Oncology Examination: Difference between revisions
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==I Mental Function, Pain & Somatosensory Screening== | ==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><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 | 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 induced 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 == | == Diagnostic & Screening Measures == | ||
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=== 1. Mental Status === | === 1. Mental Status === | ||
The [ | The [https://physio-pedia.com/Mini-Mental_State_Examination mini-mental state examination measure] | ||
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> | |||
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1. Visual Analog Scale | 1. Visual Analog Scale | ||
2. Numeric Rating Scale | 2. [https://physio-pedia.com/Numeric_Pain_Rating_Scale Numeric Rating Scale] | ||
3. Faces Pain Scale | 3. Faces Pain Scale | ||
4. [ | 4. [https://physio-pedia.com/Brief_Pain_Inventory_-_Short_Form Brief Pain Inventory] | ||
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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 drugs such as </span>Cisplastin | 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. 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> | ||
==== b) Somatosensory ==== | ==== b) Somatosensory ==== | ||
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Balance Measures | Balance Measures | ||
*Functional Reach | *[https://physio-pedia.com/Functional_Reach_Test_(FRT) Functional Reach] | ||
*Berg Balance Scale | *[[Berg Balance Scale]] | ||
*Standard Romberg Test | *[https://physio-pedia.com/Romberg_Test Standard Romberg Test] | ||
*Tandem Romberg Test | *Tandem Romberg Test | ||
*Timed Get up | *[https://physio-pedia.com/Timed_Up_and_Go_Test_(TUG) Timed Get up and Go Test] | ||
===Gait=== | ===Gait=== | ||
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#Vital signs (RR, HR, BP) | #Vital signs (RR, HR, BP) | ||
#Oxygen Sautration | #Oxygen Sautration | ||
# Aerobic Test--6 Minute Walk | # Aerobic Test--[[Six Minute Walk Test / 6 Minute Walk Test|6 Minute Walk]] | ||
#Dyspnea Scale | #Dyspnea Scale | ||
#Borg Rating of Perceived Exertion<br> | #[https://physio-pedia.com/Borg_Rating_Of_Perceived_Exertion Borg Rating of Perceived Exertion]<br> | ||
<br> | <br> | ||
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*Karnofsky Performance Scale | *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 | 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.<br> Performance or self-report measure of independence in basic activities of daily living<br> | *Barthel Index includes multiple components and diverse self-care activities. May be more responsive in rehabilitation.<br> Performance or self-report measure of independence in basic activities of daily living<br> | ||
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== References == | == References == | ||
<references /> | <references /> | ||
[[Category:Oncology]] | [[Category:Oncology]] | ||
Revision as of 02:49, 15 July 2020
Original Editor - Elaine Lonnemann
Top Contributors - Elaine Lonnemann, Sehriban Ozmen, Admin, Kim Jackson, Fasuba Ayobami, Vidya Acharya and WikiSysop
Oncology Examination[edit | edit source]
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.[1]
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 induced 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
Profile of Mood States[6]
2. Pain Assessment[edit | edit source]
1. Visual Analog 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.[7]
b) Somatosensory[edit | edit source]
c) Neuromusculoskeletal[edit | edit source]
1. Peripheral Neuropathies: Chemotherapy induced
modified Total Neuropathy Score[8]
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 and 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[9]
- 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
- ↑ Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.
- ↑ 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
