Musculoskeletal Complications of Cancer

Issue title: Cancer and Its Effects on the Back and Musculoskeletal System

Subtitle: A Survey of 50 Patients

Guest editors: Michael J. BrennanIssue Editor

Article type: Research Article

Authors: Brennan, Michael J.^{a; b} | Warfel, Benjamin S.^b

Affiliations: [a] Rehabilitation Center of Fairfield County, Bridgeport, CT | [b] The New York Hospital – Cornell University Medical College, New York, NY

Abstract: A variety of complications associated with cancer may adversely affect the spine and musculoskeletal system, resulting in physical impairment, pain, or both. Dysfunction may arise because of tissue injury at the primary site of disease; from metastatic lesions and paraneoplastic syndromes; or as the result of treatment and bed rest. This study evaluated 50 patients seen in consultation by the Rehabilitation Service at Memorial Sloan-Kettering Cancer Center (28 retrospective, 22 prospective). Patients were evaluated for functional problems resulting from their disease or therapy. Patients were noted to have an average of 1.74 physical impairments. Thirteen (26%) patients had only one identifiable problem adversely affecting function. Fifty-four percent of patients were found to have two physical impairments. Ten patients (20%) had three or more such abnormalities. The mean Karnofsky score, a measure commonly used in assessing cancer patient function, at initial evaluation was 46.6 (standard deviation (SD) 12.05). The most frequently encountered problem limiting function was deconditioning (56%); 36% of patients had central nervous system dysfunction; 28% had peripheral neurologic disease; 22% of patients were found to have bone metastasis. Additionally, pain was present in 44% of all patients. These results suggest that it is common for cancer patients who are referred for physiatric evaluation to have more than one functional problem, and that deconditioning, neurological, and skeletal abnormalities are common causes of impairment in cancer patients. Cancer is a significant cause of morbidity and mortality in the United States.1 It is a disease process which is inherently destructive, both at the primary site as well as areas to which it may spread. Additionally, remote effects of cancer, such as paraneoplastic syndromes, may result in further compromise of the patient. Antineoplastic therapies such as chemotherapy, radiotherapy, and surgery are also potentially injurious to native tissues and organ systems. The deleterious effects of these direct and indirect consequences of cancer, whether affecting the musculoskeletal, nervous, cardiovascular, or pulmonary systems, may result in functional impairment and disability. Therefore, it is not surprising to find a high prevalence of disabilities among cancer patients.2,3 Significant functional impairment has been noted by previous authors.2,3 A variety of organ systems may be either primarily or secondarily involved, including the spine and musculoskeletal systems. These authors have demonstrated a high prevalence of functional deficits in cancer patients. Additionally, they noted that the majority of cancer patients with disabilities can be successfully treated by physical medicine intervention. The principal impediments preventing patients from obtaining optimal rehabilitation, as determined by these authors were: primary care physicians' inability to recognize functional impairment; and a lack of understanding by these same physicians in rehabilitation principles.2 The scope of musculoskeletal and neurological impairments, as well as the number of functionally compromising problems faced by the individual patient is less well known. The object of this survey was to evaluate a series of cancer patients, seen in consultation by a rehabilitation medicine service, for musculoskeletal, neurologic, and other relevant impairments.

Keywords: Physical impairments, Karnofsky score, deconditioning, CNS dysfunction, peripheral neurologic disease, bone metastasis

DOI: 10.3233/BMR-1993-3204

Journal: Journal of Back and Musculoskeletal Rehabilitation, vol. 3, no. 2, pp. 1-6, 1993