Oncology Examination
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation[1][2] by Gilchrist LS, Galantino ML, Wampler M, et al.
Original Editor - Elaine Lonnemann
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I. Mental Function, Pain & Somatorsensory Screening[edit | edit source]
Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system[3] [4][5] Mental impairments can be indusced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[6]. Emotional Functions may alos 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[7]
read more about the Mini-Mental State Examination Measure & Link
Profile of Mood States[8]
read more about the 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.[10]
b) Somatosensory[edit | edit source]
c) Neuromusculoskeletal[edit | edit source]
1. Peripheral Neuropathies--Chemotherapy induced
modified Total Neuropathy Score[11]
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
ROM
- Scar tissue formation after surgical resections, chemotherapy or radiation therapy.
- Fibrosis after irradiation.
Strength
- 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
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
- Kinetmatic Analysis
- Gait Speed Measurements
Gait Measures
- Tinetti Balance & Gait Scale
III. System Screening[edit | edit source]
Cardiovascular
- Cardiotoxicity can be a late effect of chemotherapy due damage o fthe 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
Immunologic
- 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
- 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
- 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
- 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
- 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
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 o ftheir ability to resume life roles after trauma or illness
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ International Classification of Functioning, Disability and Health: ICF. Geneva,Switzerland: World Health Organization; 2001
- ↑ Gilchrist LS, Galantino ML, Wampler M, et al. A Framework for Assessment in Oncology Rehabilitation. Physical Therapy . 89 (3 ):286–306. Available at: http://ptjournal.apta.org/content/89/3/286.abstract.
- ↑ 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.