PALYATİF BAKIMDA KANSER REHABİLİTASYONU VE HEMŞİRELİK YÖNETİMİ

Yıl 2018, Cilt: 34 Sayı: 3, 103 - 118, 25.12.2018

Gönül Düzgün , Ayfer Karadakovan

Öz

Başlık:PALYATİF BAKIMDA KANSER
REHABİLİTASYONU VE HEMŞİRELİK YÖNETİMİ

Özet:Günümüzde kanserin
tanı  tedavisindeki gelişmeler, gittikçe
daha fazla sayıda kanserli hastanın daha uzun yaşamasını sağlamaktadır.
1960’lardan beri rehabilitasyon; miyokardiyal enfeksiyon, inme, baş ve spinal
kord yaralanmaları, amputasyonla birlikte diğer fiziksel/nörolojik
yetersizlikten muzdarip hastalar için bakım programlarının önemli bir parçası
olarak kabul edilmiştir.

Kansere bağlı kötü prognoz
sonucu temel tedavilerin ön plana çıkması nedeniyle rehabilitasyona yeterli
ilgi gösterilmemektedir. Ancak palyatif bakım felsefesi hastanın yaşam
kalitesinin iyileştirilmesi, temel yaşam aktivitelerini sürdürmesi, semptom
kontrolü ve fiziksel fonksiyonları sürdürmesine destek sağlanmayı amaçlandığı
için rehabilitasyon hizmetinin önemi de dikkat çekmektedir.

Palyatif Bakım Geliştirme
Merkezi konsensüs raporunda, hastane ortamında bakım değerlendirmesine ihtiyaç
duyan hastaların belirlenmesine yardımcı olmak için birincil tetikleyici
kriterlerin ana hatları verilmektedir. Böylelikle hastaların palyatif bakıma
yatışları sırasında hangi riskleri barındırdığı ve alınabilecek önlemleri
planlamada yardımcı olması amaçlanmıştır.

Kanser hastalarında
rehabilitasyon tedavisine uyumunu azaltan ve tedaviyi bırakmasına neden olan en
önemli faktörler terapiye ilgi eksikliği, tıbbi komplikasyonlar, zaman ve
yoğunluk egzersiz programlarının uzun olması, hastalığın evresi ve ulaşım
sorunlarıdır. Egzersiz programının yoğunluğu ve uzunluğu, özellikle son
dönem kanser hastaları söz konusu olduğunda, hastayı yormayacak ya da sıkmayacak
şekilde ayarlanmalıdır.

Hemşirelerin kanıta dayalı
uygulamaların geliştirilmeleri, hasta odaklı daha kapsamlı araştırmalar
yapmaları ve palyatif bakım hastalarının yaşam kalitelerini arttırmaya yönelik
çalışmalar içinde aktif bulunmaları önerilmektedir. 

Anahtar kelimeler:   Palyatif
Bakım, Kanser, Rehabilitasyon, Hemşirelik

Destekleyen kurumlar:

Kaynakça:1.       
Adamsen L, Quist M, Midtgaard J, Andersen C, Møller T,
Knutsen L, et al. The effect of a multidimen-sional exercise intervention on
physical capacity, well-being and quality of life in cancer patients undergoing
chemotherapy. Support Care Cancer 2006; 14: 116- 27.

2.       
Akdemir, N., Akkuş, Y. Rehabilitasyon ve hemşirelik.
Hacettepe Üniversitesi Hemşirelik Yüksekokulu Dergisi, 2006;13(1), 82–91.

3.       
Andersen C, Adamsen L, Moeller T, Midtgaard J, Quist M,
Tveteraas A, et al. The effect of a multidimensional exercise programme on
symptoms and side-effects in cancer patients undergoing chemotherapy-the use of
semi-structured diaries. Eur J Oncol Nurs 2006; 10: 247-62.

4.       
Barawid E, Covarrubias N, Tribuzio B, Liao S. The benefits of
rehabilitation for palliative care patients. Am J Hosp Palliat Care. 2015;
32(1):34-43.

