Cancer Rehabilitation Past Paper PDF

SPECIAL CONDITIONS ​ LEC #4: CANCER REHABILITATION Lecturer: Jon Timothy Rivero, MS, PTRP ​ 3rd Year, 1st Term, 2nd Shift, A.Y. 2023-2024 TABLE OF CONTENTS ○​Good news...

SPECIAL CONDITIONS ​ LEC #4: CANCER REHABILITATION Lecturer: Jon Timothy Rivero, MS, PTRP ​ 3rd Year, 1st Term, 2nd Shift, A.Y. 2023-2024 TABLE OF CONTENTS ○​Good news ○​Gives another problem as there are problems I.​ General Aspects for Rehabilitation that affect the daily functioning of these patients A.​ Rehabilitation Goals ​Rehabilitation goals are: II.​ Inpatient Rehabilitation ○​Restorative A.​ Steps to Wellness ○​Supportive B.​ Karnofsky Scale ○​Preventive C.​ Rehabilitation Priorities during Treatment ○​Palliative III.​ Outpatient Rehabilitation ​Functional decline of patients in palliative A.​ Precautions care IV.​ Cancer-related Pain V.​ Bony Metastatic Disease VI.​ Cancer-Related Fatigue VII.​ Exercise A.​ Exercises for Patients undergoing Chemotherapy B.​ Exercises for Patients who undergo Marrow Transplant VIII.​ Neurologic Complications of Cancer A.​ Metastatic Brain Disease B.​ SCI Involvement C.​ Polyneuropathy IX.​ Radiation-Induced Tissue Damage X.​ Lymphedema ​Everytime the disease progress, some XI.​ Impact of Cancer and Cancer Treatment on patients get well, but some decline Nutrition ​Vertical axis = functioning XII.​ Cancer-related Sexual Dysfunction ​Horizontal axis = life while condition XIII.​ Return-to-work after Cancer progresses XIV.​ Specific Tumors and Rehabilitation Needs ​The functioning of patients decline and XV.​ OMTs everytime there is a significant medical event XVI.​ Additional Reading(s) that happened, it can go down; if treated, it can go up or continuously go down until they GENERAL ASPECTS FOR REHABILITATION die ​Patients with CA live longer due to: ○​Supportive and Palliative goals are for chronic ○​Early detection or life-limiting illnesses (e.g., cancer) ○​A broad selection of treatment options REHABILITATION GOALS ○​Better medical management REHAB GOALS CONTEXT GOAL ​2nd leading cause of death in the US and the Restorative: aim to Patient has good To regain the ability Philippines return patients to a potential to regain to stand and ​Most common cancers include: previous level of sufficient strength transfer from bed to ○​Breast, lung, colorectal, liver, and prostate function and balance to chair independently ​189 of every 100,000 Filipinos are afflicted with transfer - within one week independently cancer Preventive: attempt Patient is at risk of To actively ​13th most common cause of self-reported to prevent avoidable deconditioning and participate in disability deterioration in further weakness activities of daily ​Throughout the years, detection and treatment of function related to arising from living to their cancer has already progressed; many survived disease or treatment inactivity optimal level of ​Patients diagnosed with cancer tend to live longer process (e.g., functioning - now than before weakening, LOM) ongoing 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson ​ ​ ​ ​ ​ 1  REHABILITATION GOALS improve cardiac health, more endurance and REHAB GOALS CONTEXT GOAL higher fitness level Supportive: focus Patient has To walk to the toilet ○​Ensure that patients will perform the exercise on maximizing insufficient balance independently using properly functioning, to walk to toilet a zimmer frame ​Requires to be very knowledgeable about independence and independently but is rather than being exercises participation in safe with support of dependent on the ​Cancer patients can be less functional prior to the meaningful activities a walking aid (e.g., assistance of a carer alongside disability problems in amb) - within two weeks program -​ Give AD or balance ​They can be very apprehensive at first exercises to ○​ This program enhances camaraderie and address prevent or lessen patients’ anxiety the risk of falls ​We can use Borg’s scale (RPE Scale) to see if the Palliative: involve Patient is unable to To safely access supporting people manage the stairs