Oncology Examination: Difference between revisions
(Removed numbers/letters from subheadings. Edited reference. Updated the introduction.) |
(Formatting, spelling, hyperlink edits.) |
||
Line 9: | Line 9: | ||
* Mental Function | * Mental Function | ||
* | * Sensory Functions & Pain | ||
* Neuromusculoskeletal Function | * Neuromusculoskeletal Function & Movement-Related Functional Assessment | ||
* Functions of Body Systems | * Functions of Body Systems | ||
* Red and Yellow Flag Measures & Risk Patterns | * Red and Yellow Flag Measures & Risk Patterns | ||
Line 16: | Line 16: | ||
* Psychosocial | * Psychosocial | ||
== Mental Function | == Mental Function == | ||
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>. | * 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. | |||
'''Outcome Measures:''' | |||
* 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> | |||
=== | == Sensory Functions & Pain == | ||
Sensory functions 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. | |||
'''Outcome Measures For Sensory Functions:''' | |||
* 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> | |||
'''Outcome Measures For Pain:''' | |||
* [https://physio-pedia.com/Visual_Analogue_Scale Visual Analog Scale] | |||
* [https://physio-pedia.com/Numeric_Pain_Rating_Scale Numeric Rating Scale] | |||
* Faces Pain Scale | |||
* [https://physio-pedia.com/Brief_Pain_Inventory_-_Short_Form Brief Pain Inventory] | |||
== Neuromusculoskeletal Function & Movement-Related Functional Assessment == | |||
Peripheral Neuropathies (chemotherapy induced), Anesthesia/Dysesthesias (with compression or surgical dissection of nerves), Motor Function Loss and Radiation Plexopathy, range of motion limitation (due to scar tissue formation after surgical resections, chemotherapy or radiation therapy and fibrosis after irradiation) may occur. | |||
Muscle functions can be affected by any of the following: | |||
*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) | |||
Balance dysfunction can be caused from any of the following: | |||
*Sensory input | |||
*Central processing of balance-related information | |||
*Range of motion limitations | |||
*[[Orthostatic Hypotension|Orthostatic hypotension]] | |||
*Muscle weakness | |||
*Peripheral neuropathies from taxane | |||
'''Outcome Measures:''' | |||
* Peripheral neuropathies: 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> | |||
* Range of motion: Goniometry | |||
* Muscle functions: Manual muscle testing, handheld dynamometry | |||
* Balance: [https://physio-pedia.com/Functional_Reach_Test_(FRT) Functional Reach], [[Berg Balance Scale]] , [https://physio-pedia.com/Romberg_Test Standard Romberg Test] , Tandem Romberg Test, [https://physio-pedia.com/Timed_Up_and_Go_Test_(TUG) Timed Get up and Go Test] | |||
* Gait: Kinematic Analysis, Gait Speed Measurements, Tinetti Balance & Gait Scale | |||
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> | |||
*Muscle | |||
* | |||
== Functions of Body Systems == | == Functions of Body Systems == | ||
===Cardiovascular=== | ===Cardiovascular === | ||
*Cardiotoxicity can be a late effect of chemotherapy due damage of the cardiac myoctyes ultimately resulting in congestive heart failure. | *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. | ||
'''Outcome Measure:''' | |||
*Echocardiogram to assess ventricular function, cardiac motion and output. | |||
===Hematologic=== | ===Hematologic=== | ||
'''Outcome Measure:''' | |||
Complete blood count | |||
===Immunologic=== | ===Immunologic=== | ||
*Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels | * Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels. | ||
Measures | '''Outcome Measures:''' | ||
*Limb Circumfrence Measurements Pre-op and Post-op | |||
*Water Displacement Method of measuring limb volume | |||
===Integumentary=== | ===Integumentary=== | ||
*With | * With [[lymphoedema]], skin breakdown or infection can occur. | ||
Uses Grades to assess severity of different conditions for example Lymphedema | '''Outcome Measure:''' | ||
*[http://www.eortc.be/services/doc/ctc/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf 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=== | ===Respiratory=== | ||
