Oncology Examination: Difference between revisions
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==== Diagnostic & Screening Measures ==== | ==== 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> | 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> | ||
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read more about the [http://www.mhs.com/product.aspx?gr=cli&prod=poms&id=overview POMS] | read more about the [http://www.mhs.com/product.aspx?gr=cli&prod=poms&id=overview POMS] | ||
=== 2. Pain Assessment === | |||
1. Visual Analog Scale | 1. Visual Analog Scale | ||
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=== 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 | 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 | ||
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[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> | [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 | 1. Peripheral Neuropathies--Chemotherapy induced | ||
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3. Motor Function Loss | 3. Motor Function Loss | ||
Radiation Plexopathy | Radiation Plexopathy | ||
== II. Neuromusculoskeletal Function (Movement Related Functional Assessment) == | == II. Neuromusculoskeletal Function (Movement Related Functional Assessment) == | ||
'''Posture''' | === '''Posture''' === | ||
'''ROM''' | === '''ROM''' === | ||
*Scar tissue formation after surgical resections, chemotherapy or radiation therapy. | *Scar tissue formation after surgical resections, chemotherapy or radiation therapy. | ||
*Fibrosis after irradiation. | *Fibrosis after irradiation. | ||
'''Strength''' | === '''Strength''' === | ||
*Muscle weaknesses from inflammatory intermediates produced by the tumor that are catabolic and cause muscle wasting (cachexia). | *Muscle weaknesses from inflammatory intermediates produced by the tumor that are catabolic and cause muscle wasting (cachexia). | ||
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*MMT | *MMT | ||
'''Balance''' | === '''Balance''' === | ||
Balance Dysfunction can be caused from any of the following | Balance Dysfunction can be caused from any of the following | ||
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*Timed Get up & Go Test | *Timed Get up & Go Test | ||
'''Gait''' | === '''Gait''' === | ||
*Kinetmatic Analysis | *Kinetmatic Analysis | ||
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== III. System Screening == | == III. System Screening == | ||
'''Cardiovascular''' | === '''Cardiovascular''' === | ||
*Cardiotoxicity can be a late effect of chemotherapy due damage o fthe cardiac myoctyes ultimately resulting in congestive heart failure. | *Cardiotoxicity can be a late effect of chemotherapy due damage o fthe cardiac myoctyes ultimately resulting in congestive heart failure. | ||
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#Echocardiogram to assess ventricular function, cardiac motion and output. | #Echocardiogram to assess ventricular function, cardiac motion and output. | ||
'''Hematologic''' | === '''Hematologic''' === | ||
'''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 | ||
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#Water Displacement Method of measuring limb volume | #Water Displacement Method of measuring limb volume | ||
'''Integumentary''' | === '''Integumentary''' === | ||
*With lymphedema, skin breakdown or infection can occur. | *With lymphedema, skin breakdown or infection can occur. | ||
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Uses Grades to assess severity of different conditions for example Lymphedema | 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. | ||
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*Patients are then at risk for pneumonitis or fibrosis. | *Patients are then at risk for pneumonitis or fibrosis. | ||
Measures | === Measures === | ||
#Vital signs (RR, HR, BP) | #Vital signs (RR, HR, BP) | ||
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== V. Functional Activities, Mobility & Self-Care == | == V. Functional Activities, Mobility & Self-Care == | ||
'''Measures''' | === '''Measures''' === | ||
*Functional Mobility Assessment | *Functional Mobility Assessment | ||
Revision as of 21:09, 28 January 2014
Original Editor - Elaine Lonnemann
Top Contributors - Elaine Lonnemann, Sehriban Ozmen, Admin, Kim Jackson, Fasuba Ayobami, Vidya Acharya and WikiSysop
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.[edit | edit source]
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[1] [2][3] Mental impairments can be indusced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[4]. 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[5]
read more about the Mini-Mental State Examination Measure & Link
Profile of Mood States[6]
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.[8]
b) Somatosensory[edit | edit source]
c) Neuromusculoskeletal[edit | edit source]
1. Peripheral Neuropathies--Chemotherapy induced
modified Total Neuropathy Score[9]
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[edit | edit source]
ROM[edit | edit source]
- Scar tissue formation after surgical resections, chemotherapy or radiation therapy.
- Fibrosis after irradiation.
Strength[edit | edit source]
- 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[edit | edit source]
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[edit | edit source]
- Kinetmatic Analysis
- Gait Speed Measurements
Gait Measures
- Tinetti Balance & Gait Scale
III. System Screening[edit | edit source]
Cardiovascular[edit | edit source]
- 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[edit | edit source]
Immunologic[edit | edit source]
- 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[edit | edit source]
- 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[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.
Measures[edit | edit source]
- 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[edit | edit source]
- 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.
- ↑ 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.