both levels of home patient can perform moderately difficult exercises, to adapt to and and will not regain using a stair lift - and monitor the amount of intensity they exhibit come to terms with this level of function within three weeks ​Seen in the video are general exercises after irreversible changes receiving cancer treatments (e.g., surgical, in function and chemotherapy, radiation therapy) associated losses or ○​Can provide these exercises during or better if to ‘habilitate’ to their done before the treatment new reality (e.g., can’t walk causing further frustration or KARNOFSKY SCALE tiredness; can give ​Used in classifying functional impairments or w/c) performance status in serious illnesses ​60% of ALL cancers occur in people >/= 65 years KARNOFSKY SCALE old PROGRESSION SCORE DESCRIPTION ○​Cancer is in our genes Mild 100 Normal; no complaints; no ○​As we grow old, there is a higher chance to evidence of disease activate these cancer cells Able to carry on 90 Able to carry on normal ​Relative survival normal activity and activity; minor signs or ○​35% in 1950's -> 51% in 1975-1977 -> 66% in to symptoms of disease 1996-2002 work; no special 80 Normal activity with effort; ​Increasing survival rate care some signs or symptoms of needed disease ○​CA with high survival rates: Breast and Prostate Moderate 70 Cares for self; unable to carry on normal activity or do active INPATIENT REHABILITATION Unable to work; able work STEPS TO WELLNESS: PHYSICAL REHAB FOR to live at home and 60 Requires occasional CANCER SURVIVORS (VIDEO) care for most assistance; able to care for personal needs; most personal needs ​A medically-based, exercise intervention for cancer varying amount of 50 Requires considerable survivors - to provide exercise opportunities for assistance needed assistance and frequent cancer survivors medical care ​Exercises are composed of resistance and aerobic Severe 40 Disabled; requires special care training and assistance ○​Evaluated by PTs, physician, mid-level Unable to care for 30 Severely disabled; hospital self; requires admission is indicated; death practitioner equivalent of not imminent ○​To avoid any issues that might arise institutional or 20 Very sick; hospital admission ​Trainers role is to: hospital care; necessary; active supportive ○​Help navigate patient to exercise programs disease treatment necessary ○​Help learn how to use the equipment properly, may be progressing 10 Moribund; fatal processes do different set-ups rapidly progressing rapidly ○​Monitor their heart rate to ensure patients that 0 Death they are exercising at a safe range that will still ​Also used by doctors and nurses 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 2  ​To be more accurate, they use the Australia-modified REHABILITATION PRIORITIES DURING CANCER Karnofsky Performance Status (AKPS) TREATMENT ○​Not much difference; only on description Initial Diagnosis AUSTRALIA-MODIFIED KARNOFSKY PERFORMANCE ​ Detect and manage acute morbidity from cancer STATUS treatments AKPS ASSESSMENT CRITERIA SCORE ​ Address worsening of premorbid physical impairments Normal; no complaints; no evidence of disease 100 ○​ Comes mainly after a comprehensive assessment Able to carry on normal activity; minor sign of 90 ○​ See strengths and limitations of patients symptoms of disease ○​ Pain (quality & location), ROM, Fatigue, appetite, Normal activity with effort; some signs or 80 ​ Can affect strength and endurance with exercises symptoms of disease ○​ Lifestyles & ADL’s Cares for self; unable to carry on normal activity 70 ​ Don't just ask generic questions, ask them what is or to do active work important in their lives Able to care for most needs; but requires 60 occasional assistance Surveillance Considerable assistance and frequent medical 50 ​ Physically recondition care required ○​ Pts are usually weak especially with progressive In bed more than 50% of the time 40 cancer Almost completely bedfast 30 ​ Detect and address delayed cancer treatment toxicities Totally bedfast and requiring extensive nursing 20 ○​ Leading cause for