Cancer

Cancer survivorship definition

Any person with cancer diagnosis through end of life

Dietz model of cancer rehab?

Preventative, restorative, supportive, palliative

What are prehab and prospective surveillance?

P: rehab after dx before treatment begins

PS: periodical exam and ongoing assessment during and after tx

Benign vs malignant tumors

B: localized, non-invasive, slow growing, encapsulated
M: invasive, rapid growth, encapsulate in early stages

Local vs systemic treatment

L: surgery, radiation

S: chemotherapy, hormone therapy, targeted therapy/immunotherapy

Surgery for - and - -. The systems effected are -, -, -.

Tumor+ lymph nodes. Integumentary, MSK, lymphatic

Side effects of radiation?

Fatigue, ROM deficits, scar adhesions/immobility, pain, weakness, lymphedema, increased risk of other cancers

Chemo side effects?

Integ (alopecia/nails), GI (n-v/enterocolitis/mucositis/diarrhea), Nervous (CIPN/vestibular-balance/cognition), CVP (cardiotoxicity/CHF), fatigue, immunosuppression

Hormone therapy for which cancers?

• Side effects

Thyroid, prostate, breast

• Joint arthralgia, endocrine changes, sexual dysfunction/infertility, loss of muscle mass, HTN, cardiotoxicity

Breast Cancer

• Treatments

• Surgery

• Lymph node removal

• Reconstruction

• Common issues

• Surgery with axillary LN removal, rad, chemo, hormone therapy, immune modulators

• Lumpectomy, Mastectomy

• Axillary lymph node dissection, sentinel node biopsy

• Implants, lat flap, TRAM flap, deep inferior epigastric artery flap

• Lymphedema, cardiotoxicity, fatigue, CIPN, cognitive issues, ROM deficits, poor posture, functional loss, axillary web syndrome

Prostate Cancer

• Treatments

• Common issues

• Surgery with pelvic LN removal, radiation, hormone therapy, active surveillance

• Osteoporosis, fatigue, weakness, pain, CIPN, cognitive dysfunction/memory loss, lymphedema

Lung Cancer

• Treatments

• Common issues

• Surgical lung resection, chemotherapy, radiation, immunotherapy

• impaired pulmonary function, fatigue, pain, weakness, CIPN, cognitive dysfunction

Colorectal Cancer

• Treatments

• Common issues

• Surgical resection with pelvic LN removal, chemo, radiation

• Mobility issues, fatigue, lymphedema, weakness, pain

Gynecological Cancers

• Treatments

• Important vaccine

• Common issues

• Surgery with pelvic LN removal, chemo, hormones, rad, immuno

• HPV

• Lymphedema, incontinence, osteoporosis, fatigue, deconditioning, pelvic pain, sexual dysfunction, hot flashes

Melanoma

• Treatments

• Common issues

• Wide surgical excision with local LN removal, immuno/targeted, chemo, rad

• Lymphedema, severe scarring, reduced ROM, function, weakness/atrophy, osteoporosis, fatigue, deconditioning, axillary web syndrome

Bladder Cancer

• Treatments

• Common issues

• Surgery, intravesical therapy, chemo, rad, immun/target

• urinary issues, fatigue, neurotoxicity

Head and Neck Cancer

• Treatments

• Common issues

• Surgery with cervical LN removal, rad, chemo, immun

• Lymphedema, dysphagia/speech, radical dissections, weakness (sh/n/back/face), rad tissue fibrosis, scar tissue, decreased ROM, postural changes, TMJ/trismus

Talk me through the MSK system impacts from cancer/tx

Generalized/local mm weakness, reduced ROM, tight tissue, biomechanical changes, osteopenia/porosis, pathological fracture, joint stiffness/swelling/pain/immobility

Talk me through the Neurological system impacts from cancer/tx

Mild cognitive impairment, chemo-induced peripheral neuropathy (CIPN)

CIPN sx→ sensory/motor changes, functional loss, pain, gait impairments, muscle weakness, balance issues/fall risk

Talk me through the Cardiovascular + Pulmonary system impacts from cancer/tx

Chemotoxicity (cardiac muscle cell death), weakened pump, scar tissue on lungs

Talk me through the Integumentary system impacts from cancer/tx

Wounds, lymphedema, skin changes (scar adherence), radiation fibrosis, axillary web syndrome

Acute radiation (1-4m): erythema, desquamation, decrease in tissue healing

Sub-acute (4-12m): microcellular changes, fibrosis of tissue, collagen buildup

Chronic (1-8+yrs): Tissue restriction, immobility, lymphedema

What is axillary web syndrome?

Cording in axilla down medial arm, generally from surgery, lymphatic issue, painful abduction (shoulder flexion + elbow/wrist motions possible too)

Risk factors for AWS?

Lower BMI, younger age, more developed cancer, more invasive procedures, HTN

How to assess AWS?

Supine: Passive abduction of arm with supination until tension, palpate axilla/arm/trunk, assess location and number of cords, measure ROM and pain level

How do you treat AWS?

Manual therapy, lymphedema therapy, stretching/ROM, strengthening issues, meds (NSAIDs, antibiotics), patient education

For radiation, do not do PA for - hours after

2

Exercise Recommendations

• Aerobic

• Resistance

• 3×30 mins/wk

• 2×12-15 reps/wk for all major muscle groups

Red flags for metastatic cancer

• Bone

• Brain

• Lung

• Liver

• Lymph

• Idiopathic fractures/fractures that don’t match Mechanism of Injury

• Headaches, seizures, dizziness

• New onset dyspnea

• Jaundice, abdominal swelling

• Proximal swelling, pain, skin changes, neuropathy