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Qin E, Lim S, Essman M, Howard I. Increasing cancer rehabilitation awareness and referrals in the Veterans Health Administration-A quality improvement initiative. PM R 2023; 15:1292-1299. [PMID: 36695293 DOI: 10.1002/pmrj.12949] [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: 04/11/2022] [Revised: 10/10/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To expand access to comprehensive rehabilitation services among veterans with cancer by increasing cancer rehabilitation referrals in a Veterans Affairs (VA) hospital. DESIGN A rapid cycle improvement approach based on the Institute of Healthcare Improvement's Model for Improvement was used to assess and optimize the cancer rehabilitation referral process. In this quality improvement project, our cancer rehabilitation workgroup developed an electronic screening tool within the VA electronic patient record system to streamline cancer rehabilitation referrals. Providers could complete an optional Cancer Rehabilitation (CaRe) Screen that consisted of 12 questions related to patient symptoms and function. If the screen was positive, a nonvisit electronic consult was automatically generated and sent to a physiatrist for review. The physiatrist would then triage patients to appropriate services including physiatry, physical therapy, occupational therapy, speech therapy, rehab psychology, and other rehabilitation services. RESULTS A total of 90 referrals were placed between 2019-2021. A total of 84% of the patients referred were male, 73% were white. The top cancer types referred were lung (27%), blood (23%), gastrointestinal (12%), and prostate (10%). There were 19 referrals in 2019, 13 in 2020, and 58 in 2021. The electronic screening tool was implemented in mid-2021. Advanced practice providers placed 48% of consults. Of the referrals placed in 2021, 13% of consults were initiated through the electronic screening tool. The most common rehabilitation-related referrals placed after initial cancer rehabilitation triage included physical therapy (n = 47, 35.1%), physiatry (n = 28, 20.9%), and occupational therapy (n = 24, 17.9%). CONCLUSIONS Implementing an electronic screening tool can streamline cancer rehabilitation referrals and increase access to cancer rehabilitation services for Veterans with cancer. Ongoing work is required to refine the referral process and educate providers and patients on the importance of cancer rehabilitation in the cancer care continuum.
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Affiliation(s)
- Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Sara Lim
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Matthew Essman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Ileana Howard
- Department of Rehabilitation Medicine, Veterans Affairs Puget Sound, Seattle, Washington, USA
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2
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Crimi S, Battaglia S, Maugeri C, Mirabella S, Fiorillo L, Cervino G, Bianchi A. Does Age Affect the Rate of Spinal Nerve Injury after Selective Neck Dissection? Age as a Prognostic Factor of Spinal Nerve Injury after Selective Neck Dissection. J Pers Med 2023; 13:1082. [PMID: 37511696 PMCID: PMC10381417 DOI: 10.3390/jpm13071082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate whether age is a significant risk factor for spinal nerve injury following selective neck dissection (SND) in patients with head and neck cancer. METHODS A retrospective cohort study was conducted on patients who had undergone SND for head and neck cancer at a tertiary hospital between 2020 and 2022. The primary outcome was the incidence of spinal nerve injury after SND. The secondary outcomes included the types and severity of spinal nerve injury and the impact of age on these outcomes. RESULTS A total of 78 patients were included in the study and subdivided into two groups. Two shoulder-specific questionnaires (the Shoulder Pain and Disability Index (SPADI) and the Shoulder Disability Questionnaire (SDQ)) were administered to assess shoulder morbidity postoperatively. Twelve patients showed shoulder impairment following surgery. We divided the sample into two age-based groups; the older group showed a higher rate of SAN injury and the younger group showed a lower rate of improvement over time. CONCLUSION This study suggests that age is a significant risk factor for spinal nerve injury following SND in patients with head and neck cancer. Older patients are more likely to experience spinal nerve injury after SND than younger patients. The findings of this study may help in the development of strategies to prevent spinal nerve injury in older patients undergoing SND for head and neck cancer.
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Affiliation(s)
- Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Salvatore Battaglia
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Claudia Maugeri
- Division of Maxillofacial Surgery, Surgical Science Department, Città della Salute e Delle Scienze Hospital, University of Turin, 10024 Turin, Italy
| | - Sergio Mirabella
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", 80121 Naples, Italy
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri 411018, India
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy
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3
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Kessler MR, Dove AP, Kirschner AN. Radiation Fibrosis After Stereotactic Body Radiation Therapy for Osseous Metastases: A Case Report. Cureus 2022; 14:e28925. [PMID: 36237749 PMCID: PMC9547492 DOI: 10.7759/cureus.28925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
Radiation-induced fibrosis is a potentially severe late complication after high-dose radiotherapy. Over the last decade, there has been increasing use of stereotactic body radiation therapy (SBRT) to treat both primary and metastatic malignancies. While there has been evolving evidence of appropriate dose constraints for certain organs receiving hypofractionated radiotherapy, the risk, and appropriate dose constraints to limit the risk of radiation-induced muscle fibrosis are poorly defined. In this report, two patients are presented who underwent SBRT for osseous oligometastatic renal cell carcinoma. While the treatment was well-tolerated with no acute toxicities and complete local control of the metastasis, both patients experienced late toxicity of radiation-induced fibrosis in the adjacent musculature. In both cases, toxicity was nonresponsive to medical interventions and was severe enough to require surgical resection of the affected tissue. Following surgery, both patients reported improved pain relief and mobility. Further studies are needed to explore the dose constraints that may reduce the risk of radiation-induced muscle fibrosis in five-fraction treatment.