those who had undergone care by professionals and/or family treatment is cardiotoxicity Comatose or barely rousable 10 ​ Death dt medicine toxicity Dead 0 ○​ Exercises can help address this ​ Promote reentry into vocational , social, and family roles ​ ​CA = Non CA patients in terms of functional gains ○​ Quality of life would greatly depend on their function from inpatient rehabilitation ○​ Are they able to do the things they used to do or ○​Improvement in regular pts can be expected from things they would want to do now. those c cancer as well ​Functional improvements gained from inpatient rehab Recurrence is maintained 3 months after D/C ​ Screen for cancer treatment toxicities, given the increased risk ○​Once we see initial improvement, we can expect ​ Proactively manage early-stage impairments to see improvement for at least 3 months after ○​ Assess changes in function discharge ○​ Sir recommends frequent re-eval especially if change ○​Not necessarily an increase in life but overall a in function is observed better quality of life. ​Chemotherapy, radiation therapy and specific tumor Temporization type: NO adverse effect on rehabilitation outcome ​ Control symptoms ○​Regardless if pt is under chemotherapy or not, it ○​ We are mainly doing this with CA patients is still ideal that they are doing exercises. ○​ Not done alone, usually in collab c nurses, & doctors ○​ If we see new sx, it is good to communicate them to ○​Same improvement for all, normally an improve other members of the team in inc VO2Max ​ Prevent and proactively address disablement (caused by ​VO2Max can be an indicator of lifespan the disease itself) ​CA > Non-CA in incidence of transfer back to acute care from rehab ○​Risk factors for transfers: Low albumin, elevated creatinine, use of feeding tube or indwelling catheter ​Effects of cancer and its treatments ​Pts who are undergoing treatment have a higher chance of returning to acute care 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 3  REHABILITATION PRIORITIES DURING CANCER TABLE 29-1. FIVE-YEAR SURVIVAL STATISTICS FOR TREATMENT DIFFERENT CANCERS, 2004 TO 2010 Cancer Five Year Survival (%) Common Sites of Palliation ​ Preserve community integration Local Regional Distant Metastatic spread ○​ We don't want them to be isolated, for them to still Esophagus 40 21 4 Liver, lung do activities meaningful to them Pancreas 26 10 2 Liver ​ Support and educate caregivers/family members Urinary 69 34 6 Bone, intraperitoneal ○​ We involve caregivers or family members in our bladder overall goal From American Cancer Society: Cancer facts and figures ​ Maintain functional autonomy as feasible 2015, Atlanta, 2015, American Cancer Society ○​ Quote from proponent of modern palliative care ​Local - in one organ “Goal is to enable patients to live as actively as possible” ​Regional - spreads around one organ ○​ We should strive to support our patients' goals ​Distal - evident metastasis to other organs despite their condition, even if their function level is ​When metastasis occurs, Five Year Survival rate decreasing. decreases significantly. ○​ We can adjust the to fit their level of function to ​Breast cancer patients have a high five-year survival achieve their goal rate if cancer does not metastasize. Prostate cancer ​ Pt goal was to walk to attend mass. Di daw kaya patients have a higher five-year survival rate than so adjusted nalang na mass via W/C breast cancer patients. ​Prostate cancer develops in geriatric patients. This ​Prognosis and the patient’s general tolerance should cancer has a very good prognosis, and patients will be weighed in making inpatient rehab decisions more likely die due to aging than the complications ○​Just because prognosis is poor, it doesn't mean and effects of cancer. that we would not try to help them ○​Cancer = palliative care OUTPATIENT REHABILITATION ​Poor expected long term survival is not a ​Addresses musculoskeletal problems (lymphedema, contraindication to inpatient rehab if functional gains contracture, pain, mobility, ADLs, self-care) are to be expected ​Functional