Maryland Physical Therapy Ebook Continuing Education

Localized swelling is part of the body’s natural response to injury; however, lymphedema may develop when lymph nodes are removed during surgery. Lymph node removal can lead to pooling of lymph fluid in the surrounding tissues because it is unable to drain through the lymphatic system. As the area becomes swollen and tight, patients may complain of significant pain, limited movement, and limited use of the affected area, such as the arm or leg. If lymphedema is left untreated, it can result in more serious health problems. Chemotherapy Chemotherapy is effective in treating cancer, but it also has a variety of potential side effects depending on the type of cancer, location, patient’s general health, and drugs/dose used. Side effects are caused when chemotherapy agents damage healthy cells. These drugs work on active cells that are growing and reproducing. Therefore, they can affect healthy cells in addition to attacking cancer cells. Cells in the mouth, hair, blood, and digestive system are particularly vulnerable. Side effects can be treated with other drugs, combinations of drugs, or adjusting the chemotherapy treatment schedule. Preventing and treating side effects is an important part of the treatment plan. Fatigue is the most common side effect from chemotherapy, especially in the treatment of breast cancer. It can appear suddenly and last until several months after treatment has ended. Rest does not usually ease this type of fatigue. The symptoms can include lack of energy, increased sleep time, lack of interest in normal activities, feeling tired even after sleeping, difficulty concentrating, and difficulty finding words. One potential cause of fatigue is anemia. Anemia can occur in patients who receive chemotherapy, if the drugs damage red blood cell production or the actual cells. The symptoms of anemia are fatigue, dizziness, irritability, weakness, and feeling cold. Chemotherapy drugs can lower white blood cell and platelet counts, but the symptoms are not always obvious. Low white blood cell increases the risk for infection and illness. Patients with weakened immune systems need to take precautions to reduce exposure to viruses, bacteria, and other germs. Low platelet counts (thrombocytopenia) can lead to bruising, frequent nosebleeds, heavier menstruation, and blood in vomit or stools. Patients may have difficulty eating due to tongue, mouth, or throat sores that can develop as a result of chemotherapy. The condition, called mucositis, can appear as red and swollen areas like ulcers. It leads to difficulty swallowing, pain, impaired sense of taste, potential bleeding, and risk for infection. Dental

Bleeding and drainage can occur after any surgical procedure and will usually resolve after a few days. However, the surgeon should be notified if either is excessive. Localized bruising can be expected, but it could indicate a bleeding problem if it does not improve. Redness, fever, and drainage that becomes cloudy (white or yellow) or has a strong odor are signs of infection. The surgeon should also be notified immediately if there are signs of infection to prevent cellulitis or sepsis. problems, including bleeding gums and tooth damage, are possible. Oral yeast infections can occur if a patient’s immune system is compromised. Patients often develop gastrointestinal distress such as nausea, vomiting, diarrhea, constipation, or appetite loss. Nausea is the most common of these symptoms, but it can be treated with anti-nausea medications. Some chemotherapy drugs cause problems with the hair, skin, and nails. Hair loss (alopecia) is a common side effect that can occur within a few weeks of the first treatment. The loss affects hair on the head, eyebrows, eyelashes, and body, but it is generally temporary. Patients may experience skin irritations such as rash, dryness, and itching. Changes in fingernails and toenails can include slow growth, yellow or brown appearance, and weakening where nails become brittle and break easily. The endocrine system can be disrupted by certain chemotherapy agents. Some patients may experience depression, anxiety, and stress due to hormone changes. Female patients can have symptoms of menopause or problems with menstruation. Male patients can have difficulty regulating hormones and experience decreased sex drive. Both men and women can be at risk for infertility. Some patients may begin to have problems regulating blood glucose that can lead to diabetes. Neurological side effects can occur depending on the type of cancer, location, and type of chemotherapy agent. These symptoms include memory loss, headaches, peripheral neuropathy, and “chemo brain” (difficulty concentrating or thinking clearly). Patients may also experience respiratory symptoms such as shortness of breath and excessive coughing. Chemotherapy can have a significant impact on the musculoskeletal system. Patients often experience muscle/ joint pain, swelling/edema, weakness, decreased muscle mass, bone loss (osteopenia/osteoporosis), and peripheral neuropathy (numbness, tingling, and pain). These deficits often directly relate to functional limitations that can be addressed by an appropriate oncology rehabilitation program.

OVERVIEW OF ONCOLOGY REHABILITATION

Oncology rehabilitation focuses on the treatment of impairments and functional limitations that result from the medical treatment of cancer. A paper by J.K. Silver, et al. (2013) defines it as: Medical care that should be integrated throughout the oncology care continuum and delivered by trained rehabilitation professionals who have it within their scope of practice to diagnose and treat patients’ physical, psychological, and cognitive impairments in an effort to maintain or restore function, reduce symptom burden, maximize independence and improve quality of life in this medically complex population.

As cancer survivorship increases, so does the need for oncology rehabilitation programs. Research from the American Cancer Society indicates that the five-year survival rate of all cancers diagnosed during 2009-2015 was 67% (American Cancer Society, 2020). The improvement in survival rate reflects improvements in cancer treatments and earlier diagnosis. Oncology rehabilitation is similar to other types, including orthopedic and neurological rehabilitation. The most effective programs are those delivered by an interdisciplinary team of skilled professionals who specialize in cancer rehabilitation. Table 4 below, adapted from Livestrong.org, demonstrates the comprehensive nature of these teams and the role of each provider.

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