|
|
| Line 4: |
Line 4: |
| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] |
| </div> | | </div> |
| == Introduction == | | == Introduction == |
|
| |
|
| Physiotherapy is an autonomous profession concerned with the care, management and rehabilitation of<br>patients. These principles apply to the management of patients with cancer through all care and<br>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<ref>The Role of Physiotherapy for People with Cancer - CSP Position Statement. The Chartered Society of Physiotherapy, July 2003. Available at http://www.csp.org.uk/uploads/documents/csp_statement_physioandcancer.pdf. Retrieved 10/7/2010</ref>.<br> | | Physiotherapy is an autonomous profession concerned with the care, management and rehabilitation of<br>patients. These principles apply to the management of patients with cancer through all care and<br>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<ref>The Role of Physiotherapy for People with Cancer - CSP Position Statement. The Chartered Society of Physiotherapy, July 2003. Available at http://www.csp.org.uk/uploads/documents/csp_statement_physioandcancer.pdf. Retrieved 10/7/2010</ref>.<br> |
| Line 35: |
Line 35: |
| == Examination == | | == Examination == |
|
| |
|
| Using the International Classification Framework Model for Assessment in Oncology Rehabilitation<ref>International Classification of Functioning, Disability and Health: ICF. Geneva,Switzerland: World Health Organization; 2001</ref><ref>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.</ref>
| | *[[Oncology Examination]] |
|
| |
|
| by Gilchrist LS, Galantino ML, Wampler M, et al.
| | == Interventions == |
|
| |
|
| <br>
| | *[[Medical Management]] |
| | | *[[Physiotherapy Intervention]] |
| === I. Mental Function, Pain & Somatorsensory 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 indusced 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 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<ref>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.</ref>
| |
| | |
| read more about the [http://www.rehabmeasures.org/lists/rehabmeasures/dispform.aspx?id=912 Mini-Mental State Examination Measure & Link]
| |
| | |
| 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>
| |
| | |
| read more about the [http://www.mhs.com/product.aspx?gr=cli&prod=poms&id=overview POMS]
| |
| | |
| ===== 2. Pain Assessment =====
| |
| | |
| 1. Visual Analog Scale
| |
| | |
| 2. Numeric Rating Scale
| |
| | |
| 3. Faces Pain Scale
| |
| | |
| 4. [http://medicine.iupui.edu/RHEU/Physicians/bpisf.pdf Brief Pain Inventory]<ref>Cleeland C. Measurement and prevalence of pain in cancer. Semin Oncol Nurs. 1985;1:87–92.</ref>
| |
| | |
|
| |
| | |
| ===== 3. Neurological Assessment Measure =====
| |
| | |
| ====== 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
| |
| | |
| [http://www.southamptonhospital.org/Resources/10355/FileRepository/Forms/Dizziness%20Hanicap%20Inventory%20-%20English.pdf 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 ======
| |
| | |
| ====== c) Neuromusculoskeletal ======
| |
| | |
| 1. Peripheral Neuropathies--Chemotherapy induced
| |
| | |
| 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>
| |
| | |
| 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
| |
| | |
| <br>
| |
| | |
| Balance Measures
| |
| | |
| *Functional Reach
| |
| *Berg Balance Scale
| |
| *Standard Romberg Test
| |
| *Tandem Romberg Test
| |
| *Timed Get up & Go Test
| |
| | |
| '''Gait'''
| |
| | |
| *Kinetmatic Analysis
| |
| *Gait Speed Measurements<br>
| |
| | |
| 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
| |
| | |
| #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.
| |
| *[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'''
| |
| | |
| *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<br>
| |
| | |
| <br>
| |
| | |
| === 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
| |
| | |
| <br>
| |
| | |
| Mobility Assessment
| |
| | |
| *changing and maintaining body positions
| |
| *carrying
| |
| *moving and handling objects
| |
| *walking
| |
| *moving around using transportation
| |
| | |
| <br>
| |
| | |
| 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.<br> Performance or self-report measure of independence in basic activities of daily living<br>
| |
| | |
| === VI. Psychosocial ===
| |
| | |
| Consider the patients domestic life, interpersonal relations and major life areas. <br>
| |
| | |
| 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<ref>Higdon M et. al. Treatment of Oncologic Emergencies. Am Fam Physician 2006; 74: 1873-80</ref>.
| |
| | |
| ==== I. Metabolic<br> ====
| |
| | |
| #Tumor Lysis Syndrome
| |
| #Hypercalcemia of Malignancy
| |
| #Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
| |
| | |
| ==== II. Hematologic ====
| |
| | |
| #Febrile neutropenia
| |
| #Hyperviscosity syndrome
| |
| | |
| ==== III. Structural ====
| |
| | |
| #Epidural Spinal Cord Compression
| |
| #Malignant Pericardial Effusion
| |
| #Superior Vena Cava Syndrome
| |
| | |
| ==== IV. Side Effects from Chemotherapy ====
| |
| | |
| #Diarrhea
| |
| #Extravasations
| |
| #Obstipation
| |
| | |
| == Physiotherapy Intervention ==
| |
| | |
| [http://ptjournal.apta.org/content/82/10/1009.full 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
| |
| | |
| <br>
| |
|
| |
|
| == Outcome Measures == | | == Outcome Measures == |