gains of patients who are in the advanced CANCER REHABILITATION (COLUMBUS REGIONAL stage of the disease should include family/caregiver HEALTH) training Julie Abedian (President, CRH): The mission and vision of CRH is TABLE 29-1. FIVE-YEAR SURVIVAL STATISTICS FOR really to be focused on the health and well-being of the communities DIFFERENT CANCERS, 2004 TO 2010 that we serve and the cancer Cancer Five Year Survival (%) Common Sites of rehab services are a really Local Regional Distant Metastatic spread wonderful example of how CRH Lung and 54 27 4 Brain, bone, liver, does that. Bronchus mediastinal lymph Zachary Siegel, MD: (CRH nodes Doctor): Rehab in general can improve their quality of life by Breast 99 85 25 Brain, lung, bone, liver limiting the amount of pain that Prostate >99 >99 28 Bone, pelvic lymph they’re having on a day to day nodes basis. Colon and 90 71 13 Liver, lung rectum Shayla Holtkamp (Physical Therapist): Cancer related fatigue Ovary 92 72 27 Peritoneum, pleura is one of the most prominent side Uterine 91 57 16 Peritoneum, lung, effects from chemotherapy, cervix retroperitoneal lymph exercising can help increase your nodes energy levels. I’m an 18-year Uterine 95 68 18 Retroperitoneal lymph breast cancer survivor and while I corpus nodes, lung was going through treatment I was taking fitness classes and walking Pharynx 83 61 37 Lung, regional lymph and I know that all of that work for and oral nodes me. cavity Melanoma 98 63 16 Brain Stomach 64 29 4 Liver, lung, peritoneum 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 4  Nancy Clark (Cancer Survivor): I ○​As a result of cancer treatment think the programs enhanced my ○​Causes behavior changes, seizures, headache, life because I think I feel better and I’m more active and I feel delirium more confident. ​Some experience delirium because of the increase in toxins that circulate the blood ○​May be due to kidney damage - toxins are not Amy Swinford (Physical Therapist): Cancer is more of a excreted/filtered properly chronic disease these days than a ​Orthostatic Hypotension death sentence. Its a big slam in ○​If pt has been bed bound for awhile and life but if you can turn it into just a suddenly stands up expect OH since they are not blip in your life you can go on and you can get past it. used to upright position Exercise is really important for your patients whether it would be ​HR > 110 bpm building their endurance again or just in general conditioning ○​Need clearance from MD before participating in exercise PRECAUTIONS ○​Exercise is not performed in pts with high HR ​Hematologic profile since it can cause further increase in HR which ○​What we look for is the hemoglobin will put the pt a risk ​Lower hemoglobin levels = decreased ○​Important to monitor exercise capacity ​Fever >101 F / >38C ​Important for us to know the average values ○​PTs do not treat pts with fever since there is an and the effects of going beyond or below the infectious process going on normal values ○​Most important if they are undergoing ​eg. platelets, RBCs (cancer and radiation chemotherapy, as it should not cause a fever therapy can affect bone marrow) ○​Stop the patient and consult with the doctor ​Patients can be fatigued easily if they are anemic. CANCER-RELATED PAIN ​Metastatic bone disease ​60% of patients experience pain (25-30% severe ○​Pt are not allowed to carry heavy weights, also pain) high-intensity activities due to the risk for ○​Follow level/hierarchy of drugs for pain Mx pathologic fractures because of a tumor in the ​(+) pain with other associated symptoms - bone which makes it weaker. decreased functional status ○​Pain medications may help the patient if they are ​First line of rx: Non-opioid analgesics immobile, but pain may persist if they move. Pain ​Opioids control may not be enough so the PT must ○​Morphine communicate with the doctor since our goal is to ​There are some hesitations regarding pts help the patient function. who use morphine as it can be addictive ​Compression of a hollow viscous vessel or spinal ​Regulated cord ○​It is still