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7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Austrian Society of Physical Medicine and Rehabilitation

26.-29.10.2011, Salzburg, Austria

Rehabilitation of patients suffering from metastatic bone disease

Meeting Abstract

  • corresponding author presenting/speaker Richard Crevenna - Department of PMR, Medical University of Vienna, Austria
  • Bruno Mähr - RZ Rosalienhof, BVA, Bad Tatzmannsdorf, Austria
  • Tanya Sedghi Komanadj - Department of PMR, KH Hietzing, Vienna, Austria
  • Mohammad Keilani - Department of PMR, Medical University of Vienna, Austria

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation. Salzburg, 26.-29.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11esm135

DOI: 10.3205/11esm135, URN: urn:nbn:de:0183-11esm1350

Published: October 24, 2011

© 2011 Crevenna et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Metastatic bone disease has become an important issue in cancer rehabilitation. Modern oncologic treatment strategies are able to increase survival of these patients. Typical entities which involve the skeleton are breast cancer, prostate cancer, lung cancer, kidney cancer, and multiple myeloma. Furthermore, thyroid cancer and melanoma, but also very often the so called “cancer of unknown primum” can involve skeleton. Patients suffering from metastatic bone disease often are a challenge for cancer rehabilitation due to the danger of pathological fractures with the consequence of neurological deficits, immobility and dependency, hypercalcaemia, severe pain, and of reduced survival time.

Material/Methods: A rehabilitation concept for patients suffering from metastatic bone disease is presented. This includes a description of functional deficits, specific dangers, therapeutic options and contraindications. Furthermore, the planning process within a specialised tumour board and a helpful tool (checklist) are presented.

Results: Rehabilitation plans for cancer patients suffering from metastatic bone disease have to be individually tailored depending on their individual functional deficits, and on their individual general and specific (metastatic bone disease) medical conditions. They can include medical exercise with the intention to increase endurance capacity and/or muscular strength, neuromuscular electrical stimulation (as an passive option to exercise), nutrition, lymph massage, breathing therapy, physiotherapy, immersion/hydrotherapy, biofeedback, ergonomics, orthotics, occupational therapy, different forms of massage, analgesic electrotherapy, and other physical modalities, psychotherapy/psychooncology, but also drug treatment for pain (especially the so called co-analgesics).

Most of the functional deficits of the these very challenging cancer patients are pain (often due to bone disease), fractures, neurological deficits, daily fatigue, decreased endurance capacity and muscular strength, weight loss (cachexia) or weight gain (depending on their treatment), sensorimotor deficits and polyneuropathy, dyspnoea, lymphedema, incontinence, cognitive deficits (“chemobrain”), psychological distress and anxiety, walking disturbances due to polyneuropathy with the risk of falls and the danger of fractures.

For most patients suffering from metastatic bone disease, an individual rehabilitation concept is defined within a specialized tumour board (with referring specialists from different medical specialities all involved in the rehabilitation process, and with the goal to plan rehabilitation, but NOT to treat the oncologic disease itself!). Furthermore, for the individual patient, we recommend a check list which displays medical history and diagnoses, medication, special risks, individually allowed treatment options and contraindications, but also the information of the patient and of the members of the rehabilitation team.

Conclusion: Rehabilitation concepts for cancer patients suffering from metastatic bone disease have to be individually tailored depending on their individual needs. A specialized tumour board, a checklist, and an individual rehabilitation plan which includes specific nutrition, psychooncologic help, and different options from the field of Physical Medicine and Rehabilitation may help these patients to improve their functional health, and independence in daily activities, and to maintain social participation.