special topics

Why is PT important in oncology?

Cancer and cancer treatments cause weakness, deconditioning, decreased ROM, fatigue, balance deficits, neuropathy, pain, lymphedema, and functional loss that PT can address.

Why is exercise considered important before cancer treatment?

Prehab improves strength, conditioning, and physiologic reserve so the patient may better tolerate chemotherapy, radiation, or surgery.

What percentage of people diagnosed with cancer stop exercising?

About 30%.

What percentage of people exercise during cancer treatment?

About 16%.

Why is inactivity a major issue among cancer survivors?

It worsens deconditioning, fatigue, cardiovascular health, weight gain, and long-term function.

How many cancer survivors are currently in the United States?

Nearly 19 million.

How many cancer survivors are expected by 2040?

About 26.1 million.

What age group makes up most cancer survivors?

Adults older than 60.

Why does long-term survivorship matter for PT?

Many people live 10–20+ years after diagnosis, so PT helps manage long-term impairments and health risks.

What are common cancer treatments?

Surgery, chemotherapy, and radiation.

Why can chemotherapy increase the need for exercise?

It can cause deconditioning, cardiotoxicity, neuropathy, fatigue, and sometimes weight gain.

Why is cardiotoxicity important after chemotherapy?

Patients may survive cancer but later have cardiac complications, so exercise helps protect cardiovascular health.

Why is radiation often underestimated?

It can severely decrease energy and contribute to fatigue, fibrosis, ROM loss, and functional limitation.

What are common side effects of cancer and cancer treatment?

Impaired mobility, weakness, deconditioning, fatigue, swelling, decreased ROM, neuropathy, pain, balance problems, anxiety, and depression.

When can cancer patients exercise?

Before treatment, during treatment, after treatment, and during survivorship if medically appropriate.

What is the main rule for exercise during cancer treatment?

Exercise is usually appropriate, but must be modified based on symptoms, labs, precautions, and current medical status.

What does “good day/bad day plan” mean in oncology rehab?

The PT adjusts exercise intensity and type based on the patient’s energy, labs, symptoms, and tolerance that day.

If a patient is too medically fragile for the gym, what can PT do instead?

Room exercises, bed exercises, bodyweight activity, breathing exercises, walking as tolerated, or fall prevention education.

What does “if blood counts are too low for treatment, they are too low for exercise” mean?

Low blood values may require holding or modifying exercise because of infection, bleeding, fatigue, or safety risk.

What is the normal WBC range?

4,000–11,000/µL.

What does low WBC increase risk for?

Infection.

What is the normal platelet range?

150,000–400,000/µL.

What does low platelet count increase risk for?

Bleeding and bruising.

How should exercise change with low platelets?

Avoid high resistance, high impact, aggressive manual techniques, and activities with fall risk.

What is a lytic bone lesion?

A bone lesion that erodes or weakens bone.

Why are lytic bone lesions dangerous during exercise?

They increase risk of pathologic fracture.

What is a blastic bone lesion?

A bone lesion that increases bone density and usually does not weaken the bone as much as lytic lesions.

What should PT avoid with bone metastases?

Heavy loading, aggressive MMT, twisting, high impact, and anything that increases fracture risk.

A patient with bone mets reports new focal bone pain during resisted exercise. What should you do?

Stop or modify the activity and communicate with the oncology team due to possible fracture risk.

Why can cancer patients have balance problems?

Neuropathy, weakness, fatigue, medications, dizziness, and decreased sensation.

Why can chemotherapy-related neuropathy increase fall risk?

It decreases sensation in the feet, reducing balance input.

What hospital fall prevention education may be needed for oncology patients?

Use non-slip socks, call for help, manage lines/tubes, avoid rushing to the bathroom, and keep pathways clear.

What psychosocial factors should PT consider in cancer survivors?

Fear, depression, anxiety, acceptance of a new normal, appreciation for survival, and medication noncompliance.

Why might cancer survivors avoid medications?

They may be tired of taking medications after extensive cancer treatment.

What are PT goals in oncology?

Improve ROM, strength, balance, endurance, ADLs, function, edema/lymphedema management, fatigue, sleep, stress, and pain.

What is cancer-related fatigue?

Persistent fatigue related to cancer or cancer treatment that is not relieved well by rest.

What is the only strongly supported treatment for cancer-related fatigue discussed in lecture?

Exercise.

Why does rest alone not fix cancer-related fatigue?

CRF is improved by graded movement and physiologic adaptation, not inactivity.

Why does exercise help “chemo brain”?

Exercise may improve cognition, circulation, and overall physiologic function.

Why can exercise reduce recurrence risk?

It helps manage weight, BMI, cardiovascular health, metabolism, and overall activity level.

Why is BMI important in some cancers, especially breast cancer?

Higher BMI is associated with increased risk and recurrence.

What physiologic reserves do cancer patients often lack?

Cardiovascular, muscular, and energy reserves.

How is the physiologic response to exercise different in cancer patients?

The basic response is the same, but they fatigue faster due to lower reserve.

What does FITT stand for?

Frequency, intensity, time/duration, and type.

What is the general frequency guideline for cancer exercise?

3–5 times per week.

What is the general weekly moderate activity goal?

150–300 minutes per week.

What is the general weekly vigorous activity goal?

75–150 minutes per week.

What is the most important exercise principle for very fatigued cancer patients?

Any movement is better than no movement.

What is the “5-minute rule”?

Ask the patient to try 5 minutes of exercise; if they feel worse, stop, but many feel better and continue.

Why is the 5-minute rule useful?