5.       
Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ. et al.
Prospective study of physical activity and depressive symptoms in middle-aged
women. Am J Prev Med 2005; 29: 265-72

6.       
Cheville A. Cancer Rehabilitation. In: Physical Medicine
& Rehabilitation, Ed: Braddom RL, Saunders Company, Third Edition, 2007;
1369-98

7.       
Cheville AL, Kollasch J, Vandenberg J, Shen T, Grothey A,
Gamble G, et al. A home-based exercise program to improve function, fatigue,
and sleep quality in patients with Stage IV lung and colorectal cancer: a
randomized controlled trial, J Pain Symptom Manage. 2013; 45 (5): 811-21

8.       
Clemens KE, Jaspers B, Klaschik E, Nieland P. Evaluation of
the clinical effectiveness of physiotherapeutic management of lymphoedema in
palliative care patients. Jpn J Clin Oncol. 2010; 40
(11): 1068-72.

9.       
Corsonello A, Scarlata S, Pedone C, Bustacchini S, Fusco S,
Zito A, et al. Treating COPD in older and oldest old patients. Curr Pharm
Des. 2015; 21 (13): 1672-89

10.     
Curtis EB, Krech R, Walsh TD.. Common symptoms in patients
with advanced cancer. J
Palliat Care. 1991; 7 : 25-29

11.     
Dietz JH. Rehabilitation oncology. John Wiley & Sons Inc,
New York. 1981

12.     
Escalante CP, Meyers C, Reuben JM, Wang X, Qiao W, Manzullo
E, Alvarez RH, Morrow PK, Gonzalez-Angulo AM, Wang XS, Mendoza T, Liu W, Holmes
H, Hwang J, Pisters K, Overman M, Cleeland C. A randomized, double-blind,
2-period, placebocontrolled crossover trial of a sustained-release
methylphenidate in the treatment of fatigue in cancer patients. Cancer J 2014:20(1):8–14.
doi: 10.1097/PPO.0000000000000018

13.     
Eyigor S, Akdeniz S. Is exercise ignored in palliative cancer
patients? World J Clin Oncol. 2014; 5(3):554-9

14.     
Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E,
Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, et al. Definition and
classification of cancer cachexia: an international consensus. Lancet
Oncol.2011; 12 : 489-495.

15.     
Guo Y, Shin KY, Hainley S, Bruera E, Palmer JL. Inpatient rehabilitation
improved functional status in asthenic patients with solid and hematologic
malignancies. Am J Phys Med
Rehabil. 2011; 90 (4): 265-71. 

16.     
Institute of Medicine (2001) Crossing the quality chasm: a
new health system for the 21st century. National Academy Press. https://www.iom.edu/Reports/2001/Crossing-the-Quality-ChasmA-New-Health-System-for-the-21st-Century.aspx Erişim Tarihi;
20.07.2018

17.     
Javier NS, Montagnini ML, Rehabilitation of the hospice and
palliative care patient, J Palliat Med. 2011; 14 (5): 638-48.

18.     
Jensen W, Baumann FT, Stein A, Bloch W, Bokemeyer C, de Wit
M, et al. Exercise training in patients with advanced gastrointestinal
cancer undergoing palliative chemotherapy: a pilot study. Support Care Cancer.
2014; 22 (7): 1797-806

19.     
Johansson B, Wentzel AP, Andrell P, Mannheimer C, Ronnback L. Methylphenidate reduces
mental fatigue and improves processing speed in persons suffered a traumatic
brain injury. Brain Inj 2015:1–8. doi:10.3109/02699052.2015.1004747

20.     
Kanser İstatistikleri http://kanser.gov.tr/Dosya/2017Haberler/2017_4_subat.pdf
Erişim Tarihi; 16.07.2018

21.     
Kubler Ross E. On Death and Dying. New York, NY,
Scribner, 1969

22.     
Lehmann JF, DeLisa JA, Warren CG, deLateur BJ, Bryant PL,
Nicholson CG, Cancer
rehabilitation: assessment of need, development, and evaluation of a model of
care. 1978; 59 :
410-419.

23.     
Maddocks M, Mockett S, Wilcock A. Is exercise an acceptable
and prac-tical practical therapy for people with or cured of cancer? A
systematic review. Cancer Treat Rev 2009; 35: 383-90.

24.     
Martinsen EW. Physical activity for mental health. Tidsskr
Nor Laegeforen 2000; 120: 3054-6. 29.

25.     
Molinaro J, Kleinfeld M, Lebed S. Physical therapy and
dance in the surgical management of breast cancer. Phys Ther 1986;66:967-9.

