Cancer Rehabilitation Key Reference
Articles
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The following
are recommended as key reference articles on Cancer Rehabilitation by Christina
Marciniak, MD. Click on the articles to view their abstracts.
TITLE: Functional outcome following rehabilitation of
the cancer patient.
AUTHORS: Marciniak CM; Sliwa JA; Spill G; Heinemann AW; Semik PE
AUTHOR AFFILIATION: Department of Physical Medicine and
Rehabilitation, University Medical School, Chicago, IL, USA.
SOURCE: Arch Phys Med Rehabil 1996 Jan;77(1):54-7
CITATION IDS: PMID: 8554474 UI: 96143271
ABSTRACT: OBJECTIVE: To identify impairments resulting from cancer
or treatment in patients undergoing inpatient rehabilitation, to assess the
extent of functional gains, and to determine if cancer type, ongoing radiation
treatment, or the presence of metastatic disease influences functional improvement.
DESIGN AND SETTING: A retrospective, case series of cancer patients undergoing
inpatient rehabilitation at a free-standing, university-affiliated hospital.
PARTICIPANTS: A referred sample of 159 admitted because of functional
impairments resulting from or its treatment during a 2-year time period.
INTERVENTION: Comprehensive inpatient rehabilitation. MAIN OUTCOME MEASURE:
Functional status as measured by the motor score of the Functional Independence
Measure. RESULTS: Significant functional gains were made between admission
(mean = 42.9) and discharge (mean = 56.0; p < .001), with all cancer
subgroups making similar gains. The presence of metastatic disease did not
influence functional outcome, and those patients receiving radiation actually made
larger functional improvements (p = .025). CONCLUSION: Individuals impaired by
cancer or its treatment benefit from inpatient rehabilitation. The presence of
metastatic disease or ongoing radiation should not preclude participation.
TITLE: Functional outcome after brain tumor and acute
stroke: a comparative analysis.
AUTHORS: Huang ME; Cifu DX; Keyser-Marcus L
AUTHOR AFFILIATION: Rehabilitation and Research Center, Department
of Physical Medicine and Rehabilitation, Virginia Commonwealth University,
Medical College of Virginia Hospitals, Richmond 23298, USA.
SOURCE: Arch Phys Med Rehabil 1998 Nov;79(11):1386-90
CITATION IDS: PMID: 9821898 UI: 99037660
ABSTRACT: OBJECTIVE: To compare the functional outcome, length of
stay, and discharge disposition of patients with brain tumors and those with
acute stroke. DESIGN: Case-controlled, retrospective study at a tertiary care
medical center inpatient rehabilitation unit. SUBJECTS: Sixty-three brain tumor
patients matched with 63 acute stroke patients according to age, sex, and
location of lesion. MAIN OUTCOME MEASURES: The functional independence measure
(FIM) was measured on admission and discharge. The FIM change and FIM
efficiency were also calculated. The FIM was analyzed in three subsets:
activities of daily living (ADL), mobility (MOB), and cognition (COG).
Discharge disposition rehabilitation length of stay were compared. RESULTS:
Demographic variables of race, marital status, and payer source were comparable
for the two groups. No significant difference was found between the brain tumor
and stroke populations with respect to total admission FIM, total discharge
FIM, change in total FIM, or FIM efficiency. The admission MOB-FIM was found to
be higher in the brain tumor group (13.6 vs 11.1, p = .04), whereas the stroke
group had a greater change in ADL-FIM score (10.8 vs 8.3, p = .03). The two
groups had similar rates of discharge to community at greater than 85%. The
tumor group had a significantly shorter rehabilitation length of stay than the
group (25 vs 34 days, p < .01). CONCLUSION: Brain tumor patients can achieve
comparable functional outcome and rates of discharge to community and have a
shorter rehabilitation length of stay than stroke patients.
TITLE: Functional outcome of inpatient rehabilitation in
persons with brain tumors.
