Oncology Examination


Original Editor - Elaine Lonnemann

Top Contributors - Elaine Lonnemann  



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

I.  Mental Function, Pain & Somatorsensory Screening

Mental function can be affected by radiation and chemotherapy through the changes in the central nervous system[2] [3][4] Mental impairments can be indusced by inflammation, destructive autoimmune responses, toxicity levels and oxidative damage[5].  Emotional Functions may alos affect the ability of our patients to respond to and/or participate in physical therapy.

Diagnostic & Screening Measures

1.  Mental Status

              The Mini-Mental State Examination[6] 

                   read more about the Mini-Mental State Examination Measure & Link

              Profile of Mood States[7]

                   read more about the POMS

2.  Pain Assessment

                     1.  Visual Analog Scale

                     2.  Numeric Rating Scale

                     3.  Faces Pain Scale

                     4.  Brief Pain Inventory[8]

                     

3.  Neurological Assessment Measure

a)  Vestibular

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.[9]

b)  Somatosensory

c)  Neuromusculoskeletal

1.  Peripheral Neuropathies--Chemotherapy induced

          modified Total Neuropathy Score[10]

2.  Anesthesia/Dysesthesias

         with compression or surgical dissection of nerves

3.  Motor Function Loss

         Radiation Plexopathy

II. Neuromusculoskeletal Function (Movement Related Functional Assessment)

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

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

  1. 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

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

Integumentary

       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

  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

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

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


Shoulder Measures for Breast Cancer[11]

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

VI.  Psychosocial

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)

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References

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  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. 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.
  7. Cella D, Tross S, Orov E, et al. Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol. 1989;7:45–53.
  8. Cleeland C. Measurement and prevalence of pain in cancer. Semin Oncol Nurs. 1985;1:87–92.
  9. 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.
  10. Cavaletti G, Bogliun G, Marzorati L, et al. Grading of chemotherapy-induced peripheral neurotoxicity using the Total Neuropathy Scale. Neurology. 2003;61:fckLR1297–1300.
  11. 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