Miami Cancer Institute Oncology Rehabilitation Update

Cancer is a public health problem of major proportions. Each year, more than 600,000 people in the United States die from cancer. There have been many advances in the practice of rehabilitation medicine, neurology and other clinical specialties that identify and treat patients with cancer. Fatigue and loss of physical performance are frequent problems of cancer patients. This online update will provide practical, evidence-based rehabilitation strategies to accurately treat oncology patients of various types, including contraindications for treatment.

Topics include:

  • Cancer Rehabilitation: Current State of the Science and Future Horizons
  • Shoulder Pain and Dysfunction in Breast Cancer
  • Rehabilitation of the Person With Breast Cancer 
  • Neuromuscular Complications of Gynecologic Cancers
  • Rehabilitation of the Person With Gynecologic Cancer 
  • Chemotherapy-Induced Peripheral Neuropathy (CIPN)

Target Audience

Neurologists, Neurosurgeons, Psychiatrists, Psychiatrists, General Internists, Oncologists, Pharmacists, Pharmacy Technicians, Athletic Trainers, Nurses, Occupational Therapists, Physical Therapists and Assistants, Advanced Practice Registered Nurses and Family Practice Physicians.

Learning Objectives

  • Identify the areas of rehabilitation practice and clinical interventions that have strong and moderate levels of evidence for integration into oncology care.
  • Align cancer rehabilitation with survivorship care services and utilize frameworks for integration and collaboration of care. 
  • Evaluate clinical pathways for exercise and rehabilitative interventions for implementation into practice. 
  • Recognize the impact of breast cancer treatments, such as surgery, radiation therapy and chemotherapy on shoulder anatomy and function. 
  • Diagnose commonly seen shoulder impairments in breast cancer patients and prescribe the most appropriate treatment options. 
  • Describe the neuromuscular impairments associated with gynecologic cancers and their treatment, including paraneoplastic syndromes, post-surgical complications, post-chemotherapy and post-radiation therapy.
  • Utilize the multimodal approach needed to address the functional impairments caused by the neuromuscular issues associated with gynecologic cancers.
  • Identify common chemotherapeutic agents and their pathophysiologic mechanisms associated with peripheral neuropathy.
  • Describe neuropathy grading scales and assessments of neuropathy in the cancer patient, including the role of electrodiagnosis. 
  • Prescribe pharmacologic and non-pharmacologic interventions used to prevent and manage CIPN.
  • Describe breast cancer-related impairments and their impact on the quality of life for the patient.
  • Explain available treatments of cancer-related impairments.
  • Identify strategies to minimize barriers to early referral for cancer-related impairments.
  • Describe gynecologic cancer-related impairments and their impact on the quality of life for the patient.
  • Describe the treatments of gynecologic cancer-related impairments.
  • Identify strategies to minimize barriers to early referral for cancer-related impairments.
Additional information
Bibliography: 
  • Alfano, C. M., & Pergolotti, M. (2018). Next-generation cancer rehabilitation: a giant step forward for patient care. Rehabilitation Nursing Journal, 43(4), 186-194.
  • Schmitz, K. H., Campbell, A. M., Stuiver, M. M., Pinto, B. M., Schwartz, A. L., Morris, G. S., ... & Patel, A. V. (2019). Exercise is medicine in oncology: engaging clinicians to help patients move through cancer. CA: a cancer journal for clinicians, 69(6), 468-484.
  • Hidding, J. T., Beurskens, C. H., van der Wees, P. J., van Laarhoven, H. W., & Nijhuis-van der Sanden, M. W. (2014). Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PloS one, 9(5).
  • McNeely, M. L., Campbell, K., Ospina, M., Rowe, B. H., Dabbs, K., Klassen, T. P., ... & Courneya, K. (2010). Exercise interventions for upper‐limb dysfunction due to breast cancer treatment. Cochrane Database of Systematic Reviews, (6).
  • Georgiou, A., Grigsby, P. W., & Perez, C. A. (1993). Radiation induced lumbosacral plexopathy in gynecologic tumors: clinical findings and dosimetric analysis. International Journal of Radiation Oncology* Biology* Physics, 26(3), 479-482.
  • Viau, M., Renaud, M. C., Grégoire, J., Sebastianelli, A., & Plante, M. (2017). Paraneoplastic syndromes associated with gynecological cancers: A systematic review. Gynecologic oncology, 146(3), 661-671.
  • Shah, A., Hoffman, E. M., Mauermann, M. L., Loprinzi, C. L., Windebank, A. J., Klein, C. J., & Staff, N. P. (2018). Incidence and disease burden of chemotherapy-induced peripheral neuropathy in a population-based cohort. Journal of Neurology, Neurosurgery & Psychiatry, 89(6), 636-641.
  • Seretny, M., Currie, G. L., Sena, E. S., Ramnarine, S., Grant, R., MacLeod, M. R., ... & Fallon, M. (2014). Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis. PAIN®, 155(12), 2461-2470.
  • Silver, J. K., Baima, J., & Mayer, R. S. (2013). Impairment‐driven cancer rehabilitation: an essential component of quality care and survivorship. CA: a cancer journal for clinicians, 63(5), 295-317.
  • Hidding, J. T., Beurskens, C. H., van der Wees, P. J., van Laarhoven, H. W., & Nijhuis-van der Sanden, M. W. (2014). Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PloS one, 9(5), e96748.
  • Ramaseshan, A.S., Felton, J. Roque, D. Rao, G. Shipper, A. G., & Sanses, T.V. (2018). Pelvic floor disorders in women with gyencologic malignancies: a systematic review. International urogynecology journal, 29(4), 459-476.
  • Cannioto, R. A., LaMonte, M.J., Kelemen, L.E., Risch, H.A., Eng, K.H., Minlikeeva, A. N., ...& Berchuck, A. (2016). Recreational physical inactivity and mortality in woman with invasive epithelial ovarian cancer: evidence from the Ovarian Cancer Association Consortium. British journal of cancer, 115(1), 95.
Course Summary
Available credit: 
  • 3.00 AMA PRA Category 1 Credit™
  • 3.00 Florida Board of Athletic Training
  • 3.00 General certificate of attendance
  • 3.00 Nurse Practitioners
  • 3.00 Florida Board of Nursing
  • 3.00 Florida Board of Occupational Therapy
  • 3.00 Florida Board of Pharmacy
  • 3.50 Florida Board of Physical Therapy Practice
Course opens: 
02/01/2022
Course expires: 
01/31/2024

