Oncology Examination

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (17/11/2023)


Introduction[edit | edit source]

A study [1] was published before to guide rehabilitation therapists who provide oncology rehabilitation to choose appropriate measurement tools that are relevant to the three human function domains (body functions and structure, activities, and participation) of the International Classification Framework (ICF) developed by the World Health Organisation (WHO).

The study included measurement tools that have been used in oncology research so far since the time it was published, without considering the reliability, validity, or responsiveness of the particular outcome measure. However, some of those measurement tools were commonly used by physical therapists, and some were specifically developed for oncology populations. The study also categorised the measurement tools areas under the ICF domains, as shown in the following table.

Body Function and Structure Activity and Participation
Mental Functions Mobility
Sensory Functions and Pain Self-care
Neuromusculoskeletal and Movement-Related Functions and Structures Domestic Life, Interpersonal Relations, and Major Life Areas
Functions of the Cardiovascular, Hematologic, Immunologic, and Respiratory Systems
Diagnostic Measures of Body Function and Structure Indicating “Red Flags” or “Yellow Flags” for Physical Therapists

This specific page aims to provide comprehensive and up-to-date information to clinicians by including measurement tools used in recent oncological studies as well as measurement tools included in the above-mentioned study. The page format aligns with the categorisation shown in the table to maintain continuity.

Measurement of Body Function and Structure[edit | edit source]

Mental Function[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.

Outcome Measures:

Sensory Functions & Pain[edit | edit source]

Sensory functions may be affected by neoplasms such as a Vestibular Schwannoma which may cause unilateral dysfunction or chemotherapy drugs such as Cisplastin.

Outcome Measures For Sensory Functions:

  • Dizziness Handicap Inventory Questionnaire: 25 items assess the impact of disequilibrium on functional activities.[7]

Outcome Measures For Pain:

Neuromusculoskeletal Function & Movement-Related Functional Assessment[edit | edit source]

Peripheral Neuropathies (chemotherapy induced), Anesthesia/Dysesthesias (with compression or surgical dissection of nerves), Motor Function Loss and Radiation Plexopathy, range of motion limitation (due to scar tissue formation after surgical resections, chemotherapy or radiation therapy and fibrosis after irradiation) may occur. Muscle functions can be affected by any of the following:

  • 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)

Balance dysfunction can be caused from any of the following:

  • Sensory input
  • Central processing of balance-related information
  • Range of motion limitations
  • Orthostatic hypotension
  • Muscle weakness
  • Peripheral neuropathies from taxane

Outcome Measures:

Functions of Body Systems[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.

Outcome Measure:

  • Echocardiogram to assess ventricular function, cardiac motion and output.

Hematologic[edit | edit source]

Outcome Measure:

Complete blood count

Immunologic[edit | edit source]

  • Damage to lymph vessels by tumor obstruction, surgical resection of lymph nodes, radiation leading to fibrosis of the lymph vessels.

Outcome Measures:

  • Limb Circumfrence Measurements Pre-op and Post-op
  • Water Displacement Method of measuring limb volume

Integumentary[edit | edit source]

  • With lymphoedema, skin breakdown or infection can occur.

Outcome Measure:

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.

Outcome Measures:

Red and Yellow Flag Measures & Risk Patterns[edit | edit source]

  1. 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

2. Cancers that often metastasize to the spine:

  • Prostate
  • Breast
  • Lung
  • Colon

3. Cancers that often present in the femur:

  • Sarcoma

4. Cancer and it's treatment increases risk for osteonecrosis in the following regions:

  • Proximal or Distal Femur
  • Proximal Humerus
  • Jaw
  • Metatarsals

5. Other Risks:

  • Osteoporosis
  • Neutropenia
  • Thrombocytopenia

Measurement of Activity and Participation[edit | edit source]

Functional Activities, Mobility & Self-Care[edit | edit source]

Outcome measures for mobility assessment:

  • 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 ask patients to indicate the level of difficulty they experience in dressing, grooming, mobility, work, sports, and leisure.
  • Changing and maintaining body positions
  • Carrying
  • Moving and handling objects
  • Walking
  • Moving around using transportation


Outcome measures for self-care:

  • 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.

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.

Outcome 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, Marchese VG, Morris GS, Ness KK. A framework for assessment in oncology rehabilitation. Physical Therapy. 2009 Mar 1;89(3):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