Original Editor - Elaine Lonnemann
- 1 Oncology Examination
- 2 I Mental Function, Pain & Somatosensory Screening
- 3 Diagnostic & Screening Measures
- 4 II Neuromusculoskeletal Function (Movement Related Functional Assessment)
- 5 III. System Screening
- 6 IV. Red and Yellow Flag Measures & Risk Patterns
- 7 V. Functional Activities, Mobility & Self-Care
- 8 VI. Psychosocial
- 9 References
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.
I Mental Function, Pain & Somatosensory Screening
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.
Diagnostic & Screening Measures
1. Mental Status
Profile of Mood States
2. Pain Assessment
3. Faces Pain Scale
3. Neurological Assessment Measure
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.
1. Peripheral Neuropathies: Chemotherapy induced
modified Total Neuropathy Score
with compression or surgical dissection of nerves
3. Motor Function Loss
II Neuromusculoskeletal Function (Movement Related Functional Assessment)
- Scar tissue formation after surgical resections, chemotherapy or radiation therapy.
- Fibrosis after irradiation.
- 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
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
- Functional Reach
- Berg Balance Scale
- Standard Romberg Test
- Tandem Romberg Test
- Timed Get up and Go Test
- Kinetmatic Analysis
- Gait Speed Measurements
- Tinetti Balance & Gait Scale
III. System Screening
- 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
- Echocardiogram to assess ventricular function, cardiac motion and output.
- Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels
- Limb Circumfrence Measurements Pre-op and Post-op
- Water Displacement Method of measuring limb volume
- 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
- 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.
- 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
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
Cancers that often present in the femur
Cancer and Cancer Treatment increases risk for Osteonecrosis
- Proximal or Distal Femur
- Proximal Humerus
V. Functional Activities, Mobility & Self-Care
- 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
- changing and maintaining body positions
- moving and handling objects
- 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
Shoulder Measures for Breast Cancer
- The Functional Assessment of Cancer Therapy Breast (FACT-B+4)
- Disability of Arm, Shoulder and Hand (DASH) questionnaires.
Consider the patients domestic life, interpersonal relations and major life areas.
assess participation in or attending community activities, reduced job expectations, etc
- Reintegration to Normal Living Index
Measures adults' perception of their ability to resume life roles after trauma or illness
- Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306.
- 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
- Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.
- 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.
- Davies C, Ryans K, Levenhagen K, Perdomo M. Quality of Life and Functional Outcome Measures for Secondary Lymphedema in Breast Cancer Survivors. Rehabil Oncol Vol 32 (1)p. 7-12