Perioperative immunosuppression and risk of cancer progression

 

STATS:

WHO states 5.5 M cancer survivor with poorly managed pain. 

    - 38% reported 5+ on VAS. 

    - 66% have advanced cancer (? what stage is)

   - 35% have pain with treatments

   - 39.5%  after radical surgeries. 

Evidence shows that Pain decreases immune system:

    - decreased Natural killers, decreased t-cell activation and decreased macrocyte recruitments

 thus pain management for cancer population is very important.

Evidence shows that stress decreases immune system

    - decreased Natural killers, decreased t-cell activation and  decreased cortisol releasing hormone

?? do Opioids decrease immune response?

        - MOP receptors tend to suggest yes :  decreased ACH decreased corticosteroids, decreased sympathetics.

        - MOP also related to Angiogenesis and migration and proliferation of cells.

?? do opioids limited Cancer progression:

    - some suggest yes.

episodic increased pain:

    Surgery: increased risk fo spread d/t tumor manipulation,  and anigogenesis (VEGF) associated with healing. 

Alternative options

  GOALS:  decreased systemic exposure,  decreased pain ( return to homeostasis) decreased mental stress

 - suggestions: Blocks usually only done with surgery, varied results 

- adjunct medications: NSIADS seem to decreased immunosuppression of the opioids

        - regular NSAIDs risk apply: GIB, Renal, Cardiotoxicity

 

Leisure Activities

 

Recreation's purpose is not to kill time, but to make life, 

Not to keep a person occupied, but to keep a person refreshed,

Not to offer an escape from life, but to provide a discovery of life. 

-- Author unknown

 Quick review of piano lessons for cognitive recovery in cancer survivors. 

Rodriguez-Wolfe, Marlen, et al. "Individualized Piano Instruction for Improving Cognition in Breast Cancer Survivors." Oncology nursing forum. Vol. 46. No. 5. 2019.

 6 young, otherwise  mentally resilient and healthy individuals were provided 8  piano lessons with  'lifestyle, implementation  and learning tips.' 

used assessments to  determine how and which cognitive domains may be affected.

Often, patients with CRCI report issues with executive function and memory as well as attention and processing

speed, balance, and coordination, among other cognitive skills

Fluid: the ability to learn and retain information

Crystallized: learned and built from childhood

PQH-- Depression scale

Found that all benefited, despite varied degrees of compliance, from 5-20 minutes of daily practice. 

All areas of Cognitive Impairment improved: 

challenges, they noted, include difficulty in scheduling,  possible direct cost to patient. 

-- things to consider the "lessons were not just piano"

"In addition, the participants were taught strategies to acquire and retain knowledge on piano techniques, as well

integrate piano playing into their daily routine. "

I was hopeful that this article may help provide proof for what I have often thought and considered to be the most important part of life: that of our hobbies.  The benefits of healthy and active hobbies. I feel is greatly underestimated.  I don't think people realize that a hobby doesn't have to be something you are excellent at doing,  and may not be something you can share with the world. 

A hobby is simply something you do to help you maintain, help you relax. I usually recommend a hobby that doesn't require a lot of equipment to start,  one with lots of easily accessible assistance, of straight forward.  and one that will allow you to continue to improve as time goes on. 

As opposed to other interventions addressing cognitive impairments, this intervention seems to had some actual science behind it.