Oncology Examination

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (17/11/2023)

Original Editor - Elaine Lonnemann

Top Contributors - Elaine Lonnemann, Sehriban Ozmen, Admin, Kim Jackson, Fasuba Ayobami, Vidya Acharya and WikiSysop

Introduction

A study was published before to guide rehabilitation therapists who provide oncology rehabilitation to choose appropriate outcome measures that are relevant to the three human function domains (body functions and structure, activities, and participation) of the International Classification Framework (ICF) developed by the World Health Organisation (WHO).

In this study, outcome measures are grouped according to ICF domains as shown in the table:

Table 1: Measurement Tools For ICF Domains

Measurement of Body Function and Structure	Measurement of Activity and Participation
Mental Functions	Mobility
Sensory Functions and Pain	Self-care
Neuromusculoskeletal and Movement-Related Functions and Structures	Domestic Life, Interpersonal Relations, and Major Life Areas
Functions of the Cardiovascular, Hematologic, Immunologic, and Respiratory Systems
Diagnostic Measures of Body Function and Structure Indicating “Red Flags” or “Yellow Flags” for Physical Therapists

Measurement of Body Function and Structure

Mental Function

• Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system.
• Mental impairments can be induced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage.
• 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

Sensory Functions & Pain

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.

Outcome Measures For Pain:

• Visual Analog Scale
• Numeric Rating Scale
• Faces Pain Scale
• 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
• Muscle weakness
• Peripheral neuropathies from taxane

Outcome Measures:

• Peripheral neuropathies: Modified Total Neuropathy Score
• 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

Cardiovascular

• 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

Outcome Measure:

Complete blood count

Immunologic

• 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

• 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

• 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

1. 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

Measurement of Activity and Participation

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.

• 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:

• The Functional Assessment of Cancer Therapy Breast (FACT-B+4)
• Disability of Arm, Shoulder and Hand (DASH) questionnaires.

Psychosocial

• 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