Oncology Examination: Difference between revisions
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'''Original Editor '''- [[User:Elaine Lonnemann|Elaine Lonnemann ]] | '''Original Editor '''- [[User:Elaine Lonnemann|Elaine Lonnemann]] | ||
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} | ||
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==Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.<ref name="Oncology Framework">Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306.</ref> | ==Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.<ref name="Oncology Framework">Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306.</ref> == | ||
==Mental Function, Pain & | ==I Mental Function, Pain & Somatosensory Screening== | ||
Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system<ref name="Breast Cancer Cognitive Dysfunction">Ahles T, Saykin A. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer.2002;3:S84–S90.</ref> | Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system<ref name="Breast Cancer Cognitive Dysfunction">Ahles T, Saykin A. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer.2002;3:S84–S90.</ref><ref>Castellon S, Ganz P, Bower J, et al. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp Neuropsychol. 2004;26:955–969.</ref><ref>Stewart A, Bielajew C, Collins B, et al. A meta analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clin Neuropsychol. 2006;20:76–89.</ref> Mental impairments can be indused by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage<ref>Ahles T, Saykin A, Furstenberg C, et al. Neuropsychologic impact of standard dose systemic chemotherapy in longterm survivors of breast cancer and lymphoma.J Clin Oncol. 2002;20:485–493</ref>. Emotional Functions may also affect the ability of our patients to respond to and/or participate in physical therapy. | ||
== Diagnostic & Screening Measures == | |||
=== 1. Mental Status === | === 1. Mental Status === | ||
The Mini-Mental State Examination<ref>Folstein M, Folstein S, McHugh P. Mini-Mental State: a practical method for grading the state of patients for the clinician J Psychiatr Res. 1975;12:189–198.</ref> | The [http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=912 Mini-Mental State Examination Measure]<ref>Folstein M, Folstein S, McHugh P. Mini-Mental State: a practical method for grading the state of patients for the clinician J Psychiatr Res. 1975;12:189–198.</ref> | ||
read more about the [http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=912 | read more about the [http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=912 Link] | ||
Profile of Mood States<ref>Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.</ref> | Profile of Mood States<ref>Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.</ref> [http://www.mhs.com/product.aspx?gr=cli&prod=poms&id=overview POMS] | ||
| | ||
=== 2. Pain Assessment === | === 2. Pain Assessment === | ||
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==== a) Vestibular==== | ==== a) Vestibular==== | ||
May be affected by neoplasms such as a <span style="line-height: 1.5em;">Vestibular schwannoma which may cause unilateral dysfunction </span><span style="line-height: 1.5em;">or chemotherapy | May be affected by neoplasms such as a <span style="line-height: 1.5em;">Vestibular schwannoma which may cause unilateral dysfunction </span><span style="line-height: 1.5em;">or chemotherapy drugs such as </span>Cisplastin | ||
[http://www.southamptonhospital.org/Resources/10355/FileRepository/Forms/Dizziness%20Hanicap%20Inventory%20-%20English.pdf Dizziness Handicap Inventory Questionnaire]--25 items assess the impact of disequilibrium on functional activities.<ref>Jacobson G, Newman C, Hunter L, Balzer G. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol. 1991;2:253–260.</ref> | [http://www.southamptonhospital.org/Resources/10355/FileRepository/Forms/Dizziness%20Hanicap%20Inventory%20-%20English.pdf Dizziness Handicap Inventory Questionnaire]--25 items assess the impact of disequilibrium on functional activities.<ref>Jacobson G, Newman C, Hunter L, Balzer G. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol. 1991;2:253–260.</ref> | ||
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==== c) Neuromusculoskeletal ==== | ==== c) Neuromusculoskeletal ==== | ||
1. Peripheral Neuropathies | 1. Peripheral Neuropathies: Chemotherapy induced | ||
modified Total Neuropathy Score<ref>Cavaletti G, Bogliun G, Marzorati L, et al. Grading of chemotherapy-induced peripheral neurotoxicity using the Total Neuropathy Scale. Neurology. 2003;61:fckLR1297–1300.</ref> | modified Total Neuropathy Score<ref>Cavaletti G, Bogliun G, Marzorati L, et al. Grading of chemotherapy-induced peripheral neurotoxicity using the Total Neuropathy Scale. Neurology. 2003;61:fckLR1297–1300.</ref> | ||