AUTHORS: O'Dell MW; Barr K; Spanier D; Warnick RE
AUTHOR AFFILIATION: Department of Physical Medicine and
Rehabilitation, University of Cincinnati College of Medicine, OH, USA.
SOURCE: Arch Phys Med Rehabil 1998 Dec;79(12):1530-4
CITATION IDS: PMID: 9862294 UI: 99077110
ABSTRACT: OBJECTIVE: To document functional outcome in persons
with brain tumors undergoing inpatient rehabilitation and to compare outcomes with
a group of traumatically brain injured patients. DESIGN: Retrospective,
descriptive, and case-matched. SETTING: A free-standing inpatient brain injury
rehabilitation unit. PARTICIPANTS: Forty consecutive patients with a variety of
tumor types (40% were either glioblastoma multiforme or meningioma) and a mean
age of 53.1 (SD 15.4) years. Sixty percent were men, 25% had recurrent tumors,
and 15% had metastatic disease. Also, 40 patients with traumatic brain injury
(TBI) matched for age, gender, and admission functional status. MAIN OUTCOME
MEASURES: Change in Functional Independence Measure (FIM) scores, length of
rehabilitation stay (LOS), and disposition. RESULTS: The mean LOS for the tumor
group was 17.8 (SD 9.9) days, mean FIM gain was 25.4 (SD 20.1) points, and
82.5% were discharged home. No demographic or tumor characteristic
statistically significant in predicting functional outcome at discharge, but
greater gains were seen for persons with the diagnosis of meningioma, those
with left-sided cerebral lesions, and those not receiving radiation therapy.
TBI patients made statistically significant greater gains in total FIM change
(34.6 vs 25.4), self-care (12.3 vs 8.5), and social cognition (5.2 vs 3.6).
However, FIM efficiency and LOS were not statistically different between the
TBI and tumor groups (1.9 vs 1.5 FIM points/day and 22.1 vs 17.8 days,
respectively). CONCLUSIONS: Daily functional gains made by persons with brain
tumor undergoing rehabilitation were similar to those made by a group of persons
with TBI matched by age, gender, and admission functional status. Further
research should use larger samples and address the impact of psychosocial and
team factors on LOS and discharge disposition.
TITLE: Management of pain and spinal cord compression in
patients with advanced cancer. ACP-ASIM End-of-life Care Consensus Panel.
American College of Physicians-American Society of Internal Medicine.
AUTHORS: Abrahm JL
AUTHOR AFFILIATION: Hospital of the University of Pennsylvania,
Philadelphia 19104, USA.
SOURCE: Ann Intern Med 1999 Jul 6;131(1):37-46
CITATION IDS: PMID: 10391814 UI: 99308807
ABSTRACT: General internists often care for patients with advanced
cancer. These patients have substantial morbidity caused by moderate to severe
pain and by spinal cord compression. With appropriate multidisciplinary care,
pain can be controlled in 90% of patients who have advanced malignant
conditions, and 90% of ambulatory patients with spinal cord compression can
remain ambulatory. Guidelines have been developed for assessing and patients
with these problems, but implementing the guidelines can be problematic for
physicians who infrequently need to use them. This paper traces the last year
of life of Mr. Simmons, hypothetical patient who is dying of refractory
prostate cancer. Mr Simmons and his family interact with professionals from
disciplines during this year. Advance care planning is completed activated.
Practical suggestions are offered for assessment and treatment of all aspects
of his pain, including its physicalpsychological, social, and spiritual
dimensions. The methods of pain relief used or discussed include
nonpharmacologic techniques, nonopioid analgesics, opioids, adjuvant
medications, therapy, and radiopharmaceutical agents. Overcoming resistance
taking opioids; initiating, titrating, and changing opioid routes and agents;
and preventing or relieving the side effects they induce also covered. Data on
assessment and treatment of spinal cord compression are reviewed. Physicians
can use the techniques described to more readily implement existing guidelines
and provide comfort and optimize quality of life for patients with advanced
cancer.