*Lung tumors may limit thoracic cavity expansion, compress the airways or reduce the surface area of the lung. | *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. | *Chemotherapy agents (beomycin, methotrexate and docetaxel) may damage pneumocytes. This reduces alveoli and air exchange. | ||
*Patients are then at risk for pneumonitis or fibrosis. | *Patients are then at risk for pneumonitis or fibrosis. | ||
'''Outcome Measures:''' | |||
* Vital signs (RR, HR, BP) | |||
* Oxygen Saturation | |||
* Aerobic Test--[[Six Minute Walk Test / 6 Minute Walk Test|6 Minute Walk]] | |||
* Dyspnea Scale | |||
* [https://physio-pedia.com/Borg_Rating_Of_Perceived_Exertion Borg Rating of Perceived Exertion] | |||
== Red and Yellow Flag Measures & Risk Patterns == | == Red and Yellow Flag Measures & Risk Patterns == | ||
# Sites at Risk for Neural Compression: | |||
* Brachial Plexus: Breast & Lung Tumors | |||
* Lumbosacral Plexus: Colorectal & Gynecological Tumors, Sarcomas & Lymphomas | |||
Symptoms: | Symptoms: Unrelenting pain, worse at night progressing to focal sensory loss or weakness | ||
Cancers that often metastasize to the | 2. Cancers that often metastasize to the spine: | ||
*Prostate | * Prostate | ||
*Breast | * Breast | ||
*Lung | *Lung | ||
*Colon | *Colon | ||
Cancers that often present in the femur | 3. Cancers that often present in the femur: | ||
*Sarcoma | * Sarcoma | ||
Cancer and | 4. Cancer and it's treatment increases risk for osteonecrosis in the following regions: | ||
*Proximal or Distal Femur | *Proximal or Distal Femur | ||
Line 174: | Line 136: | ||
*Metatarsals | *Metatarsals | ||
Other Risks | 5. Other Risks: | ||
*Osteoporosis | * Osteoporosis | ||
*Neutropenia | * Neutropenia | ||
*Thrombocytopenia | *Thrombocytopenia | ||
== Functional Activities, Mobility & Self-Care == | == Functional Activities, Mobility & Self-Care == | ||
'''Outcome measures for mobility assessment :''' | |||
* 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 ask patients to indicate the level of difficulty they experience in dressing, grooming, mobility, work, sports, and leisure. | |||
*Functional Mobility Assessment | |||
*The Toronto Extremity Salvage Score, lower-extremity version | |||
*Changing and maintaining body positions | |||
*Carrying | |||
*Moving and handling objects | |||
*Walking | |||
*Moving around using transportation | |||
'''Outcome measures for self-care:''' | |||
*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 | |||
*Karnofsky Performance Scale | |||
*Barthel Index | *[[Barthel Index]]: Includes multiple components and diverse self-care activities. May be more responsive in rehabilitation. | ||
Shoulder | *Performance or self-report measure of independence in basic activities of daily living<br /> | ||
'''Shoulder measures for breast cancer: <ref name="Oncology Breast Outcome Measures">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</ref>''' | |||
*The Functional Assessment of Cancer Therapy Breast (FACT-B+4) | *The Functional Assessment of Cancer Therapy Breast (FACT-B+4) | ||
Line 218: | Line 168: | ||
== Psychosocial == | == Psychosocial == | ||
Consider the patients domestic life, interpersonal relations and major life areas. | * Consider the patients domestic life, interpersonal relations and major life areas. | ||
* Assess participation in or attending community activities, reduced job expectations, etc. | |||
'''Outcome Measures:''' | |||
* Reintegration to Normal Living Index: Measures adults' perception of their ability to resume life roles after trauma or illness | |||
== References == | == References == |
Revision as of 18:05, 14 November 2023
Original Editor - Elaine Lonnemann
Top Contributors - Elaine Lonnemann, Sehriban Ozmen, Admin, Kim Jackson, Fasuba Ayobami, Vidya Acharya and WikiSysop
Introduction[edit | edit source]
Various domains of examination with related tools are included in this page according to the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.[1]:
- Mental Function
- Sensory Functions & Pain
- Neuromusculoskeletal Function & Movement-Related Functional Assessment
- Functions of Body Systems
- Red and Yellow Flag Measures & Risk Patterns
- Functional Activities, Mobility & Self-Care
- Psychosocial
Mental Function[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.