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Radiation Plexopathy | Radiation Plexopathy | ||
== II | == II Neuromusculoskeletal Function (Movement Related Functional Assessment) == | ||
===Posture=== | ===Posture=== | ||
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===Cardiovascular=== | ===Cardiovascular=== | ||
*Cardiotoxicity can be a late effect of chemotherapy due damage | *Cardiotoxicity can be a late effect of chemotherapy due damage of the cardiac myoctyes ultimately resulting in congestive heart failure. | ||
*Radiation may scar the cardiac and coronary arteries resulting in restrictive coronary disease | *Radiation may scar the cardiac and coronary arteries resulting in restrictive coronary disease | ||
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Consider the patients domestic life, interpersonal relations and major life areas. <br> | Consider the patients domestic life, interpersonal relations and major life areas. <br> | ||
assess participation in or attending community activities, reduced job expectations etc | assess participation in or attending community activities, reduced job expectations, etc | ||
'''Measures''' | '''Measures''' | ||
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*Reintegration to Normal Living Index | *Reintegration to Normal Living Index | ||
Measures adults' perception | Measures adults' perception of their ability to resume life roles after trauma or illness | ||
== References == | == References == |
Revision as of 18:07, 17 January 2020
Original Editor - Elaine Lonnemann
Top Contributors - Elaine Lonnemann, Sehriban Ozmen, Admin, Kim Jackson, Fasuba Ayobami, Vidya Acharya and WikiSysop
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.[1] [edit | edit source]
I Mental Function, Pain & Somatosensory Screening[edit | edit source]
Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system[2][3][4] Mental impairments can be indused by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[5]. Emotional Functions may also affect the ability of our patients to respond to and/or participate in physical therapy.
Diagnostic & Screening Measures[edit | edit source]
1. Mental Status[edit | edit source]
The Mini-Mental State Examination Measure[6]
read more about the Link
Profile of Mood States[7] POMS
2. Pain Assessment[edit | edit source]
1. Visual Analog Scale
2. Numeric Rating Scale
3. Faces Pain Scale
3. Neurological Assessment Measure[edit | edit source]
a) Vestibular[edit | edit source]
May be affected by neoplasms such as a Vestibular schwannoma which may cause unilateral dysfunction or chemotherapy drugs such as Cisplastin
Dizziness Handicap Inventory Questionnaire--25 items assess the impact of disequilibrium on functional activities.[9]
b) Somatosensory[edit | edit source]
c) Neuromusculoskeletal[edit | edit source]
1. Peripheral Neuropathies: Chemotherapy induced
modified Total Neuropathy Score[10]
2. Anesthesia/Dysesthesias
with compression or surgical dissection of nerves
3. Motor Function Loss
Radiation Plexopathy
II Neuromusculoskeletal Function (Movement Related Functional Assessment)[edit | edit source]
Posture[edit | edit source]
ROM[edit | edit source]
- Scar tissue formation after surgical resections, chemotherapy or radiation therapy.
- Fibrosis after irradiation.
Strength[edit | edit source]
- Muscle weaknesses from inflammatory intermediates produced by the tumor that are catabolic and cause muscle wasting (cachexia).
- Surgical denervation or damage
- Radiation & Chemotherapy can damage muscle or nerve tissue. (Vinca alkaloids, taxanes and platinum agents)
- Grip dynamometers
- MMT
Balance[edit | edit source]
Balance Dysfunction can be caused from any of the following
- sensory input
- central processing of balance-related information
- ROM limitations
- orthostatic hypotension
- muscle weakness
- peripheral neuropathies from taxane
Balance Measures
- Functional Reach
- Berg Balance Scale
- Standard Romberg Test
- Tandem Romberg Test
- Timed Get up & Go Test
Gait[edit | edit source]
- Kinetmatic Analysis
- Gait Speed Measurements
Gait Measures
- Tinetti Balance & Gait Scale
III. System Screening[edit | edit source]
Cardiovascular[edit | edit source]
- Cardiotoxicity can be a late effect of chemotherapy due damage of the cardiac myoctyes ultimately resulting in congestive heart failure.
- Radiation may scar the cardiac and coronary arteries resulting in restrictive coronary disease
Measures
- Echocardiogram to assess ventricular function, cardiac motion and output.
Hematologic[edit | edit source]
Immunologic[edit | edit source]
- Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels
Measures
- Limb Circumfrence Measurements Pre-op and Post-op
- Water Displacement Method of measuring limb volume
Integumentary[edit | edit source]
- With lymphedema, skin breakdown or infection can occur.
