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Ruppert L, de Vries K. Role of Rehabilitation in Spine Tumors. Am J Phys Med Rehabil 2024; 103:S28-S35. [PMID: 38364027 DOI: 10.1097/phm.0000000000002396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT Primary and metastatic spine tumors can lead to devastating complications, but timely and careful management of these patients can improve outcomes. A multidisciplinary and structured approach is the most effective way to evaluate patients with spine disease and mitigate the risk of complications. The neurologic, oncologic, mechanical and systemic disease framework gives comprehensive guidance to providers regarding appropriate management. Physiatrists play a critical role in these patients' initial evaluation and continued management throughout cancer treatment. Patients with spinal cord involvement have extensive needs, requiring an individualized management approach. Even though patients with nontraumatic spinal cord injury benefit from rehabilitation efforts and have improved outcomes, they are not routinely admitted to inpatient rehabilitation units or referred to outpatient cancer rehabilitation. Ongoing efforts are needed to promote rehabilitation medicine involvement in improving functional outcomes and quality of life for patients with spine involvement.
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Affiliation(s)
- Lisa Ruppert
- From the Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York (LR); Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York (LR, KdV); and Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York, New York (KdV)
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Harris SR. Brachial plexopathy after breast cancer: A persistent late effect of radiotherapy. PM R 2024; 16:85-91. [PMID: 37272709 DOI: 10.1002/pmrj.13007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/20/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023]
Abstract
Radiation-induced brachial plexopathy (RIBP) is an iatrogenic, progressively disabling, and often very late effect of adjuvant radiotherapy most commonly seen in breast cancer survivors but also in those treated for lymphoma, lung, and head and neck cancers. In late-onset RIBP following breast cancer, the nerve injury is chronic and irreversible, occurring more commonly when axillary and/or supraclavicular nodes have been irradiated, as well as the breast/chest wall. RIBP is manifested initially by paresthesia, hypoesthesia, dysesthesia, and later by weakness in the ipsilateral hand with those symptoms progressing distally to proximally up through the shoulder. Depressed/absent deep tendon reflexes in the upper extremity and muscle fasciculations occur also. Neither patients nor their health care providers tend to associate these unusual neurological symptoms with cancer treatments received ≥20 years prior, often failing to link these sensory-motor symptoms with radiotherapy decades before. Because long-term follow-up of these patients now typically falls to general practitioners, many cases may be missed or misdiagnosed because of the rarity of this disorder. Physiatrists and allied rehabilitation professionals must be aware of this progressively disabling, incurable condition to provide appropriate diagnoses and compensatory rehabilitation therapies. Additionally, professional oncology organizations should include RIBP in their long-term, survivorship guidelines for breast cancer. Researchers examining the iatrogenic late effects of radiotherapy should extend their follow-up periods well beyond the current 5-6 years to ascertain the true incidence of RIBP today. Rehabilitation providers must continue to advocate for awareness, diagnosis, and management of iatrogenic outcomes experienced by long-term cancer survivors.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy - Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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York B, Walsh D, Moore W, Yaguda S, Parala-Metz A, Raj VS, Szafranski M, Waldman J. Supportive oncology in a cancer center: development of a novel department (2017-2021). Support Care Cancer 2023; 31:692. [PMID: 37955710 DOI: 10.1007/s00520-023-08110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Beth York
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Declan Walsh
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA.
- The Hemby Family Endowed Chair in Supportive Oncology, Atrium Health, Charlotte, NC, USA.
| | - William Moore
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Susan Yaguda
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Armida Parala-Metz
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Vishwa S Raj
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Michele Szafranski
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
| | - Jake Waldman
- Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, 1021 Morehead Medical Drive, Suite 70100, Charlotte, NC, 28204, USA
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Harris SR, Tugwell KE. Neurological and Dexterity Assessments in a Woman with Radiation-Induced Brachial Plexopathy After Breast Cancer. Oncologist 2020; 25:e1583-e1585. [PMID: 32525604 DOI: 10.1634/theoncologist.2019-0875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/03/2020] [Indexed: 11/17/2022] Open
Abstract
The aim of this case report is to inform clinicians about radiation-induced brachial plexopathy, a rare complication that often presents well after treatment with inconsistent symptoms and manifestations. It is often a diagnosis of exclusion when a neoplastic or other cause cannot be identified. Electrodiagnostic testing is particularly useful. Here, the results of a standardized grip and pinch strength assessment and dexterity test are presented in a woman whose symptoms first appeared 20 years after completing treatments for stage IIIA breast cancer.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karen E Tugwell
- Physical Therapy Department, St. Paul's Hospital, Vancouver, BC, Canada
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Grisold W, Grisold A. Chemotherapy-induced peripheral neuropathy: limitations in current prophylactic/therapeutic strategies and directions for future research. Curr Med Res Opin 2017; 33:1291-1292. [PMID: 28375042 DOI: 10.1080/03007995.2017.1314263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Wolfgang Grisold
- a Ludwig Boltzmann Institute for Experimental und Clinical Traumatology , Vienna , Austria
| | - Anna Grisold
- b Department of Neurology , University of Vienna , Austria
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