Outcome Measures:
- The mini-mental state examination measure
- Profile of Mood States [6]
Sensory Functions & Pain[edit | edit source]
Sensory functions may be affected by neoplasms such as a Vestibular Schwannoma which may cause unilateral dysfunction or chemotherapy drugs such as Cisplastin.
Outcome Measures For Sensory Functions:
- Dizziness Handicap Inventory Questionnaire: 25 items assess the impact of disequilibrium on functional activities.[7]
Outcome Measures For Pain:
- Visual Analog Scale
- Numeric Rating Scale
- Faces Pain Scale
- Brief Pain Inventory
Neuromusculoskeletal Function & Movement-Related Functional Assessment[edit | edit source]
Peripheral Neuropathies (chemotherapy induced), Anesthesia/Dysesthesias (with compression or surgical dissection of nerves), Motor Function Loss and Radiation Plexopathy, range of motion limitation (due to scar tissue formation after surgical resections, chemotherapy or radiation therapy and fibrosis after irradiation) may occur. Muscle functions can be affected by any of the following:
- 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)
Balance dysfunction can be caused from any of the following:
- Sensory input
- Central processing of balance-related information
- Range of motion limitations
- Orthostatic hypotension
- Muscle weakness
- Peripheral neuropathies from taxane
Outcome Measures:
- Peripheral neuropathies: Modified Total Neuropathy Score[8]
- Range of motion: Goniometry
- Muscle functions: Manual muscle testing, handheld dynamometry
- Balance: Functional Reach, Berg Balance Scale , Standard Romberg Test , Tandem Romberg Test, Timed Get up and Go Test
- Gait: Kinematic Analysis, Gait Speed Measurements, Tinetti Balance & Gait Scale
Functions of Body Systems[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.
Outcome Measure:
- Echocardiogram to assess ventricular function, cardiac motion and output.
Hematologic[edit | edit source]
Outcome Measure:
Complete blood count
Immunologic[edit | edit source]
- Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels.
Outcome Measures:
- Limb Circumfrence Measurements Pre-op and Post-op
- Water Displacement Method of measuring limb volume
Integumentary[edit | edit source]
- With lymphoedema, skin breakdown or infection can occur.
Outcome Measure:
- 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.
Outcome Measures:
- Vital signs (RR, HR, BP)
- Oxygen Saturation
- Aerobic Test--6 Minute Walk
- Dyspnea Scale
- Borg Rating of Perceived Exertion
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
2. Cancers that often metastasize to the spine:
- Prostate
- Breast
- Lung
- Colon
3. Cancers that often present in the femur:
- Sarcoma
4. Cancer and it's treatment increases risk for osteonecrosis in the following regions:
- Proximal or Distal Femur
- Proximal Humerus
- Jaw
- Metatarsals
5. Other Risks:
- Osteoporosis
- Neutropenia
- Thrombocytopenia
Functional Activities, Mobility & Self-Care[edit | edit source]
Outcome measures for mobility assessment :
- 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 ask patients to indicate the level of difficulty they experience in dressing, grooming, mobility, work, sports, and leisure.
- Changing and maintaining body positions
- Carrying
- Moving and handling objects
- Walking
- Moving around using transportation
Outcome measures for self-care:
- 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.
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.
Outcome 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, Marchese VG, Morris GS, Ness KK. A framework for assessment in oncology rehabilitation. Physical Therapy. 2009 Mar 1;89(3):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