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Chao WH, Tuan SH, Tang EK, Tsai YJ, Chung JH, Chen GB, Lin KL. Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery. Front Med (Lausanne) 2022; 9:900165. [PMID: 35783624 PMCID: PMC9240316 DOI: 10.3389/fmed.2022.900165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Patients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO2), VO2 at the ventilatory threshold (VO2 at VT), and slope of minute ventilation to carbon dioxide production (VE/VCO2 slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks. Methods This was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema. Results Three intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (p = 0.061–0.910). Conclusion Patients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.
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Affiliation(s)
- Wei-Hao Chao
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Department of Medical Education and Research, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
| | - Sheng-Hui Tuan
- Institute of Allied Health Sciences, National Cheng Kung University, Tainan City, Taiwan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan
| | - En-Kuei Tang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City, Taiwan
| | - Yi-Ju Tsai
- Department of Medical Education and Research, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
- Department of Physical Therapy, National Cheng Kung University, Tainan City, Taiwan
| | - Jing-Hui Chung
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung City, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veteran General Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Post-Baccalaureate Medicine, National Sun Yat-Sun University, Kaohsiung City, Taiwan
- *Correspondence: Ko-Long Lin
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Radiotherapy-Related Fatigue Associated Impairments in Lung Cancer Survivors during COVID-19 Voluntary Isolation. Healthcare (Basel) 2022; 10:healthcare10030448. [PMID: 35326926 PMCID: PMC8954185 DOI: 10.3390/healthcare10030448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022] Open
Abstract
The main objective of this study was to investigate the impairments presented after COVID-19 voluntary isolation by lung cancer survivors that experienced radiotherapy-related fatigue. In this observational study, data were collected after COVID-19 voluntary isolation. Patients were divided into two groups according to their fatigue severity reported with the Fatigue Severity Scale. Health status was assessed by the EuroQol-5D, anxiety and depression by the Hospital Anxiety and Depression Scale, and disability by the World Health Organization Disability Assessment Schedule 2.0. A total of 120 patients were included in the study. Patients with severe fatigue obtained higher impairment results compared to patients without severe fatigue, with significant differences in all the variables (p < 0.05). Lung cancer survivors who experienced severe radiotherapy-related fatigue presented higher impairments after COVID-19 voluntary isolation than lung cancer patients who did not experience severe radiotherapy-related fatigue, and showed high levels of anxiety, depression and disability, and a poor self-perceived health status.
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Bunare A, Weldegebreal F, Habte S, Ketema I, Worku T. Utilization of Rehabilitation Services and Associated Factors Among Adults with Cancer Diagnoses at Hawassa Comprehensive Specialized Hospital, Ethiopia. Patient Prefer Adherence 2022; 16:1571-1580. [PMID: 35791427 PMCID: PMC9250770 DOI: 10.2147/ppa.s370923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rehabilitation is a type of treatment that focuses on improving a person's physical, social, cognitive, and emotional functioning. Currently, there is a significant unmet need for rehabilitation. Despite the expansion of rehabilitation services in Ethiopia, little is known about its utilization and associated factors. OBJECTIVE This study aimed to assess the utilization of rehabilitation services and associated factors among adults with cancer diagnoses at Hawassa Comprehensive Specialized Hospital, Ethiopia. METHODS An institutional-based cross-sectional study was employed among 325 participants selected using a systematic sampling technique. Data were collected using a pre-tested, interviewer-administered questionnaire and a review of medical records. Participants were considered as utilized if they attended at least one cancer rehabilitation service at the hospital in the last 1 year. The data were entered into EpiData version 4.6 and exported to Statistical Package for Social Science Version 23 for analysis. Binary logistic regression analysis was used to identify factors associated with the utilization of rehabilitation services. Variables with a P-value of < 0.05 were considered statistically significant. RESULTS Utilization of rehabilitation service among adults with cancer diagnoses in the last 1 year were found to be 33.2% (95% CI; 27.93-41.25). Being male (AOR=5.76; 95% CI: 2.60, 12.75), urban residence (AOR=2.56; 95% CI: 1.04, 6.26), ability to perform the activity of daily living independently (AOR=2.68; 95% CI: 1.20, 6.00), receiving education on cancer rehabilitation services (AOR=2.44; 95% CI: 1.21, having strong social support (AOR=2.10; 95% CI: 1.02, 4.87), 4.91) and satisfaction with cancer care (AOR=3.21; 95% CI: 1.42, 5.76) were factors associated with the utilization of rehabilitation services. CONCLUSION Only 33.2% of adults with cancer diagnoses at Hawassa Comprehensive Specialized Hospital utilized rehabilitation services. To improve the utilization of rehabilitation services, patients should receive adequate education on the benefits of rehabilitation.
