Oncology: Difference between revisions
No edit summary |
No edit summary |
||
Line 1: | Line 1: | ||
<div class="editorbox"> | <div class="editorbox"> | ||
'''Original Editor '''- | '''Original Editor '''- [[User:Elaine_Lonnemann|Elaine Lonnemann]] | ||
'''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== | |||
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> |
Revision as of 16:04, 5 February 2013
Original Editor - Elaine Lonnemann
Lead Editors - Your name will be added here if you are a lead editor on this page. Read more.
Introduction[edit | edit source]
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[1].
Physiology[edit | edit source]
Conditions[edit | edit source]
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[edit | edit source]
Using the International Classification Framework Model for Assessment in Oncology Rehabilitation[2][3]
by Gilchrist LS, Galantino ML, Wampler M, et al.
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[4] [5][6] Mental impairments can be indusced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[7]. 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[8]
read more about the Mini-Mental State Examination Measure & Link
Profile of Mood States[9]
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.[11]
b) Somatosensory[edit | edit source]
c) Neuromusculoskeletal[edit | edit source]
1. Peripheral Neuropathies--Chemotherapy induced
modified Total Neuropathy Score[12]
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
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[edit | edit source]
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.
- 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
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
- 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
Medical Management[edit | edit source]
Oncological Emergencies[edit | edit source]
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[13].
I. Metabolic
[edit | edit source]
- Tumor Lysis Syndrome
- Hypercalcemia of Malignancy
- Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
II. Hematologic[edit | edit source]
- Febrile neutropenia
- Hyperviscosity syndrome
III. Structural [edit | edit source]
- Epidural Spinal Cord Compression
- Malignant Pericardial Effusion
- Superior Vena Cava Syndrome
IV. Side Effects from Chemotherapy[edit | edit source]
- Diarrhea
- Extravasations
- Obstipation
Physiotherapy Intervention[edit | edit source]
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
Outcome Measures[edit | edit source]
Recent Research from Physiospot[edit | edit source]
References[edit | edit source]
- ↑ 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
- ↑ International Classification of Functioning, Disability and Health: ICF. Geneva,Switzerland: World Health Organization; 2001
- ↑ 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.
- ↑ 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.
- ↑ Higdon M et. al. Treatment of Oncologic Emergencies. Am Fam Physician 2006; 74: 1873-80