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CASE STUDY
P.Y. is a 42-year-old man diagnosed with chronic myelogenous leukemia (CML) in the chronic phase. He has been taking the tyrosine kinase inhibitor imatinib daily for the past 3 months. At a scheduled evaluation with his oncologist, it was discovered that the leukemia was not responding well. As a first option, the oncologist decided to increase the imatinib dose. Within a couple weeks, P.Y. began experiencing significant muscle pain and difficulty breathing. On a Friday night, his breathing became so labored and difficult that P.Y. went to the emergency department. He was admitted to the hospital for evaluation of these new symptoms. As part of the admission, a physical therapy consult was automatically ordered. On Saturday, the physical therapist reviewed the patient’s electronic medical record and discussed the case with the on-call oncology fellow before seeing the patient. After discussion with the physician, they decided that the physical therapy evaluation should be deferred for a few days.
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Cancer is among the leading causes of death worldwide and the second most common cause of death in the United States, resulting in over half a million fatalities annually. The most common cancers are breast, lung, prostate, colorectal, melanoma, bladder, non-Hodgkin lymphoma, kidney, endometrium, leukemia, pancreas, thyroid, and liver. Although the rate of smoking—a major cause of several cancers—has declined in the United States, two other important risk factors are increasing. The American population is aging and cancer rates rise with age. Another risk factor for cancer is obesity. Rates continue to rise, with the most recent estimate of over 39% of American adults being classified as obese.
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Since the early 1990s, the overall cancer death rate has declined 26% in the United States. This trend highlights both the progress that has been made in treating cancer and that the number of cancer survivors has increased. Physical therapists are likely to be treating individuals receiving cancer therapies in inpatient settings, but are even more likely to be treating cancer survivors in outpatient settings. Individuals may seek physical therapy specifically for the adverse effects of cancer treatments, such as lymphedema secondary to removal of affected lymph nodes. More commonly, patients are seeking physical therapy for another condition that may be impacted by the long-term consequences of chemotherapy. For example, a patient that had been successfully treated for testicular cancer may suffer from breathing difficulties related to the lung toxicity that is associated with bleomycin. The patient that is in remission of chronic myelogenous leukemia (CML) may suffer from significant peripheral neuropathy secondary to the specific chemotherapeutic regimen. Physical therapists must recognize that the delayed toxicities of many chemotherapeutic agents are typically irreversible. Thus, an aerobic exercise program must be adapted and combined with energy conservation principles for the person who has bleomycin-induced lung damage. Likewise, balance training and fall risk reduction strategies for the person with peripheral neuropathy may ...