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Affiliation(s)
- Arata Bunare
- Department of Nursing, Hawassa Health Science College, Hawassa, Ethiopia
| | | | - Sisay Habte
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
- Correspondence: Sisay Habte, School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia, Tel: +251 911807998, Email
| | - Indeshaw Ketema
- Department of Emergency and Critical Care Nursing, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
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Kline-Quiroz C, Nori P, Stubblefield MD. Cancer Rehabilitation: Acute and Chronic Issues, Nerve Injury, Radiation Sequelae, Surgical and Chemo-Related, Part 1. Med Clin North Am 2020; 104:239-250. [PMID: 32035566 DOI: 10.1016/j.mcna.2019.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individuals with cancer commonly experience functional impairments. Symptoms may present immediately or years to decades following their treatment. These impairments may include fatigue, pain, neuropathy, lymphedema, or radiation fibrosis syndrome and have the potential to deleteriously impact their function and quality of life. Cancer rehabilitation is a comprehensive resource that facilitates maximizing and maintaining cancer survivors' physical, social, psychological, and vocational functioning. This article covers the common functional impairments experienced by cancer survivors and the treatment strategies used in cancer rehabilitation. Application of these services can enhance the ongoing care for cancer survivors.
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Affiliation(s)
- Cristina Kline-Quiroz
- MedStar Health/Georgetown, National Rehabilitation Hospital, 102 Irving Street Northwest, Washington, DC 20010, USA
| | - Phalgun Nori
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA
| | - Michael D Stubblefield
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Select Medical, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052, USA.
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DiFrancesco T, Khanna A, Stubblefield MD. Clinical Evaluation and Management of Cancer Survivors with Radiation Fibrosis Syndrome. Semin Oncol Nurs 2020; 36:150982. [PMID: 32008860 DOI: 10.1016/j.soncn.2019.150982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To define radiation fibrosis and radiation fibrosis syndrome; review the basics of radiotherapy, the pathophysiology of radiation injury, and the principles of clinical evaluation and management of the common late effects resulting from radiation therapy for cancer treatment. DATA SOURCES Peer-reviewed journal articles, book chapters, Internet. CONCLUSION There is no cure for radiation fibrosis syndrome, but supportive treatment of its clinical sequelae can potentially result in improved function and quality of life. IMPLICATIONS FOR NURSING PRACTICE The sequelae of radiation fibrosis syndrome can often be improved with early detection and supportive care by a multidisciplinary team including cancer rehabilitation physiatrists, oncologists, oncology nurses, nurse practitioners, physical therapists, occupational therapists, and speech and language pathologists.
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Affiliation(s)
- Tanya DiFrancesco
- PGY-4 Physical Medicine & Rehabilitation, Kingsbrook Rehabilitation Institute, Brooklyn, NY
| | - Ashish Khanna
- Cancer Rehabilitation Medicine, The Kessler Institute for Rehabilitation, West Orange, NJ; Department of Physical Medicine & Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael D Stubblefield
- Cancer Rehabilitation Medicine, The Kessler Institute for Rehabilitation, West Orange, NJ.
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Raj VS, Pugh TM, Yaguda SI, Mitchell CH, Mullan SS, Garces NS. The Who, What, Why, When, Where, and How of Team-Based Interdisciplinary Cancer Rehabilitation. Semin Oncol Nurs 2020; 36:150974. [PMID: 31955923 DOI: 10.1016/j.soncn.2019.150974] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To review the key components necessary for successful application of rehabilitation principles to oncology survivors. DATA SOURCES Validated databases, including PubMed, MEDLINE, and Scopus. CONCLUSION Rehabilitation is an essential component of cancer care that addresses functional needs for oncology survivors and is best accomplished via an interdisciplinary team. Interdisciplinary care, provided by nursing, physiatry, rehabilitation therapy, and exercise physiology, are critical components for comprehensive intervention. Challenges exist in implementing services, but opportunity also exists within the post-acute care sector. IMPLICATIONS FOR NURSING PRACTICE Nurses play an important role in the screening, assessment, and treatment of cancer-related functional impairments.
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Affiliation(s)
- Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC.
| | - Terrence M Pugh
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Susan I Yaguda
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Charles H Mitchell
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation, Charlotte, NC; Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Sarah S Mullan
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
| | - Natalie S Garces
- Department of Supportive Care, Levine Cancer Institute, Charlotte, NC
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Purkayastha A, Sharma N, Sarin A, Bhatnagar S, Chakravarty N, Mukundan H, Suhag V, Singh S. Radiation Fibrosis Syndrome: the Evergreen Menace of Radiation Therapy. Asia Pac J Oncol Nurs 2019; 6:238-245. [PMID: 31259219 PMCID: PMC6518980 DOI: 10.4103/apjon.apjon_71_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: "radiation fibrosis," "radiation fibrosis syndrome," and "radiation-induced fibrosis." We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment.