used to control immense pain, and ○​Cancer cells metastasize and may impinge the prevent pts from being bedridden (d/t pain) spinal cord which can lead to loss of function and decline in ​Thoracic level impingement = possible QOL paraplegic pt ​Timeframe (acute, crescendo, chronic) ​Fluid accommodation in the pleura, pericardium, ○​Crescendo - increasing pain abdomen or retroperitoneum ​Pathophysiology (somatic/visceral/neuropathic) ○​Results to resistance to movement of ​Temporal (continuous, intermittent, breakthrough) cardiovascular organs which leads to decreased ○​Breakthrough - even if they are on pain exercise capacity medications, severity of pain increases. If this ​CNS depression or coma happens, adjunct pain Mx such as drugs will be ○​Usually palliative care and are bed bound given (regulated by oncologist or palliative care ​Hypo/hyperkalemia, hyponatremia or MD)). hypo/hypercalcemia ○​Electrolyte imbalance ○​Depending on the pt’s treatment 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 5  ​Nonpharmacologic pain management approaches VIDEO: Biofeedback Shoulder Weakness Head ○​Cryotherapy and Neck Cancer Orange County Oncology ○​Biofeedback Rehab Progressive PT ○​Iontophoresis Application of biofeedback ○​TENS in order to improve scapular ○​Massage control. ○​Relaxation techniques After surgery for cancer, ○​Meditation sometimes they take out ○​Art/Music therapy the SCM which gives ○​Counseling you support from the front of the shoulder. ○​Aromatherapy Muscles in this area get NOTE:There are different theories surrounding pain weak (*highlighted in the perception, but there is only one biological aspect for it. picture). Pain has a biopsychosocial aspect, and as PTs, it is good to approach pain Mx using this model. The biofeedback tells us if the the patient is giving a good contraction of the specific VIDEO: What is Biofeedback Training at The Perth target muscles. Brain Centre? ​Biofeedback training helps people control their brain and body’s response to stress “The next one I want you to ​In the clinics, special sensors are attached to the do is to keep your arm out body (to the ears or fingers), and around the chest. and then go to the front.” Signals such as HR variability and breathing are Pt also placed the arm at measured. his back (towards shoulder ​Using specialized hardware and software, which extension). provides real-time feedback, the person can learn to control these key responses ​Initially, when they consciously try, and with regular practice at home, these stress responses work better automatically without having to try. ​NASA, the United States military, police forces, and emergency services around the world, and many top “Sit up straight and hold olympic sports teams have been using biofeedback this arm here and try to get this muscle to come in and for years to improve performance and resilience to let’s hear it (machine beeps stress. faster) and hold it.” ​Research shows that biofeedback training can help people with problems like anxiety, depression, chronic pain, headaches including migraine, and irritable bowel syndrome. ​In clinics, biofeedback training is seen to help conditions that are dysautonomia such as postural orthostatic tachycardia syndrome or POTS. “What I’m gonna have you do is I’m gonna resist you coming back this way.” 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 6  “Now, pull back in and let ○​Common in the thoracic spine and shaft of femur the arm bend and now go ​Weight loss, point of tenderness over the involved up. You hear that buzz, ​bone, neurological impairment (especially if in the that’s it.” spine) Biofeedback for strength and ​Triple phase bone scan conditioning is just one of the tools we use in a comprehensive rehabilitation program for neck and cancer patients. Biofeedback for strength and conditioning is just one of the tools we use in a comprehensive ○​Most sensitive in identifying bony metastasis rehabilitation program for ​MRI neck and cancer patients. ○​Patients with localized bone pain, equivocal scan, or neurologic impairment