Michelle Kirschner & Jill Sherlock. Collaboration Cancer Rehab July/August 2018, Volume 43, Number 4

Main findings

• The US Commission on Cancer (2016) has stated Structured programs for cancer rehabilitation services should include “lymphedema care, pain management, lifestyle and weight management programs, physical therapy, occupational therapy, exercise therapy and alternative medicine options such as reflexology and massage
• This paper presents a case study and the issues he experienced and the management performed.
• Treatment related effects were assessed using the following tools: Functional Assessment of Cancer Therapy-Head and Neck for overall quality of life assessment, distress screening, Rehabilitation Screening Tool, Functional Assessment of Chronic Illness Therapy-Fatigue, and the Patient Health Questionnaire-9 to assess for depression.
• Significant issues identified from these screening tools and follow-up conversation with the patient included xerostomia, dysphagia, lymphedema, moderate fatigue, moderate symptoms of depression, distress of 6 out of 10 due to financial issues, memory issues and treatment-related effects from his surgery, and radiation therapy. The Rehabilitation Screening Tool identified fatigue, balance issues, decreased neck range of motion (ROM), and upper extremity weakness.
• Lymphedema programming to address his chest and neck/facial edema included 10 sessions over a span of 3 months. Initial findings revealed (a) limited knowledge of manual lymph drainage techniques and self-care, (b) limited cervical active ROM, and (c) edema and congestion in neck. Lymphedema treatment effectively reduced neck and distal facial edema by 8 cm in composite scoring.
• His orthopedic and movement evaluation revealed postural changes that included rounded and forward shoulder girdle, internally rotated shoulders, abducted scapulae, and a significant forward head posture. He maintained balance with weight on heels and hips forward. He identified arm and shoulder issues as most limiting at 5 months postradiation.
• Therapeutic intervention was planned for two times per week with his agreement to focus on (a) myofascial release for anterior neck structure flexibility, (b) posture modification exercises, (c) shoulder girdle strengthening to support functional activity, and (d) neuromuscular activities for balance retraining and fall recovery skills. He participated in five sessions over the course of 1 month.
• Skilled physical therapy intervention for the variety of sequelae identified at his survivorship visit appeared successful in mitigating late effects of cancer treatment.
• Survivors often find that they experience a typical clustering of constitutional symptoms that can include fatigue, insomnia, pain, cognitive issues, and psychological deficits. Changes in physical functioning can occur after surgery from changes in structure or neurological damage that can result in such issues as weakness and spasm. Radiation may cause fibrotic damage to any structure within the field of treatment, and these changes may not reveal themselves for an extended period. Fibrotic changes to nerves in the spinal cord, nerve roots, plexus structures, or peripherally within muscular structures are key causes of dysfunction.
• It is important to be able to sort through the complex presentation of psychological, cognitive, and physical complaints to prioritise intervention and create a practical plan of care. Using functional limitation as the litmus test to guide therapy will allow for larger impacts on re-establishing independence and improving quality of life.