26.     
Narayanan V, Koshy C. Fatigue in cancer: a review of
literature.. Hint ndian J Palliat Care 2009; 15 : 19-25

27.     
Oldervoll LM, Kaasa S, Hjermstad MJ, Lund JA, Loge JH, et al.
Physical exercise results in the improved subjective well-being of a few or is
effective rehabilitation for all cancer patients? Eur J Cancer 2004; 40:
951-62.

28.     
Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard
UV, et al. Physical exercise for cancer patients with advanced disease:
a randomized controlled trial. Oncologist. 2011; 16 (11): 1649-57

29.     
Osborne TR, Ramsenthaler C, Wolf-Linder S, Schey SA, Siegert
RJ, Edmonds PM, et al. Understanding what matters most to
people with multiple myeloma: a qualitative study of views on quality of life.
BMC Cancer. 2014; 14 (1): 496.

30.     
Palacio A, Calmels P, Genty M, Le-Quang B, Beuret-Blanquart
F. Onkoloji ve fizikî tıp ve rehabilitasyon. Ann Phys Rehabil
Med. 2009; 52 : 568-578

31.     
Porock D, Kristjanson LJ, Tinnelly K, Duke T, Blight J. An
exercise intervention for advanced cancer patients experiencing fatigue: a
pilot study. J Palliat Care. 2000 Autumn;16(3):30-6

32.     
Radbruch L, Strasser F, Elsner F, Gonçalves JF, Løge J, Kaasa
S, Nauck F, Stone P. Fatigue in palliative care patients -- an EAPC approach, Palliat
Med. 2008; 22 : 13-32

33.     
Sami MB, Faruqui R, The effectiveness of dopamine agonists
for treatment of neuropsychiatric symptoms post brain injury and stroke. Acta
Neuropsychiatr 2015:1–11. doi:10.1017/neu.2015.17

34.     
Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA,
Cancer rehabilitation and palliative care: critical components in the delivery
of high-quality oncology services, Support Care Cancer,
2015;23(12):3633-43.

35.     
Stene GB, Helbostad JL, Balstad TR, Riphagen II, Kaasa S,
Oldervoll LM. Effect of physical exercise on muscle mass and strength in cancer
patients during treatment--a systematic review. Crit Rev Oncol Hematol.
2013; 88 : 573-593.

36.     
Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC,
Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian C, Gerber
LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith RA . A prospective
surveillance model for rehabilitation for women with breast cancer. Cancer
2012:118(8 Suppl):2191–2200. doi:10.1002/cncr.27476

37.     
Taşpınar Ö , Aydın T, Akcakaya A, Kanser Rehabilitasyonunda Palyatif
Yaklaşımın Yeri ve Önemi, Bezmialem Science, 2014; 1: 31-37

38.     
Van Weert E, Hoekstra-Weebers J, Otter R, Postema K,
Sanderman R, van der Schans C. Cancer-related fatigue: predictors and effects
of rehabilitation. Oncologist. 2006; 11 : 184-196

39.     
von Haehling S, Anker SD Cachexia as a major underestimated
and unmet medical need: facts and numbers. J Cachexia Sarcopenia Muscle.
 2010; 1 : 1-5

40.     
Weissman DE, Meier DE, Identifying patients in need of a
palliative care assessment in the hospital setting: aconsensusreport from the
center to advance palliative care. J Palliat Med 2011;14(1):17– 23.
doi:10.1089/jpm.2010.0347

41.     
Wells, M., Macbride, S Rehabilitation and Survivorship.
In: Nursing Patients with Cancer Principles and Practice. Eds: Kearney N,
Richardson A, 1 th ed, Elsevier, 2006;799-819.