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Affiliation(s)
- Abhishek Purkayastha
- Department of Radiation Oncology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Neelam Sharma
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Arti Sarin
- Department of Radiation Oncology, INHS Asvini, Mumbai, Maharashtra, India
| | - Sharad Bhatnagar
- Department of Radiation Oncology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Nilotpal Chakravarty
- Department of Radiation Oncology, Army Hospital Research and Referral, New Delhi, India
| | - Hari Mukundan
- Department of Radiation Oncology, Command Hospital (Air Force), Bengaluru, Karnataka, India
| | - Virender Suhag
- Department of Radiation Oncology, Command Hospital (Southern Command), Pune, Maharashtra, India
| | - Sankalp Singh
- Department of Radiation Oncology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
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Collaboration Between Cancer Survivorship and Rehabilitation Programs With Head and Neck Patients. Rehabil Nurs 2018; 43:214-218. [PMID: 29957698 DOI: 10.1097/rnj.0000000000000172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this article is to present an example of collaboration between a cancer survivorship and cancer rehabilitation program at an academic-affiliated hospital. FINDINGS The article demonstrates the process of identifying and treating the surgical and radiation effects experienced by a head and neck cancer survivor. The specific roles of the advanced practice nurse and the physical therapist in assessing, identifying and treating cancer treatment-effects such as lymphedema and orthopedic problems are highlighted. CONCLUSION The survivorship visit is an opportunity to identify treatment-related effects amenable to rehabilitation and to refer head and neck cancer survivors to physical therapy for further evaluation and treatment. CLINICAL IMPLICATION Collaboration between nurses and physical therapists engaged in survivorship care can provide an effective and efficient pathway to improved functional outcomes for cancer survivors.
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McNeely ML, Dolgoy N, Onazi M, Suderman K. The Interdisciplinary Rehabilitation Care Team and the Role of Physical Therapy in Survivor Exercise. Clin J Oncol Nurs 2017; 20:S8-S16. [PMID: 27857275 DOI: 10.1188/16.cjon.s2.8-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rehabilitation professionals offer expertise in functional assessment, treatment of impairments and functional limitations, and disability prevention. To optimize recovery, and often prior to participating in community-based exercise programming, survivors may need rehabilitation services from a range of healthcare professionals, including physiatrists, nurses, nutritionists, psychologists, and speech, occupational, and physical therapists. OBJECTIVES Survivors with physical impairments and functional limitations may benefit from interdisciplinary rehabilitation and physical therapy, including tailored therapeutic exercise interventions. METHODS A literature review was conducted using the key words cancer survivor, cancer rehabilitation, impairment, fatigue, lymphedema, chemotherapy-induced peripheral neuropathy, and exercise. MEDLINE®, EMBASE, Cochrane Database of Systematic Reviews, and CINAHL® databases were searched. FINDINGS Nurses play a critical role in identifying survivors whose function or fitness is compromised to the point where participation in community-based exercise programming would be inappropriate or unsafe. The interdisciplinary rehabilitation care team can help facilitate the survivor's transition to community-based exercise programming.
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13
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Sarsenov D, Aktepe F, Özmen V. Radiation Fibrosis Syndrome Imitating Breast Cancer Recurrence; A Case Report. THE JOURNAL OF BREAST HEALTH 2017; 13:40-42. [PMID: 28331767 DOI: 10.5152/tjbh.2016.3351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/27/2022]
Abstract
Nowadays, surgery, radiotherapy and chemotherapy are the most frequently used modalities in the treatment of breast cancer. It is very well-known that some severe complications may result from after these treatments. Early and late complications of radiotherapy are well known. The complications of radiation therapy may be seen in (early) or after three months (late-delayed) of periods. These complications may be related with direct or indirect effect of radiation. The radiation fibrosis syndrome is a progressive fibrotic tissue sclerosis together with various clinical symptoms in the irradiation field. It is usually a late finding of radiation therapy and may be seen weeks or even years after the treatment. Many systems such as musculo-skeletal, soft tissue, neural tissue and cardiopulmonary system may be affected. In this report, we present a case of a breast cancer treated with breast conserving surgery and radiation therapy twelve years ago. The patient had ipsilateral lymphedema, right axillary mass, and pain during arm and shoulder mobilization. Her physical examination and radiologic findings revealed a big mass invading right thoracic wall, thoracic cavity and the axilla. Histopathological evaluation performed after tru-cut and open biopsy from the mass showed fibrosis resulting from radiation therapy.
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Affiliation(s)
- Dauren Sarsenov
- Department of General Surgery, İstanbul Florence Nigtingale Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, İstanbul Florence Nigtingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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14
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Cohen EEW, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, Stubblefield MD, Abbott DM, Fisher PS, Stein KD, Lyman GH, Pratt-Chapman ML. American Cancer Society Head and Neck Cancer Survivorship Care Guideline. CA Cancer J Clin 2016; 66:203-39. [PMID: 27002678 DOI: 10.3322/caac.21343] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.