It helps patients start moving despite fatigue or low motivation.

What intensity is usually appropriate for oncology exercise?

Low to moderate intensity.

What is the “talk but not sing” rule?

The patient should be able to talk during moderate exercise but not sing.

Why might HR not be reliable in cancer patients?

Medications, chemotherapy, fatigue, and physical status can affect HR response.

What should PT monitor during oncology exercise?

RPE, vitals, fatigue, pain, oxygen saturation when needed, balance, and symptoms.

A lung cancer patient’s O2 saturation drops and lips become purple while exercising, but he wants to keep talking. What should PT do?

Stop activity, enforce rest breaks, limit talking during recovery, and monitor O2 saturation.

Why might some oncology patients need to be slowed down rather than pushed?

Highly motivated patients may overexert beyond safe physiologic limits.

Why is baseline testing important in oncology rehab?

It gives a measurable starting point and helps track progress even when standardized tests are not possible.

What low-level test can assess endurance if a patient cannot do standard tests?

Marching in place or marching at bedside.

What should be documented during marching in place?

Duration, repetitions, and cadence.

What upper-extremity endurance test was discussed?

Alternating shoulder flexion overhead for as long as tolerated.

If standardized tests are too hard, what should the PT do?

Create a repeatable functional test and document it clearly.

What modes of exercise may cancer patients need?

Aerobic, resistance, stretching, balance, fall prevention, or mixed exercise.

What is the aerobic duration goal for cancer patients?

At least 10 minutes per session, progressing toward 20–60 minutes as tolerated.

What is the starting strength dosage?

1 set of 8–12 repetitions as tolerated.

How can duration be modified for deconditioned patients?

Use shorter, more frequent sessions such as 3 bouts of 10 minutes.

Why is long-term exercise adherence important in oncology?

It helps reduce recurrence risk, manage BMI, improve fatigue, and maintain function.

What questions help build a long-term exercise plan?

Ask what they enjoy, what they have access to, what is safe in their environment, and whether they like variety.

Why might walking not be realistic for some patients?

Their environment may be unsafe, such as narrow roads, hills, or no sidewalks.

What cancer type is most researched in PT oncology?

Breast cancer.

Why is breast cancer heavily studied in PT?

It is common and often causes UE ROM limitations that affect radiation positioning and function.

What are common classifications of breast cancer based on?

Where it starts, behavior, microscopic appearance, and hormone/protein response.

What is a lumpectomy?

Removal of the mass and surrounding tissue.

What is a simple or total mastectomy?

Removal of breast tissue.

What is a modified radical mastectomy?

Removal of breast tissue plus axillary lymph nodes.

What is a radical mastectomy?

Removal of breast tissue, axillary nodes, pectoralis major, and possibly pectoralis minor.

Why are radical mastectomies less common now?

Surgery is usually more tissue-sparing unless cancer location and severity require it.

What care may occur after breast cancer surgery?

Chemotherapy, radiation, lymphedema management, and rehabilitation.

What are common post-op impairments after breast cancer surgery?

Decreased UE/thorax/rib ROM, weakness, paresthesia, infection risk, seroma, lymphedema, hematoma, scar tissue, pain, fibrosis, and tightness.

What is a seroma?

A painful fluid-filled pocket after surgery.

Why can radiation cause long-term ROM issues?

Post-radiation fibrosis can continue for 4–5 years.

Why is shoulder ROM important before radiation?

Radiation positioning often requires the arm overhead.

What can happen if shoulder ROM is limited before radiation?

Radiation may be delayed while PT restores motion.

What should be included in pre-op PT for breast cancer surgery?

Education, precautions, baseline ROM/strength/circumference/BMI, early exercises, and lymphedema precautions.

Why take circumferential UE measurements pre-op?

To compare post-op swelling and monitor for lymphedema.

What shoulder motion precautions are used early after mastectomy?

Limit overhead reach and end-range forward reach for about 2 weeks.

What ROM limit is used while drains are still in place?

Keep shoulder below 90 degrees.

Should patients avoid all UE movement after mastectomy?

No, encourage allowed movement below precautions.

What distal UE exercises are taught early?

Hand gripping, elbow flexion/extension, pronation/supination, and isometrics.

What early shoulder/scapular movements can be used below 90 degrees?

Touch opposite shoulder, touch opposite knee, hair-combing motion, hands behind back, and gentle scapular exercises.

Why teach deep breathing after breast surgery?

To reduce risk of pulmonary complications such as pneumonia.

Why avoid prolonged dependent arm position after breast surgery?

It can worsen swelling/edema.

Why avoid staying in a sling position too long?

It promotes stiffness, edema, and guarding.

What exercise can begin immediately after breast surgery if medically appropriate?

Walking.

Why ask about breast reconstruction?

Tissue expanders or reconstruction may affect positioning, comfort, and exercise choices.

Why might prone be inappropriate after reconstruction planning or expanders?

Expanders may be hard, painful, or uncomfortable to lie on.

What are clean margins?

Cancer cells are fully surrounded by healthy tissue in the removed sample.

Why avoid aggressive manual therapy before clean margins are confirmed?

If cancer remains, further surgery may be needed and aggressive intervention may be inappropriate.

What exercises can begin after drains are removed?

Wall climbs, wand exercises, AAROM, towel stretches, pendulums, gentle PNF, and progressive scapular strengthening.

What are PT goals after breast cancer surgery?

Restore full UE ROM, proximal strength, scapular endurance, stability, and function.

What should PT consider when working with children?

Attention span, tolerance, communication, developmental stage, and caregiver involvement.