42.     
Who definition of palliative care World Health Organization. http://www.who.int/cancer/palliative/definition/en/2015. Erişim Tarihi:
22.07.2018

43.     
WHO, Search results, http://www.who.int/mediacentre/factsheets/fs297/en/,
erişim tarihi: 16.07.2018

Anahtar Kelimeler

Palyatif Bakım, Kanser, Rehabilitasyon, Hemşirelik

Kaynakça

• Adamsen L, Quist M, Midtgaard J, Andersen C, Møller T, Knutsen L, et al. The effect of a multidimen-sional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy. Support Care Cancer 2006; 14: 116- 27. Akdemir, N., Akkuş, Y. Rehabilitasyon ve hemşirelik. Hacettepe Üniversitesi Hemşirelik Yüksekokulu Dergisi, 2006;13(1), 82–91. Andersen C, Adamsen L, Moeller T, Midtgaard J, Quist M, Tveteraas A, et al. The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy-the use of semi-structured diaries. Eur J Oncol Nurs 2006; 10: 247-62.
• Barawid E, Covarrubias N, Tribuzio B, Liao S. The benefits of rehabilitation for palliative care patients. Am J Hosp Palliat Care. 2015; 32(1):34-43.
• Brown WJ, Ford JH, Burton NW, Marshall AL, Dobson AJ. et al. Prospective study of physical activity and depressive symptoms in middle-aged women. Am J Prev Med 2005; 29: 265-72
• Cheville A. Cancer Rehabilitation. In: Physical Medicine & Rehabilitation, Ed: Braddom RL, Saunders Company, Third Edition, 2007; 1369-98
• Cheville AL, Kollasch J, Vandenberg J, Shen T, Grothey A, Gamble G, et al. A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial, J Pain Symptom Manage. 2013; 45 (5): 811-21
• Clemens KE, Jaspers B, Klaschik E, Nieland P. Evaluation of the clinical effectiveness of physiotherapeutic management of lymphoedema in palliative care patients. Jpn J Clin Oncol. 2010; 40 (11): 1068-72.
• Corsonello A, Scarlata S, Pedone C, Bustacchini S, Fusco S, Zito A, et al. Treating COPD in older and oldest old patients. Curr Pharm Des. 2015; 21 (13): 1672-89
• Curtis EB, Krech R, Walsh TD.. Common symptoms in patients with advanced cancer. J Palliat Care. 1991; 7 : 25-29
• Dietz JH. Rehabilitation oncology. John Wiley & Sons Inc, New York. 1981
• Escalante CP, Meyers C, Reuben JM, Wang X, Qiao W, Manzullo E, Alvarez RH, Morrow PK, Gonzalez-Angulo AM, Wang XS, Mendoza T, Liu W, Holmes H, Hwang J, Pisters K, Overman M, Cleeland C. A randomized, double-blind, 2-period, placebocontrolled crossover trial of a sustained-release methylphenidate in the treatment of fatigue in cancer patients. Cancer J 2014:20(1):8–14. doi: 10.1097/PPO.0000000000000018
• Eyigor S, Akdeniz S. Is exercise ignored in palliative cancer patients? World J Clin Oncol. 2014; 5(3):554-9
• Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL, Jatoi A, Loprinzi C, MacDonald N, Mantovani G, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol.2011; 12 : 489-495.
• Guo Y, Shin KY, Hainley S, Bruera E, Palmer JL. Inpatient rehabilitation improved functional status in asthenic patients with solid and hematologic malignancies. Am J Phys Med Rehabil. 2011; 90 (4): 265-71.
• Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press. https://www.iom.edu/Reports/2001/Crossing-the-Quality-ChasmA-New-Health-System-for-the-21st-Century.aspx Erişim Tarihi; 20.07.2018
• Javier NS, Montagnini ML, Rehabilitation of the hospice and palliative care patient, J Palliat Med. 2011; 14 (5): 638-48.
• Jensen W, Baumann FT, Stein A, Bloch W, Bokemeyer C, de Wit M, et al. Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study. Support Care Cancer. 2014; 22 (7): 1797-806
• Johansson B, Wentzel AP, Andrell P, Mannheimer C, Ronnback L. Methylphenidate reduces mental fatigue and improves processing speed in persons suffered a traumatic brain injury. Brain Inj 2015:1–8. doi:10.3109/02699052.2015.1004747
• Kanser İstatistikleri http://kanser.gov.tr/Dosya/2017Haberler/2017_4_subat.pdf Erişim Tarihi; 16.07.2018
• Kubler Ross E. On Death and Dying. New York, NY, Scribner, 1969
