MU PT 7890, Case Management I
Topic: Oncology
Objectives: The learner will be able to:
1.
Define oncology, neoplasm, malignancy, cancer, and cachexia.
2.
Recognize cancer classification by embryologic cell type of origin. Explain Grading and
Staging.
3.
Know the cardinal S/S of systemic disease in a person who might have undiagnosed cancer.
Know when to refer. List the seven early warning signs of cancer. An importance reference is the
text: Differential Diagnosis for Physical Therapists. Goodman. 4th edition. 2007. (recommended
course text and on reserve at HSL).
 Constitutional S&S: p.13
 Red Flags p.10-11
 Screening for viscogenic sources of pain p.166-168
 Metastatic sites p.570
 S&S of metastases p.572-573
 Cancer early warning signs p.574
 Physician Referral p.610-611
 Overview: cancer presence and pain p.612-616
 Key points: p.616-617
 Subjective Exam: p.617-618
4.
State rationales and goals for chemotherapy. Recognize chemotherapeutic agents commonly
used in treatment of cancer. Describe common chemotherapy side effects (SE), the supportive and
protective measures that can be implemented, and the implications for rehabilitation.
Hillegass p.250-251 chemotherapeutic agents can cause RLD; p.315-318: Cardiopulmonary
toxicity of cancer treatments
5.
State rationales and goals for radiation therapy. Identify types of radiation and describe common
SE of radiation therapy. Recognize precautions caregivers should observe when near patients who
are receiving radiation treatment.
Hillegass p.252-254: radiation therapy and RLD.
6.
Discuss fatigue, as the most common SE of cancer therapy; other non-therapy etiologies for the
fatigue; patterns of response (over time) to chemotherapy and radiation therapy; assessment of
fatigue.
7.
Describe the method of BSE (breast self exam), TSE (testicular self exam) and other early
detection methods.
8.
Discuss the rehabilitation needs of the mastectomy patient, psychological, cosmetic, and physical.
9.
Discuss development and management of post-mastectomy lymphedema. Discuss screening for
lymphedema, s/s and patient education. Explain multiwrap compression systems.
10.
Describe a differential diagnosis of edema vs. lymphedema.
11.
Describe precautions for patients following abdominal, or pelvic surgery. Describe
management of ileostomy, colostomy, ureterostomy, and considerations for physical therapy.
12.
Distinguish primary bone cancers from metastatic bone cancers. Name 3 cancers most likely
to metastasize to bone. Describe physical therapy in the presence of bone CA (primary or metastatic):
pain control vs. safety and mobility.
13.
Describe the most common brain tumors and medical treatment. Discuss rehabilitation of the
patient with primary or metastatic disease affecting brain and / or spinal cord, including
appropriate goal setting. Name two cancers that would most likely metastasize to the brain.
14.
Discuss use of physical therapy modalities in the presence of cancer.
15.
Demonstrate awareness of Reach to Recovery and other educational programs and support
groups for patients and families.
16.
Demonstrate recognition of psychosocial, educational and economic implications of cancer for
patients, family and friends, health personnel, employers by writing an analysis given a case
description.
17.
Define palliative care. Discuss pain management for the acute and terminally ill cancer patient.
Outline how a patient would qualify for hospice care and the primary purpose of intervention.
18.
Develop a position on the concepts of "hope" and "coping" relative to the chronically or terminally
ill person. Verbalize stages of grief and explain variations in individual grief process. See
website resources.
19.
Demonstrate understanding of the options within an Advance Directive (AD), and the implication
of choices. Appreciate that there is never an option for a person to choose for pain medication to
be withheld. Understand the role of the Durable Power of Attorney for Medical Decisions.
20.
Describe when an existing Do Not Resuscitate (DNR) order would be applicable or honored.
Compare the DNR order and the Advance Directive (AD) in terms of the time frame in which they
would be consulted and applied.
21.
Differentiate discharge and discontinuation of physical therapy services, as described in The
Guide to Physical Therapist Practice. Consider the appropriateness of discontinuation of PT
services in the hospice environment.
22.
Explain the key questions to ask in order to evaluate pain and pain outcomes. Distinguish
between acute and chronic manifestations of pain. Explain the terms: physical dependence,
psychological dependence, and tolerance as they relate to the patient with chronic pain. List side
effects (SE) of opioids / narcotics.
23.
Discuss Radical Neck Dissection in Head and Neck Cancer, the risk factors, medical treatment,
impairments, acute intervention, rehabilitation for the resulting positional deformity. Which
impaired neck and scapulothoracic motions can be compensated, and which cannot?
MSH_MUPT_03.06