- National Cancer Institue's Common Termonology Criteria for Adverse Events (Lymphatic, Integumentary Systems)
Uses Grades to assess severity of different conditions for example Lymphedema
Respiratory[edit | edit source]
- Lung tumors may limit thoracic cavity expansion, compress the airways or reduce the surface area of the lung.
- Chemotherapy agents (beomycin, methotrexate and docetaxel may damage pneumocytes. This reduces alveoli and air exchange.
- Patients are then at risk for pneumonitis or fibrosis.
Measures[edit | edit source]
- Vital signs (RR, HR, BP)
- Oxygen Sautration
- Aerobic Test--6 Minute Walk
- Dyspnea Scale
- Borg Rating of Perceived Exertion
IV. Red and Yellow Flag Measures & Risk Patterns[edit | edit source]
Sites at Risk for Neural Compression
Brachial Plexus: Breast & Lung Tumors
Lumbosacral Plexus: Colorectal & Gynecological Tumors, Sarcomas & Lymphomas
Symptoms: Unrelenting pain, worse at night progressing to focal sensory loss or weakness
Cancers that often metastasize to the Spine
- Prostate
- Breast
- Lung
- Colon
Cancers that often present in the femur
- Sarcoma
Cancer and Cancer Treatment increases risk for Osteonecrosis
- Proximal or Distal Femur
- Proximal Humerus
- Jaw
- Metatarsals
Other Risks
- Osteoporosis
- Neutropenia
- Thrombocytopenia
V. Functional Activities, Mobility & Self-Care[edit | edit source]
Measures[edit | edit source]
- Functional Mobility Assessment
requires patients to physically perform specific tasks and to answer questions, quantifying their level of function.
- The Toronto Extremity Salvage Score, lower-extremity version
is a self administered questionnaire that asks patients to indicate the level of difficulty they experience in dressing,grooming, mobility, work, sports, and leisure
Mobility Assessment
- changing and maintaining body positions
- carrying
- moving and handling objects
- walking
- moving around using transportation
Self Care Measures
includes grooming, bathing and dressing
- Karnofsky Performance Scale
A standard measure of the ability of adult patients with cancer to perform ordinary tasks. scores range from 0 to 100. A higher score means the patient is better able to carry out daily activities
- Barthel Index includes multiple components and diverse self-care activities. May be more responsive in rehabilitation.
Performance or self-report measure of independence in basic activities of daily living
Shoulder Measures for Breast Cancer[11]
- The Functional Assessment of Cancer Therapy Breast (FACT-B+4)
- Disability of Arm, Shoulder and Hand (DASH) questionnaires.
VI. Psychosocial[edit | edit source]
Consider the patients domestic life, interpersonal relations and major life areas.
assess participation in or attending community activities, reduced job expectations, etc
Measures
- Reintegration to Normal Living Index
Measures adults' perception of their ability to resume life roles after trauma or illness
References[edit | edit source]
- ↑ Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306.
- ↑ Ahles T, Saykin A. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer.2002;3:S84–S90.
- ↑ Castellon S, Ganz P, Bower J, et al. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp Neuropsychol. 2004;26:955–969.
- ↑ Stewart A, Bielajew C, Collins B, et al. A meta analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clin Neuropsychol. 2006;20:76–89.
- ↑ Ahles T, Saykin A, Furstenberg C, et al. Neuropsychologic impact of standard dose systemic chemotherapy in longterm survivors of breast cancer and lymphoma.J Clin Oncol. 2002;20:485–493
- ↑ Folstein M, Folstein S, McHugh P. Mini-Mental State: a practical method for grading the state of patients for the clinician J Psychiatr Res. 1975;12:189–198.
- ↑ Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.
- ↑ Cleeland C. Measurement and prevalence of pain in cancer. Semin Oncol Nurs. 1985;1:87–92.
- ↑ Jacobson G, Newman C, Hunter L, Balzer G. Balance function test correlates of the Dizziness Handicap Inventory. J Am Acad Audiol. 1991;2:253–260.
- ↑ Cavaletti G, Bogliun G, Marzorati L, et al. Grading of chemotherapy-induced peripheral neurotoxicity using the Total Neuropathy Scale. Neurology. 2003;61:fckLR1297–1300.
- ↑ Davies C, Ryans K, Levenhagen K, Perdomo M. Quality of Life and Functional Outcome Measures for Secondary Lymphedema in Breast Cancer Survivors. Rehabil Oncol Vol 32 (1)p. 7-12