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Affiliation(s)
- Ezra E W Cohen
- Medical Oncologist, Moores Cancer Center, University of California at San Diego, La Jolla, CA
| | - Samuel J LaMonte
- Retired Head and Neck Surgeon, Former Associate Professor of Otolaryngology and Head and Neck Surgery, Louisiana State University Health and Science Center, New Orleans, LA
| | - Nicole L Erb
- Program Manager, National Cancer Survivorship Resource Center, American Cancer Society, Atlanta, GA
| | - Kerry L Beckman
- Research Analyst-Survivorship, American Cancer Society, Atlanta, GA
| | - Nader Sadeghi
- Professor of Surgery, Division of Otolaryngology-Head and Neck Cancer Surgery, and Director of Head and Neck Surgical Oncology, George Washington University, Washington, DC
| | - Katherine A Hutcheson
- Associate Professor, Department of Head and Neck Surgery, Section of Speech Pathology and Audiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael D Stubblefield
- Medical Director for Cancer Rehabilitation, Kessler Institute for Rehabilitation, West Orange, NJ
| | - Dennis M Abbott
- Chief Executive Officer, Dental Oncology Professionals, Garland, TX
| | - Penelope S Fisher
- Clinical Instructor of Otolaryngology and Nurse, Miller School of Medicine, Department of Otolaryngology, Division of Head and Neck Surgery, University of Miami, Miami, FL
| | - Kevin D Stein
- Vice President, Behavioral Research, and Director, Behavioral Research Center, American Cancer Society, Atlanta, GA
| | - Gary H Lyman
- Co-Director, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and Professor of Medicine, University of Washington School of Medicine, Seattle, WA
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Uhm KE, Yoon TH, Hwang JH. Clinical characteristics and rehabilitation of hospitalised cancer patients in a Korean tertiary hospital. Singapore Med J 2016; 58:502-507. [PMID: 27029806 DOI: 10.11622/smedj.2016064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION With the increase in the patient survival rates of many types of cancers, a greater proportion of cancer patients live with disease-related problems that diminish their quality of life. This study aimed to investigate the clinical characteristics and rehabilitation of hospitalised cancer patients who were referred to the Department of Physical and Rehabilitation Medicine (PRM) at Samsung Medical Center, a tertiary university hospital in Seoul, Korea. METHODS Hospitalised cancer patients aged > 18 years who were referred to the Department of PRM from January to December 2012 were enrolled in this retrospective study. We reviewed the clinical characteristics of the patients, the principal reasons for their referral and relevant details of their rehabilitative management. RESULTS A total of 1,340 cases were included. The most common primary cancer was lung cancer (19.0%) and 28.6% of the cases had solid organ metastasis. The most common reason for referral was deconditioning (31.7%), followed by weakness (23.1%) and respiratory problems (14.5%). Bedside exercise was prescribed to 28.4% of the patients, exercise in the rehabilitation therapy unit to 28.0% and pulmonary rehabilitation to 14.3%. Among the 1,340 cases, 107 (8.0%) were transferred to the Department of PRM for comprehensive rehabilitation. The 32 patients with an identifiable Modified Barthel Index score showed significant functional improvement. CONCLUSION The findings of the present study contribute to a better understanding of rehabilitation for hospitalised cancer patients. The information obtained will also be helpful in the development of appropriate cancer rehabilitation strategies.
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Affiliation(s)
- Kyeong Eun Uhm
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Tae Hee Yoon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Hye Hwang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
With earlier cancer diagnosis among older patients with cancer, the possibility of curing cancer increases. However, cancer treatment may have a long-lasting impact on older cancer survivors. It is vital to screen, diagnose, and properly manage the long-term toxicities of cancer treatment in order to maintain the quality of life of older cancer survivors.
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The role of physical rehabilitation in stem cell transplantation patients. Support Care Cancer 2015; 23:2447-60. [PMID: 25971213 DOI: 10.1007/s00520-015-2744-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/20/2015] [Indexed: 02/07/2023]
Abstract
The purpose of this paper is to review the evidence for the role of physical rehabilitation in stem cell transplantation patients. We will also review the literature and discuss professional experiences on how rehabilitation can play a role in stem cell transplant care and survivorship. Hematopoietic stem cell transplantation (HCT) is a procedure that has evolved substantially over the years to help treat multiple conditions, particularly hematologic malignancies. HCT can be very stressful on the body and can leave patients weakened and sometimes quite debilitated. Supportive care measures have advanced to improve the quality of life and overall survival of HCT survivors. One key component of improved supportive care is gaining increased attention, and that is physical medicine and rehabilitation. Its role in HCT survivorship care is expanding, and new insight and research within the discipline have focused on fatigue, inflammation, exercise, and the development of structured rehabilitation programs to improve the musculoskeletal sequelae of transplantation. This literature review has demonstrated the utility of physical rehabilitation in HCT, its impact on cancer-related fatigue, and to outline the current state of the literature on these topics. The paper delves into a background of HCT. Cancer-related fatigue in HCT is then discussed and summarized, and the role that exercise plays in modifying such fatigue is outlined. We then outline the models and the impact that physical rehabilitation may play in HCT recipients.
