Oncology

Original Editor - Elaine Lonnemann

Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Introduction

Physiotherapy is an autonomous profession concerned with the care, management and rehabilitation of
patients. These principles apply to the management of patients with cancer through all care and
rehabilitation programmes from diagnosis to the end of life.  Physiotherapists conduct ongoing assessment of the needs of this patient group and their carers, in order to apply skilled interventions, which are vital for patients’ independence, functional capacity and quality of life.  The role of the physiotherapist, as an essential member of the multi-disciplinary team is key to the successful rehabilitation and management of patients with cancer and palliative care needs. The absence of physiotherapy intervention would be detrimental to patient care and the ability of the patient/family to cope with the effects of the disease or its treatment on their functional capacity and quality of life.

Conditions

• Acute Lymphoblastic Leukemia
• Breast Cancer
• Chemotherapy Side Effects & Syndromes
• Chondroblastoma
• Colorectal Cancer
• Ewing's Sarcoma
• Gastric Cancer
• Giant Cell Tumor
• Glioblastoma Multiforme
• Hodgkin's Lymphoma
• Multiple Myeloma
• Neuroblastoma
• Non Hodgkin Lymphoma
• Osteochondroma
• Osteoid Osteoma
• Osteosarcoma
• Pancreatic Cancer
• Radiation Side Effects and Syndromes
• Renal Cancer
• Testicular Cancer

Examination

Using the International Classification Framework Model for Assessment in Oncology Rehabilitation

                by  Gilchrist LS, Galantino ML, Wampler M, et al.

I.  Mental Function, Pain & Somatorsensory Screening

Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system  Mental impairments can be indusced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage.  Emotional Functions may alos affect the ability of our patients to respond to and/or participate in physical therapy.

Diagnostic & Screening Measures

1.  Mental Status

              The Mini-Mental State Examination 

                   read more about the Mini-Mental State Examination Measure & Link

              Profile of Mood States

                   read more about the POMS

2.  Pain Assessment

                     1.  Visual Analog Scale

                     2.  Numeric Rating Scale

                     3.  Faces Pain Scale

                     4.  Brief Pain Inventory

                     

3.  Neurological Assessment Measure

a)  Vestibular

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.

c)  Neuromusculoskeletal

1.  Peripheral Neuropathies--Chemotherapy induced

          modified Total Neuropathy Score

2.  Anesthesia/Dysesthesias

         with compression or surgical dissection of nerves

3.  Motor Function Loss

         Radiation Plexopathy

II. Neuromusculoskeletal Function (Movement Related Functional Assessment)

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

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

1. 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

1. Limb Circumfrence Measurements Pre-op and Post-op
2. 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

1. Vital signs (RR, HR, BP)
2. Oxygen Sautration
3.  Aerobic Test--6 Minute Walk
4. Dyspnea Scale
5. Borg Rating of Perceived Exertion
   

IV.  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:  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

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

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

Medical Management

Oncological Emergencies

Physical Therapists need to be aware that certain oncologic emergencies may develop over time and it is important to know the primary systems affected or causes as well as signs and symptoms for referral.

I.  Metabolic

1. Tumor Lysis Syndrome
2. Hypercalcemia of Malignancy
3. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

II. Hematologic

1. Febrile neutropenia
2. Hyperviscosity syndrome

III. Structural 

1. Epidural Spinal Cord Compression
2. Malignant Pericardial Effusion
3. Superior Vena Cava Syndrome

IV. Side Effects from Chemotherapy

1. Diarrhea
2. Extravasations
3. Obstipation

Physiotherapy Intervention

Physical Therapy Intervention Following Surgical Treatment of Carpal Tunnel Syndrome in an Individual With a History of Postmastectomy Lymphedema by Julie E Donachy and Emily L Christian.  Physical Therapy 2002 Vol. 82 

Recent Research from Physiospot

Failed to load RSS feed from http://feeds.feedburner.com/physiospot/oncology|charset=UTF-8|short|max=10: There was a problem during the HTTP request: 404 Not Found