If you ask any rehab professional what scares them the most about oncology patients, their answer 99.9% of the time will be bone metastases.
This fear comes largely from the outdated way we discuss & teach management of patients with cancer. Regardless of why this fear exists, it’s keeping rehab professionals from actually helping their patients with cancer (even those without bone mets).
The fact is patients with bone metastases benefit from rehab, from exercise, & from physical activity. High-quality evidence overwhelmingly supports these benefits & demonstrates that there are very safe ways to administer & dose movement for patients with bone metastases. Dr. Susan Maltser is on the podcast today to discuss HOW.
Bone metastases are cancer cells that have spread to bone.
Bone metastases refer to the spread of cancer cells from their original site to the bones. They occur when cancer cells break away from the primary tumor and travel through the bloodstream or lymphatic system, eventually reaching the bones. Once in the bones, these cancer cells can start growing and forming new tumors, which is known as bone metastases.
Bone metastases can arise from various types of cancers, including breast, lung, prostate, kidney, and thyroid cancers, among others. The exact mechanism by which cancer cells target and invade the bones is not fully understood, but several factors contribute to their occurrence.
Bone metastases can cause various complications and symptoms, including bone pain, fractures, spinal cord compression, hypercalcemia (high levels of calcium in the blood), and other skeletal-related events. Early detection and appropriate management of bone metastases are crucial to improve patient outcomes and quality of life.
Even as serious as bone metastases are, bone metastases are not automatic contraindications for exercise, physical activity, & rehab. In fact, patients with bone metastases may benefit EVEN MORE from these interventions to improve their health & quality of life.
Pay attention to functional pain.
Functional pain, or pain experienced with daily activities (& no clear mechanism of injury), is a definite indicator of a potential impending pathological fracture.
Common examples of functional pain include pain with:
- walking,
- stairs,
- sit to stands,
- lifting their body part,
- lifting, &
- bending backwards
Do these 3 things with your next patient with bone metastases
In the episode, Dr. Maltser gave 3 basics steps to implement the next time you treat a patient with bone metastases:
- Assess if the patient has functional pain.
- Assess the patient’s daily activities & movements.
- Focus on education – fracture prevention, falls prevention, importance of improving & maintaining functional mobility
For more super helpful info on cancer rehab safety, make sure to check out Dr. Maltser’s article A Focused Review of Safety Considerations in Cancer Rehab.
Managing Pain in the Patient with Bone Metastases
Even for seasoned clinicians, managing patients with metastatic bone pain can be intimidating & challenging. But there ARE definitely things we can do to help these patients.
First, listen to your patient to understand what’s important to them. By understanding their values & what’s important to them, it’s much easier to establish a solid therapeutic relationship & ensure their needs are being met.
Occasionally, I will encounter a patient with metastatic pain who is resistant to taking pain medication because they are concerned about becoming addicted. Dr. Maltser recommends listening to your patient’s concerns & responding with something like this:
“If we don’t treat your pain, I’m worried that you won’t be able to participate in your life, emotionally & physically.”
I’ve also found that when I explain appropriately-prescribed pain medication is a tool for patients to do the things they love with less pain, not a crutch, sometimes that helps patients understand the benefits they’ll get, rather than focusing exclusively on the addiction concerns (also continually communicating with their pain management team is very helpful here).
Until next time, this is Elise with TheOncoPT. And remember: you are exactly the physical therapist that your patients with cancer need. So let’s get to work.
-Dr. Elise K. Cantu, TheOncoPT
About Dr. Susan Maltser, DO
I am a Rehab Medicine doctor who specializes in treating cancer patients. I help patients return to their previous level of function by treating their pain or any disability from cancer diagnosis through their cancer treatment and beyond.
Common conditions that I treat are post-mastectomy pain, lymphedema, shoulder pain, weakness and difficulty with daily activities. Common cancer patients that I encounter are cancers of the breast, head and neck, brain, spine and sarcomas. I work with a multi-disciplinary team including physical, occupational, lymphedema and speech therapists. Focusing on the highest quality of life for cancer patients and survivors is the ultimate goal of my practice.