• Lehmann JF, DeLisa JA, Warren CG, deLateur BJ, Bryant PL, Nicholson CG, Cancer rehabilitation: assessment of need, development, and evaluation of a model of care. 1978; 59 : 410-419.
• Maddocks M, Mockett S, Wilcock A. Is exercise an acceptable and prac-tical practical therapy for people with or cured of cancer? A systematic review. Cancer Treat Rev 2009; 35: 383-90.
• Martinsen EW. Physical activity for mental health. Tidsskr Nor Laegeforen 2000; 120: 3054-6. 29. Molinaro J, Kleinfeld M, Lebed S. Physical therapy and dance in the surgical management of breast cancer. Phys Ther 1986;66:967-9.
• Narayanan V, Koshy C. Fatigue in cancer: a review of literature.. Hint ndian J Palliat Care 2009; 15 : 19-25
• Oldervoll LM, Kaasa S, Hjermstad MJ, Lund JA, Loge JH, et al. Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 2004; 40: 951-62.
• Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard UV, et al. Physical exercise for cancer patients with advanced disease: a randomized controlled trial. Oncologist. 2011; 16 (11): 1649-57
• Osborne TR, Ramsenthaler C, Wolf-Linder S, Schey SA, Siegert RJ, Edmonds PM, et al. Understanding what matters most to people with multiple myeloma: a qualitative study of views on quality of life. BMC Cancer. 2014; 14 (1): 496.
• Palacio A, Calmels P, Genty M, Le-Quang B, Beuret-Blanquart F. Onkoloji ve fizikî tıp ve rehabilitasyon. Ann Phys Rehabil Med. 2009; 52 : 568-578
• Porock D, Kristjanson LJ, Tinnelly K, Duke T, Blight J. An exercise intervention for advanced cancer patients experiencing fatigue: a pilot study. J Palliat Care. 2000 Autumn;16(3):30-6Radbruch L, Strasser F, Elsner F, Gonçalves JF, Løge J, Kaasa S, Nauck F, Stone P. Fatigue in palliative care patients -- an EAPC approach, Palliat Med. 2008; 22 : 13-32Sami MB, Faruqui R, The effectiveness of dopamine agonists for treatment of neuropsychiatric symptoms post brain injury and stroke. Acta Neuropsychiatr 2015:1–11. doi:10.1017/neu.2015.17
• Silver JK, Raj VS, Fu JB, Wisotzky EM, Smith SR, Kirch RA, Cancer rehabilitation and palliative care: critical components in the delivery of high-quality oncology services, Support Care Cancer, 2015;23(12):3633-43.
• Stene GB, Helbostad JL, Balstad TR, Riphagen II, Kaasa S, Oldervoll LM. Effect of physical exercise on muscle mass and strength in cancer patients during treatment--a systematic review. Crit Rev Oncol Hematol. 2013; 88 : 573-593.
• Stout NL, Binkley JM, Schmitz KH, Andrews K, Hayes SC, Campbell KL, McNeely ML, Soballe PW, Berger AM, Cheville AL, Fabian C, Gerber LH, Harris SR, Johansson K, Pusic AL, Prosnitz RG, Smith RA . A prospective surveillance model for rehabilitation for women with breast cancer. Cancer 2012:118(8 Suppl):2191–2200. doi:10.1002/cncr.27476
• Taşpınar Ö , Aydın T, Akcakaya A, Kanser Rehabilitasyonunda Palyatif Yaklaşımın Yeri ve Önemi, Bezmialem Science, 2014; 1: 31-37
• Van Weert E, Hoekstra-Weebers J, Otter R, Postema K, Sanderman R, van der Schans C. Cancer-related fatigue: predictors and effects of rehabilitation. Oncologist. 2006; 11 : 184-196
• von Haehling S, Anker SD Cachexia as a major underestimated and unmet medical need: facts and numbers. J Cachexia Sarcopenia Muscle. 2010; 1 : 1-5Weissman DE, Meier DE, Identifying patients in need of a palliative care assessment in the hospital setting: aconsensusreport from the center to advance palliative care. J Palliat Med 2011;14(1):17– 23. doi:10.1089/jpm.2010.0347
• Wells, M., Macbride, S Rehabilitation and Survivorship. In: Nursing Patients with Cancer Principles and Practice. Eds: Kearney N, Richardson A, 1 th ed, Elsevier, 2006;799-819. Who definition of palliative care World Health Organization. http://www.who.int/cancer/palliative/definition/en/2015. Erişim Tarihi: 22.07.2018
• WHO, Search results, http://www.who.int/mediacentre/factsheets/fs297/en/, erişim tarihi: 16.07.2018