Rehabilitation of Individuals with Cancer
Summary of Key Points
• As cancer treatment improves, more patients are living longer with functional limitations, and quality of life issues become as important as survival.
• Rehabilitation must be patient centered and goal oriented. It requires an interdisciplinary team and the active participation of the patient.
• Impairments, activity limitations, and participation restrictions from cancer dramatically impact quality of life but are amenable to rehabilitation efforts.
• The focus of rehabilitation varies with the phase of the disease process.
• Important impairments include pain, fatigue, cognitive dysfunction, mood disorders, paresis, feeding difficulties, bone and soft tissue involvement, and bladder, bowel, and sexual dysfunction.
• Activity limitations can be ameliorated with training in activities of daily living, exercise, and adaptive equipment.
• Participation in home, vocational, and recreational activities plays a critical role in quality of life. Economic burdens, environmental barriers, and transportation problems often need to be addressed.
1. Which is TRUE about the International Classification of Function?
A Impairment refers to the signs and symptoms exhibited by the patient.
B Activity limitations are easily predicted by the patient’s diagnosis.
C Participation refers to the individual’s role in society.
D There is a linear relationship between disease, impairment, activity limitation, and participation restriction.
2. Which statement is TRUE regarding rehabilitation after limb salvage surgery for osteosarcoma?
A There is a low risk of deep venous thrombosis.
B Healing may be delayed as a result of chemotherapy or radiation therapy.
C Motor strength and gait are preserved in most cases.
D The incidence of unintentional nerve injury is about the same as for total knee arthroplasty.
3. Which statement is FALSE about outcomes from inpatient rehabilitation for patients with cancer?
A Patients with spinal cord metastases have a far lower rate of discharge to home than those with traumatic spinal cord injury.
B Patients with traumatic brain injury have substantially greater functional independence measure (FIM) efficiency scores than do patients with brain tumors.
C Patients with amputations resulting from bone cancer have better functional outcomes than those with amputations resulting from vascular disease.
D Patients with cancer as a whole make statistically significant gains in function as measured by FIM scores during inpatient rehabilitation.
4. In the treatment of lymphedema, which condition is NOT a contraindication to performing complete decongestive therapy?
5. Which statement about spinal cord metastasis is FALSE?
A Nontraumatic spinal cord injury is more common than traumatic spinal cord injury.
B Weakness generally precedes pain as a symptom.
C About half of patients have autonomic dysfunction.
D Patients with spinal cord compression from cancer have shorter lengths of stay in inpatient rehabilitation than do those with traumatic spinal cord injury.
1. Answer: C. Disease refers to signs and symptoms caused by pathophysiology. The relationship between disease, impairment, activity and participation is nonlinear.
2. Answer: B. Patients with limb salvage surgeries are at high risk for venous thromboembolism and nerve injury.
3. Answer: A. Patients with spinal cord and brain metastasis are more likely to go home after an inpatient rehabilitation stay than are their counterparts with traumatically induced impairments.
4. Answer: D. Deep vein thrombosis, cellulitis, and pathological fracture are contraindications to decongestive therapy for lymphedema.
5. Answer: B. Weakness is often the first sign of spinal cord compression from metastasis. Half of patients will demonstrate autonomic dysfunction such as orthostatic hypotension or bowel and bladder dysfunction. Patients with spinal metastasis are more likely to be discharged home with a shorter length of stay compared with patients who have traumatic spinal cord injuries.