Adrian Cristian, M.D., MHCM 
Chief, Cancer Rehabilitation 
Miami Cancer Institute

Christian Marcel Custodio, M.D.     
Cancer Rehabilitation Medicine Fellowship Director
Attending Physiatrist & Clinical Member
Rehabilitation Medicine Service, Department of Neurology
Memorial Sloan Kettering Cancer Center
New York, New York                  

Nicole L. Stout, DPT, CLT-LANA, FAPTA 
Clinical Research Scientist / Physical Therapist 
Research Assistant Professor
West Virginia University Cancer Institute
School of Medicine, Department of Hematology/Oncology
Morgantown, West Virginia

Nicole L. Stout, DPT, faculty for this educational activity, is a consultant for Survivorship Solutions, LLC, and has indicated that the presentation or discussion will not include off-label or unapproved product usage. 

Adrian Cristian, M.D. and Christian Marcel Custodio, M.D., faculty members for this educational activity, have indicated that they have no relevant financial relationships with ineligible companies* to disclose, and that the presentations or discussions will not include off-label or unapproved product usage.  

The following were symposium directors for the Rehabilitation of the Person With Gynecological Cancer and Rehabilitation of the Person with Breast Cancer online courses.

Gladys L. Giron, M.D., has indicated that her spouse is a member of the speakers' bureau and a consultant with Stryker.

John P. Diaz, M.D., has indicated that he is a member of the speakers' bureau with AstraZeneca and a consultant with ConMed and Intuitive Surgical.

Nicholas C. Lambrou, M.D., has no relevant financial relationship with ineligible companies* to disclose.

Starr K. Mautner, M.D., has no relevant financial relationship with ineligible companies* to disclose.
All of the relevant financial relationships listed for these individuals have been mitigated.

Non-faculty contributors and others involved in the planning, development and editing/review of the content have no relevant financial relationships to disclose with ineligible companies.*

*Ineligible companies – Companies whose primary business is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.

Disclosure Policy and Disclaimer

Baptist Health South Florida is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 
              
Baptist Health South Florida designates this enduring material for a maximum of 3 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This activity has been approved for 3.5 contact hours by the Florida Board of Physical Therapy Practice. FPTA Approval # CE22-897197 and CE Broker # 20-897197. This approval expires on 12.31.2022

Available Credit

  • 3.00 AMA PRA Category 1 Credit™
  • 3.00 Florida Board of Athletic Training
  • 3.00 General certificate of attendance
  • 3.00 Nurse Practitioners
  • 3.00 Florida Board of Nursing
  • 3.00 Florida Board of Occupational Therapy
  • 3.00 Florida Board of Pharmacy
  • 3.50 Florida Board of Physical Therapy Practice
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