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Geriatric assessment as an aide to understanding falls in older adults with cancer. Support Care Cancer 2015; 23:2273-80. [PMID: 25576434 DOI: 10.1007/s00520-014-2598-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE In older adults, falls are a common cause of functional decline, institutionalization, and reduced quality of life. This study (1) investigates the prevalence of falls in a large sample of community-dwelling older adults with a cancer diagnosis and (2) evaluates the association of falls with domains of comprehensive geriatric assessment (CGA) that pertain to falls risk. METHODS Patients completed a CGA that includes a self-reported measure of number of falls in the past 6 months. Summary statistics are used to describe prevalence of falls and associations with hypothesized risk factors using Fisher's exact tests and multivariable logistic regression. RESULTS A total of 1172 patients were enrolled, mean age 73 (65-99), 74 % female, and 89 % Caucasian. Two hundred fifty-six (22 %) reported one or more falls within the last 6 months. Patients with at least one instrumental activities of daily living (IADL) or physical function deficit had more falls as compared those with no deficits identified (p ≤ 0.001). The number of daily medications, comorbidities, Timed Up and Go score >14 s, and poor vision were also associated with increased falls (p ≤ 0.001). Reduced physical function, poor vision, and low performance status had the highest adjusted odds ratio (3.6, 3.4, and 3.0, respectively) for falls. CONCLUSIONS There is a high prevalence of falls in community-dwelling older patients with a cancer diagnosis. Falls are significantly associated with several measures of geriatric assessment including IADL, physical function, comorbidities, medications, and vision. Timely identification and management of risk factors for falls are important considerations in the care of older cancer patients.
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Abstract
The occurrence of pain in cancer survivors may be debilitating. These pain syndromes may be of different types, including neuropathic pain. The research related to cancer management has been done extensively in certain areas, but such research in cancer survivors is still lacking. The chronic pain in cancer survivors is not only under-reported but also under-treated. The assessment of pain in cancer survivors is multifaceted because of many domains like physical, social and psychological. Usually, the pain management may be considered similar to that for chronic noncancer pain, but with a caveat that such pain may at times be indicative of cancer recurrence. The multidisciplinary and multimodal management is essential for such neuralgic pain in cancer survivors. This may require a balanced combination of pharmacological and nonpharmacological techniques, including psychological support. The overall goal that remains in such patients for pain management is to improve the quality of life. Here we review certain pertinent aspects of neuropathic pain in cancer survivors.
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Affiliation(s)
- Rakesh Garg
- Department of Anaesthesiology, Pain & Palliative Care, Dr B.R. Ambedkar Institute Rotary Cancer Hospital, AIIMS, New Delhi, India
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Glare PA, Davies PS, Finlay E, Gulati A, Lemanne D, Moryl N, Oeffinger KC, Paice JA, Stubblefield MD, Syrjala KL. Pain in cancer survivors. J Clin Oncol 2014; 32:1739-47. [PMID: 24799477 DOI: 10.1200/jco.2013.52.4629] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pain is a common problem in cancer survivors, especially in the first few years after treatment. In the longer term, approximately 5% to 10% of survivors have chronic severe pain that interferes with functioning. The prevalence is much higher in certain subpopulations, such as breast cancer survivors. All cancer treatment modalities have the potential to cause pain. Currently, the approach to managing pain in cancer survivors is similar to that for chronic cancer-related pain, pharmacotherapy being the principal treatment modality. Although it may be appropriate to continue strong opioids in survivors with moderate to severe pain, most pain problems in cancer survivors will not require them. Moreover, because more than 40% of cancer survivors now live longer than 10 years, there is growing concern about the long-term adverse effects of opioids and the risks of misuse, abuse, and overdose in the nonpatient population. As with chronic nonmalignant pain, multimodal interventions that incorporate nonpharmacologic therapies should be part of the treatment strategy for pain in cancer survivors, prescribed with the aim of restoring functionality, not just providing comfort. For patients with complex pain issues, multidisciplinary programs should be used, if available. New or worsening pain in a cancer survivor must be evaluated to determine whether the cause is recurrent disease or a second malignancy. This article focuses on patients with a history of cancer who are beyond the acute diagnosis and treatment phase and on common treatment-related pain etiologies. The benefits and harms of the various pharmacologic and nonpharmacologic options for pain management in this setting are reviewed.
