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A 54-year-old female was admitted to the hospital 12 days ago with complaints of severe back pain with no identified mechanism of injury. Notable previous medical history includes breast cancer 4 years ago, treated with a partial mastectomy plus radiation. Imaging (x-rays and radionuclide bone scan) shows bone metastases (with lytic and blastic features) in the third and fourth lumbar vertebral bodies. The patient started radiation therapy and a bisphosphonate 5 days ago. The patient expects to be discharged to her single-level home with her husband in several days. She will be continuing cancer treatment as an outpatient. The oncologist stated that she has “spinal precautions,” but no weightbearing restrictions and she can ambulate within pain tolerance. Her current complaints are back pain and fatigue.

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Based on her health condition, what do you anticipate may be the contributors to activity limitations?

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What are the examination priorities?

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What are the most appropriate physical therapy interventions?

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What are possible complications interfering with physical therapy?

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  • BONE SCAN: Radionuclide imaging to detect presence and amount of metastatic lesions in bones
  • METASTASIS: Spread of cancer cells to one or more areas elsewhere in the body, usually by the lymph or vascular system
  • PARTIAL MASTECTOMY: Removal of the breast tumor and surrounding area
  • RADIATION THERAPY: Local cancer treatment involving use of high energy x-rays, electron beam, or radioactive isotopes to destroy cancer cells

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  1. Describe cancer-related fatigue.

  2. Identify a reliable and valid outcome tool to measure cancer-related fatigue.

  3. Identify critical lab values that should be checked prior to physical therapy examination.

  4. Prescribe an appropriate intensity aerobic exercise program to minimize cancer-related fatigue.

  5. Describe benefits of aerobic exercise for patients receiving cancer therapies.

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PT considerations during management of the breast cancer survivor with development of bone metastases in lumbar spine:

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  • General physical therapy plan of care/goals: Prevent or minimize loss of range of motion, strength, and aerobic functional capacity; decrease cancer-related fatigue; decrease risk of pathological fractures; improve quality of life
  • Physical therapy interventions: Patient education regarding pathological fractures and complications; modified mobility training to decrease risk of pathological vertebral fractures; energy conservation techniques; light to moderate intensity aerobic walking program
  • Precautions during physical therapy: Spinal precautions, close physical supervision to decrease risk of falls, monitor vital signs
  • Complications interfering with physical therapy: Spinal cord compression, pathological fractures

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Breast cancer is one of the most common cancers in women in the United States, affecting approximately one in eight women during their lives.1 Treatment of breast cancer can include surgery, radiation, chemotherapy, or hormonal therapy. Cancer recurrence—the detection of cancer after treatment and some period of time when the patient is considered “cancer-free”—can be local or distant. Metastases occur most often within 3 years of the initial cancer diagnosis.1 The most common ...

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