherapie, bij lagere stages niet.
De behandeling heeft erg veel impact op QoL:
Cancer en behandeling related morbidities, 2 categorieën:
• Psychologische en psycho-sociale related
• Fysiologisch related
Beide categorieën laten wat overlap zien van morbidities
2
, Physiotherapy in Internal Diseases 1e master jaar Revaki UA
2.2.1 Psychological and psycho-social related
2.2.1.1 Body image and intimacy
Factors that might influence Body image:
(Visible) scars, hair loss, physical appearance, discoloration of the skin,…
Due to:
Treatment; e.g. surgery, irradiation, chemotherapy, hormonal therapy, etc.
Negative impact on:
(a.o. self-esteem affecting) Emotional and physical intimacy
What can you do as physiotherapist?
- Identification
- Treatment
Factoren dat body image doet beïnvloeden:
Haaruitval, littekens, discolorations..
Negatieve impact op:
Deze veranderingen gaan hand in hand met de behandelingen. Ze kunnen een negatief effect hebben
op body image en self esteem
Lack of emotional support heeft drastisch effect op QoL.
Ook fysieke intimacy heeft effect op de patiënt. Veel hebben twijfels over fysieke appearance.
Erectile dysfunction zijn belangrijk voor de man.
2.2.1.2 Anxiety and distress
Cancer diagnosis might induce emotions of anxiety anddistress:
E.g. Fear, anger, sadness
Normal coping behaviour can evolve towards disorder
What can you do as physiotherapist?
- Identification
- Treatment
Kanker diagnose kan ook emoties van angst en distress induceren:
Angst, agressie, verdriet
Vaak tijdelijk, concentratieproblemen etc.
Normal coping behaviour kan daardoor evolven naar een stoornis.
Negatieve gedachtes kan in een loop van negatieve gedachtes blijven, een distress continuum. In
erge cases kan evolven naar een major depressive disorder
Veel risicofactoren zijn er gevonden.
Functionaliteiten in ADL is een risicofactor. Problemen in sociale isolatie etc.
3