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Affiliation(s)
- Paul A Glare
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Pamela S Davies
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Esmé Finlay
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Amitabh Gulati
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Dawn Lemanne
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natalie Moryl
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kevin C Oeffinger
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Judith A Paice
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael D Stubblefield
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karen L Syrjala
- Paul A. Glare, Amitabh Gulati, Dawn Lemanne, Natalie Moryl, Kevin C. Oeffinger, and Michael D. Stubblefield, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College; Pamela S. Davies, Esmé Findlay, Judith A. Paice, and Karen L. Syrjala, Weill Cornell Medical College, New York, NY; Pamela S. Davies, Seattle Cancer Care Alliance, University of Washington; Karen L. Syrjala, Fred Hutchinson Cancer Research Center, Seattle, WA; Esmé Finlay, University of New Mexico School of Medicine, Albuquerque, NM; and Judith A. Paice, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Berg L, Nolbris MJ, Koinberg I, Melin-Johansson C, Möller A, Ohlén J. Characterisation of cancer support and rehabilitation programmes: a Swedish multiple case study. Open Nurs J 2014; 8:1-7. [PMID: 24478809 PMCID: PMC3905349 DOI: 10.2174/1874434601408010001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 11/22/2022] Open
Abstract
Cancer support and rehabilitation are suggested to be an integral part of cancer care strategies. This study focuses on comparativeness of cancer support and rehabilitation programmes. The aim of this study was to analyse available cancer support and rehabilitation programmes in Sweden presented as complementary to cancer rehabilitation at cancer clinics. A multiple case study design was chosen in order to inquire the small number of existing supportive and rehabilitative cancer programmes. Based on the structures, processes and outcomes of the nine included programmes, three types of cancer support and rehabilitation programmes were identified: multimodal rehabilitation, comprehensive cancer support and art therapy. Cancer support and rehabilitation programmes offer a variety of activities and therapies which are highly valuable and relevant for people with cancer. The typology of cancer support and rehabilitation programmes and comparability between programmes need further inquiry.
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Affiliation(s)
- Linda Berg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Margaretha Jenholt Nolbris
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Ingalill Koinberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Christina Melin-Johansson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Anders Möller
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
| | - Joakim Ohlén
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE 40530, Sweden
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Soffietti R, Trevisan E, Rudà R. Neurologic complications of chemotherapy and other newer and experimental approaches. HANDBOOK OF CLINICAL NEUROLOGY 2014; 121:1199-218. [PMID: 24365412 DOI: 10.1016/b978-0-7020-4088-7.00080-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Neurologic complications of conventional cytototxic agents as well as those from monoclonal antibodies and targeted therapies are increasingly observed in patients with cancer. The major categories are represented by alkylating agents (platinum compounds, ifosfamide, procarbazine, thiotepa), mitotic spindle inhibitors (vinca alkaloids, taxanes, etoposide, teniposide), proteasome inhibitors (bortezomib), antibiotics, antimetabolites, thalidomide, lenalidomide, topoisomerase inhibitors, interferon-α, hormones, bevacizumab, trastuzumab, and small tyrosine kinase inhibitors. Peripheral neuropathy is a common adverse effect of a number of chemotherapeutic drugs and often represents a critical factor limiting an adequate dose-intensity of chemotherapy. Regarding the central nervous system (CNS), it is vulnerable to many forms of toxicity from chemotherapeutic agents, including encephalopathy syndromes and confusional states, seizures, headache, cerebrovascular complications, visual loss, cerebellar syndromes, and myelopathy. For a given drug, the occurrence of CNS toxicity depends on several factors, including the total dose, route of administration, presence of structural brain lesions, exposure to prior or concurrent irradiation, and interactions with other drugs. However, many of the neurotoxic reactions are rare and idiosyncratic, and remain unpredictable. Several forms of neuroprotection and rehabilitation are being investigated. Last, the so-called "chemobrain" is an emerging issue, as it is a model of a subtle of and long-lasting damage to neuronal structures from some antineoplastic agents.
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Affiliation(s)
- Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy.
| | - Elisa Trevisan
- Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University and San Giovanni Battista Hospital, Turin, Italy
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Brown JC, Winters-Stone K, Lee A, Schmitz KH. Cancer, physical activity, and exercise. Compr Physiol 2013; 2:2775-809. [PMID: 23720265 DOI: 10.1002/cphy.c120005] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review examines the relationship between physical activity and cancer along the cancer continuum, and serves as a synthesis of systematic and meta-analytic reviews conducted to date. There exists a large body of epidemiologic evidence that conclude those who participate in higher levels of physical activity have a reduced likelihood of developing a variety of cancers compared to those who engage in lower levels of physical activity. Despite this observational evidence, the causal pathway underlying the association between participation in physical activity and cancer risk reduction remains unclear. Physical activity is also a useful adjunct to improve the deleterious sequelae experienced during cancer treatment. These deleterious sequelae may include fatigue, muscular weakness, deteriorated functional capacity, and many others. The benefits of physical activity during cancer treatment are similar to those experienced after treatment. Despite the growing volume of literature examining physical activity and cancer across the cancer continuum, a number of research gaps exist. There is little evidence on the safety of physical activity among all cancer survivors, as most trials have selectively recruited participants. The specific dose of exercise needed to optimize primary cancer prevention or symptom control during and after cancer treatment remains to be elucidated.