BONY METASTATIC DISEASE ​PET Scan ​Metastasis to the skeleton is the most problematic ○​When the lesion is osteoclastic situations for clinicians ​Survival Rate (after metastasis (pagkalat)) ○​Makes it difficult for the pt to move, painful ○​21-33 months ○​Bones become weaker, increases risk for fx ​Skeleton: 3rd most common for systemic metastasis ​Mx: Protection, pain control, energy conservation, ○​Common because sobrang connected ang maintenance of function bones sa circulatory system ○​Protection and pain control ​80% of bone metastasis is attributed to breast, lung ​Bracing (prevent fx), mobility aids (AD), prostate, kidney, and thyroid cancers activity precautions (educate pt on the risks) ​Bony metastases: ​Pain control and function preservation ○​Osteolytic - nasisira ang buto ​Neutral spine techniques (mobility) ○​Osteoblastic - mas lumalaki/dense ang buto ​Exercise prescription should focus on: ○​Mixed ○​Strength ○​Endurance ○​Function with limited loading or torsion of the affected bone (less stress on affected bone to prevent fx) VIDEO: Nuclear Medicine: Tell me about three phase bone imaging... with Dr. Sid Crawley ​3-Phase Bone Imaging ​This is the most frequent nuclear type-imaging study. ​It is used to evaluate vascular flow, blood pool ​Highest rate of osteoclastic activities: lymphoma, activity, and delayed bone uptake. multiple myeloma, thyroid, and renal cell ​This imaging allows for limitation of the scope of malignancies imaging to a particular region such as the knees, hips, or shoulders. ​Pain ​This type of imaging evaluates for osteomyelitis or ○​Most insidious clinical presentation of bony bone infection vs. cellulitis or soft tissue infection vs. metastases stress fx vs infected joint. ○​Insidious, unrelenting, not associated with trauma or activity, present or worse at rest 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 7  CANCER-RELATED FATIGUE ​Interventions are not exclusive for any ​Great challenge for PTs, as pts may not meet high professional; bleeds into different practices levels of exercise, or at least moderate physical such as nurses, counselors, doctors, PTs activity ○​Deconditioning ○​May be d/t cancer treatment ○​Steroid myopathy ​Pathological when it persists, occurs during our ○​Centrally acting medications usual activities and does not respond to rest ○​Altered oxidative capacity ​Assessment and Rx is central goal of rehabilitation ​CV endurance improves, VO2max increases ​Used of mild/moderate/severe based on a 0-10 likert ○​Pain scale ​Non pharmacological methods for PT ○​1 to 3 = mild intervention ○​4 to 6 = moderate ○​Adrenal insufficiency ○​7 to 10 = severe ○​Cachexia ​OMT used: FACIT Fatigue Scale EXERCISE FOR THE CANCER PATIENT ○​Measures how much a patient’s ADLs are ​Gains in CV endurance, fatigue, QOL, depression, affected by their fatigue anxiety, and in immune functions ○​Higher score = better QOL ​Obesity has been associated with increased risk of death for cancer ​Most common associated factors: ○​OW and obesity account for 14% cancer deaths ○​Pain in men ○​Emotional distress, sleep disturbance, anemia, ○​OW and obesity account for 20% of cancer nutritional deficiencies, deconditioning, medical deaths in women comorbidities ​30 minutes of moderately vigorous exercise on 5 ○​When treating patients, we are not just purely or more days of the week (45 to 60 mins for adults, PTs – our scope of practice is not limited 60 mins for children) ​We should be aware of the different factors ○​Min 150 per week that contribute to the pt’s condition ​Cycle ergometry is the most favored type of aerobic ​For other factors in the aspect of their life, exercise not just physical ○​non-WB, easier ○​When we see emotional distress, it can affect our ​Precautionary measure is taken with goals thrombocytopenic patients ​Refer them to social workers, counselors, ○​Unrestricted exercises can be pursued with doctors to address >30-50k ○​There are dietary changes for patients so it ○​Aerobic exercise okay in patients with platelets needs to be addressed as well >10-20k ​Strengthening