Oncology Examination

Original Editor - Elaine Lonnemann

Top Contributors -

Oncology Examination[edit | edit source]

Using the International Classification Framework Model for Assessment in Oncology Rehabilitation by Gilchrist LS, Galantino ML, Wampler M, et al.[1]  

I Mental Function, Pain & Somatosensory Screening[edit | edit source]

Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system[2][3][4] Mental impairments can be induced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[5].  Emotional Functions may also 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 measure

              Profile of Mood States[6]

                 

2.  Pain Assessment[edit | edit source]

                     1.  Visual Analog Scale

                     2.  Numeric Rating Scale

                     3.  Faces Pain Scale

                     4.  Brief Pain Inventory

                     

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.[7]

b)  Somatosensory[edit | edit source]

c)  Neuromusculoskeletal[edit | edit source]

1.  Peripheral Neuropathies: Chemotherapy induced

          modified Total Neuropathy Score[8]

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

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 of the 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[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

  1. Limb Circumfrence Measurements Pre-op and Post-op
  2. Water Displacement Method of measuring limb volume

Integumentary[edit | edit source]

       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]

  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[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


Shoulder Measures for Breast Cancer[9]

  • The Functional Assessment of Cancer Therapy Breast (FACT-B+4)
  • Disability of Arm, Shoulder and Hand (DASH) questionnaires.

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 of their ability to resume life roles after trauma or illness

References[edit | edit source]

  1. Gilchrist LS, Galantino ML, Wampler M, et al. A framework for assessment in oncology rehabilitation. Phys Ther. 2009;89:286–306.
  2. Ahles T, Saykin A. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Cancer.2002;3:S84–S90.
  3. 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.
  4. 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.
  5. 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
  6. Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.
  7. 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.
  8. Cavaletti G, Bogliun G, Marzorati L, et al. Grading of chemotherapy-induced peripheral neurotoxicity using the Total Neuropathy Scale. Neurology. 2003;61:fckLR1297–1300.
  9. 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