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Affiliation(s)
- Justin C Brown
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Hojan K, Milecki P. Opportunities for rehabilitation of patients with radiation fibrosis syndrome. Rep Pract Oncol Radiother 2013; 19:1-6. [PMID: 24936313 DOI: 10.1016/j.rpor.2013.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/23/2013] [Accepted: 07/08/2013] [Indexed: 11/18/2022] Open
Abstract
This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders that can result as late effects of radiation treatment. Although radiation therapy is often an effective method of killing cancer cells, it can also damage nearby blood vessels that nourish the skin, ligaments, tendons, muscles, nerves, bones and lungs. This can result in a progressive condition called radiation fibrosis syndrome (RFS). It is generally a late complication of radiotherapy which may manifest clinically years after treatment. Radiation-induced damage can include "myelo-radiculo-plexo-neuro-myopathy," causing muscle weakness and dysfunction and contributing to neuromuscular injury. RFS is a serious and lifelong disorder which, nevertheless, may often be decremented when identified and rehabilitated early enough. This medical treatment should be a complex procedure consisting of education, physical therapy, occupational therapy, orthotics as well as medications.
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Affiliation(s)
- Katarzyna Hojan
- Department of Rehabilitation, Greater Poland Cancer Centre, Poznan, Poland
| | - Piotr Milecki
- Department of Electroradiology, Poznan University of Medical Sciences, Poland ; Department of Radiotherapy, Greater Poland Cancer Centre, Poznan, Poland
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Grisold W, Cavaletti G, Windebank AJ. Peripheral neuropathies from chemotherapeutics and targeted agents: diagnosis, treatment, and prevention. Neuro Oncol 2013; 14 Suppl 4:iv45-54. [PMID: 23095830 DOI: 10.1093/neuonc/nos203] [Citation(s) in RCA: 299] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Peripheral neuropathies induced by chemotherapy (CIPN) are an increasingly frequent problem. Contrary to hematologic adverse effects, which can be treated with hematopoetic growth factors, neither prophylaxis nor specific treatment is available, and only symptomatic treatment can be offered. Neurotoxic drugs are becoming a major dose-limiting factor. The epidemiology is still unclear. Several drug-dependent pathogenetic mechanisms exist. CIPN are predominately sensory, length-dependent neuropathies that develop after a typical cumulative dose. Usually, the appearance of CIPN is dose dependent, although in at least 2 drugs (oxaliplatin and taxanes), immediate toxic effects occur. The most frequent substances causing CIPN are platin compounds, vinka alkaloids, taxanes, and bortezomib and thalidomide. The role of synergistic neurotoxicity caused by previously given chemo-therapies and concomitant chemotherapies and the role pre-existent neuropathy on the development of a CIPN is not clear. As the number of long-term cancer survivors increases and a new focus on long-term effects of chemotherapy-induced neuropathies emerge, concepts of rehabilitation need to be implemented to improve the patients' functions and quality of life.
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Affiliation(s)
- Wolfgang Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
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Abstract
Many cancer survivors suffer from chronic pain related to treatment. Pain management in the survivor is similar to chronic noncancer pain, with the important caveat that new or worsening pain must be promptly assessed for malignancy. This article reviews cancer survivorship, identifies common pain problems, and discusses strategies for management.
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Fu J, Gutiérrez C, Bruera E, Guo Y, Palla S. Use of injectable spasticity management agents in a cancer center. Support Care Cancer 2012; 21:1227-32. [PMID: 23142955 DOI: 10.1007/s00520-012-1651-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/30/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to analyze the utilization and effectiveness of injectable spasticity medications by the physiatry team at a referral-based tertiary cancer center. METHODS A retrospective review and analysis of patient and injection characteristics were obtained from patients who had received onabotulinum toxin or phenol nerve block injections from December 1, 2007 through January 31, 2012. Out of 3,724 physiatry consultations during this period, 20 (less than 1 %) different cancer patients received a total of 54 total procedures. RESULTS The majority of patients (17/20, 85 %) had a positive response to the injection. A positive response to the injection was defined by: (1) if the patient qualified to receive and was given another injection or (2) if there is a record of improvement if they did not receive another injection. A total of ten of 20 (50 %) patients received only one injection. Of these, seven of ten (70 %) reported a positive response to the injected agent. Those with only one injection tended to live farther away and die sooner. Four of 54 (7 %) injection procedures resulted in undesirable reported side effects (two for phenol, two for botulinum toxin). Nine of 54 (17 %) procedures occurred while the patients were on a chemotherapy protocol. All patients were injected at least 1 year out from initial diagnosis.
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Affiliation(s)
- Jack Fu
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, TX 77030, Houston, USA.
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Stubblefield MD, McNeely ML, Alfano CM, Mayer DK. A prospective surveillance model for physical rehabilitation of women with breast cancer. Cancer 2012; 118:2250-60. [DOI: 10.1002/cncr.27463] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stubblefield MD. Commentary on “Oncologists' and Physiatrists' Attitudes Regarding Rehabilitation for Patients With Advanced Cancer”. PM R 2012; 4:109-10. [DOI: 10.1016/j.pmrj.2011.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 09/08/2011] [Indexed: 11/29/2022]
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