endurance programs, nutritional ​If count is lower, we have to be more careful management, sleep optimization ○​Active therapy not advocated with platelet ○​Should be maximized as all of these will affect count motor nerves their lifestyle and not just limited for 21 weeks ​Dysesthesias, sensory loss, allodynia ○​We know that there will be a long term effect of ○​Altered sensation of these patients cancer treatment and their condition itself to their ○​We would have to do assessments as well if we heart see that they have metastasis to the neurological ​Aerobic training 3x/week for 15 weeks improves system endurance RADIATION-INDUCED TISSUE DAMAGE EXERCISE FOR PATIENTS UNDERGOING MARROW TRANSPLANT TABLE 44.7 RADIATION THERAPY SIDE EFFECTS Acute Delayed ​Supine or sitting exercises well tolerated ​Supine exercises with the head of the bed elevated ​ Fatigue ​ Soft-tissue fibrosis ○​To avoid hypotension and be used to the upright ​ Nausea ​ Skin atrophy position ​ Vomiting ​ Auditory changes ​Standing exercises for brief periods to avoid ​ Anorexia ​ Pulmonary fibrosis gastroc-soleus tightness ​ Skin erythema ​ GI structure ​ROM, aerobic exercise (walking, cycle ergometry), ​ Desquamation ​ Thyroid dysfunction 1 light resistive exercises, deep breathing exercises ​ Mucositis ​ Brain necrosis ​ Xerostomia2 ​ Myelitis ​ Taste loss ​ Plexopathy NEUROLOGIC COMPLICATIONS OF CANCER ​ Proctitis ​ Lymphedema METASTATIC BRAIN DISEASE ​ Cystitis ​ Secondary ​ Decreased libido malignancies ​Most common catastrophic neurologic ​ Sterility ​ Osteonecrosis impairment in the cancer population ​ Amenorrhea ​Occur most frequently with lung, breast, colorectal, ​ Hematological melanoma, and genitourinary cancers changes ○​If the brain spreads to the cancer, we will see 1 neurologic symptoms Dryness of or inflamed mucosal membrane 2 ​85% in the cerebrum, 15% in the cerebellum Dryness of mouth ​Progressive HA, hemiparesis, seizures, mental status LYMPHEDEMA change ​Most common malignancies associated with ​Magnetic resonance imaging lymphedema ​Leptomeningeal disease ○​Breast cancer → one of the most common type ○​Back pain, radiculopathies, cranial nerve ○​Melanoma dysfunction, mental status changes ○​Gynecological malignancies ​Includes cancer of the ovaries SPINAL CORD INVOLVEMENT ○​Lymphoma ​Occurs in 5-14% of all CA patients ​Most common sources: metastases from prostate, NOTE: Since the cancer cells travel along the lymph, it may breast, lung, and kidney, multiple myeloma also affect the flow of the lymphatic circulation ​Areas of predilection: ○​Thoracic spine - 70% ​Painless, gradual and colorless swelling with ○​Lumbar spine - 20% heaviness and loss of limb contour ○​Cervical spine - 10% ○​Similar to elephantiasis ​Progressive, insidious back pain worse when lying ​Reduced symptoms, preserve cosmesis, maintain, ​down function, decrease the risk of recurring infection ​S/Sx: Point tenderness, paresis, sensory impairment, ​Resolved through Complexion decongestive upper neuron lesion findings therapy (MLD) ○​Decongestive phase POLYNEUROPATHY ○​Maintenance phase ​Chemotherapy-induced ​As PTs, we do: Skin care, stretching, soft tissue ​Disruption of axoplasmic microtubule transport, mobilization to proximal limbs axonal "dying back", has direct effects to the DRG 3PTC: Bargas, Duldulao, Katigbak, Maravilla, Santos, Tiangson 9  ○​Phantom breast pain NOTE: ​We can perform anthropometric measurements to ○​incisional allodynia monitor if there is a progression or improvement in there ○​neuroma formation condition ○​pectoralis muscle pain ○​Intercostal neuropathy ​Cutaneous desensitization, soft tissue mobilization, stretching, shoulder ROM, thermal modalities with caution ○​If cold modalities works on the patient, we must opt for the cold modalities instead of heating ​What we can do as PTs modalities ○​ Massage, bandaging ​Breast cancer-related shoulder dysfunction ○​d/t operation IMPACT OF CANCER AND CANCER TREATMENT ○​>50% affected and is the most common long ON NUTRITION term morbidity MALNUTRITION HEAD AND NECK CANCER ​Serum albumin