Journal of Back and Musculoskeletal Rehabilitation - Volume 3, issue 2

Authors: LaBan, Myron M.

Article Type: Research Article

Abstract: The specialist in physical medicine and rehabilitation, joining with medical and surgical colleagues, can contribute special skills to both the diagnosis and management of complications related to neoplastic diseases and their treatment. The multifaceted team approach—lending the skills of the physiatrist and the physical, occupational, and speech therapists as successfully employed in the rehabilitation of chronic neuro-musculoskeletal disability—can with equal facility be utilized in the management of the cancer patient. Although in these instances the rehabilitative goals of caring for patients with spinal metastatic disease may remain essentially the same, treatment time is often telescoped by progressive disease requiring frequent …accommodation to the staging of functional levels of locomotion and self-care. The direct or remote effects of the cancer itself; the residual effects of radical surgery, and the toxic side effects of chemoprophylaxis and radiotherapy, combined with a sympathetic understanding of the dying process, individually or collectively are challenges the physiatrist has to master to become a productive member of the oncology treatment team. In this role the physiatrist can bring to bear his or her considerable diagnostic expertise in the neuro-musculoskeletal clinical and electroneuromyographic evaluation of spinal pain and weakness syndromes as well as their treatment. Realistic expectations, tempered by a knowledge of the natural history of the specific malignancy and the presence of associated comorbidities of pain, asthenia, and weakness, separately and together can influence the rehabilitation effort to restore patients to their fullest psychological, social, vocational, physical, avocational, and educational potential.1 Show more

Keywords: Physiatric management, spinal metastases, radiotherapy, cancer pain

DOI: 10.3233/BMR-1993-3211

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 3, no. 2, pp. 69-77, 1993

Authors: McDonnell, Mary Ellen | Shea, Bernadette D.

Article Type: Research Article

Abstract: The American Cancer Society estimates that in 1991 over seven million Americans were alive despite a diagnosis of cancer.1 As the medical community becomes more successful in prolonging the lives of cancer patients, a significant number will experience the resultant disability of cancer and its treatment. Those with advanced disease may find the quality of their lives to be profoundly compromised. The role of rehabilitation with the latter population is to maximize the patients' functional capabilities and to conserve their limited energy reserves. Clearly, quality of life is an overriding issue fix this population. The development of bony …metastases is devastating for the cancer patient and presents a considerable challenge for the physical therapist. Approximately 50% of patients with breast, lung, or prostate cancer will develop bony metastases. Less common, though equally problematic, are bone metastases in patients with carcinoma of the kidney, pancreas, bladder, thyroid, and cervix. Patients with advanced disease present a complex clinical picture. It is imperative that the physical therapist consult and confer regularly with the oncologist, physiatrist, and/or orthopedist to remain abreast of the patient's changing clinical picture. Information vital to safe and effective rehabilitation includes the presence, location, and extent of bony metastases, involvement of bone marrow potentiating refractory pancytopenia, infection, and hypercalcemia secondary to prolonged immobility. In patients with metastatic disease to bone, it is not sufficient to rely solely on plain X-ray findings. Plain radiographs will not detect bone lesions unless a sufficient amount of matrix is destroyed (30–50% of bone matrix must be involved to be visualized). Bone scan results should be assessed prior to establishing a rehabilitation program for most cancer patients. Patients with advanced disease frequently present with pain, neurologic deficits, impending or pathologic fractures, and generalized weakness associated with prolonged immobility. Any new complaints of pain, or findings of progressive weakness should be discussed with the patient's physician in order to initiate an appropriate work-up. Show more

Keywords: Oncology rehabilitation, physical therapy, pain, metastases to bone

DOI: 10.3233/BMR-1993-3212

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 3, no. 2, pp. 78-84, 1993