11.5 Cancer Rehabilitation & Oncologic Rehabilitation

ABPMR Physical Medicine and Rehabilitation Board Exam Study Guide Exam

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1 Chapter 1: Introduction & Exam Overview

1.1 ABPMR Part I Exam Overview & Format 1.2 Board Review Strategy & Content Blueprint Breakdown

2 Chapter 2: Musculoskeletal Medicine

2.1 Shoulder & Upper Extremity Diagnostics 2.2 Knee, Hip & Lower Extremity Conditions 2.3 Spine Pathology, Radiculopathy & Myelopathy 2.4 Inflammatory Arthritis, Tendinopathies & Concussion 2.5 Bone Health, Osteoporosis & Metabolic Bone Disease 2.6 Thoracic Outlet Syndrome & Peripheral Nerve Entrapment 2.7 Fracture Rehabilitation & Immobilization Complications 2.8 Overuse Tendinopathies & Regenerative Medicine 2.9 Gait Analysis & Abnormal Gait Patterns

3 Chapter 3: Spinal Cord Injury Rehabilitation

3.1 ASIA Examination & Impairment Scale 3.2 Spinal Cord Injury Syndromes 3.3 Autonomic Dysreflexia & Acute Complications 3.4 Neurogenic Bladder, Bowel & Secondary Complications

4 Chapter 4: Stroke & Neuromuscular Rehabilitation

4.1 Stroke Vascular Syndromes & Acute Assessment 4.2 Stroke Motor Recovery & Hemiplegic Complications 4.3 Spasticity Assessment & Multimodal Management 4.4 ALS, GBS, CIDP & Neuromuscular Disease Rehab 4.5 Multiple Sclerosis & Demyelinating Disease Rehabilitation 4.6 Parkinsonism, Movement Disorders & Functional Neurologic Disorder

5 Chapter 5: Electrodiagnostics (EMG/NCS)

5.1 Nerve Conduction Studies Principles & Physics 5.2 Needle Electromyography & MUAP Analysis 5.3 Mononeuropathies & Radiculopathy Patterns 5.4 Neuromuscular Junction Disorders & Myopathies

6 Chapter 6: Traumatic Brain Injury

6.1 TBI Severity Classification, Glasgow Coma Scale, and Pathophysiology 6.2 Rancho Los Amigos Levels of Cognitive Functioning and Disability Rating Scale 6.3 Neurobehavioral Sequelae and Agitation Management 6.4 Concussion Evaluation, Vestibular-Ocular Dysfunction, and Return-to-Play/Work Protocols

7 Chapter 7: Chronic Pain & Interventional Spine

7.1 Fluoroscopic Spine Interventions 7.2 Opioid Stewardship & Controlled Substance Compliance 7.3 Complex Regional Pain Syndrome, Fibromyalgia & Myofascial Pain 7.4 Spinal Cord Stimulation & Intrathecal Therapy

8 Chapter 8: Amputee Rehabilitation & Prosthetics

8.1 Amputation Surgical Levels & Medicare K-Levels 8.2 Socket Designs & Suspension Systems 8.3 Prosthetic Feet & Microprocessor Knee Mechanisms 8.4 Post-Amputation Care, Residual Limb & Phantom Pain

9 Chapter 9: Pediatric Rehabilitation

9.1 Cerebral Palsy Classification & GMFCS 9.2 Spina Bifida & Myelomeningocele Management 9.3 Muscular Dystrophies & Neuromuscular Disease in Children 9.4 Pediatric Brachial Plexopathy & Congenital Disorders

10 Chapter 10: Prosthetics, Orthotics & Assistive Technology

10.1 Lower Limb Orthoses — AFOs & KAFOs 10.2 Spinal & Upper Extremity Orthoses 10.3 Upper Limb Prosthetics — Body-Powered vs Myoelectric 10.4 Wheelchairs, Seating Systems & Pressure Mapping

11 Chapter 11: Medical Rehabilitation & Outcomes

11.1 Dysphagia Assessment & Management 11.2 Neurogenic Bladder & Bowel Management 11.3 Pressure Injuries & Wound Management 11.4 Outcome Measures & Medical Complications 11.5 Cancer Rehabilitation & Oncologic Rehabilitation 11.6 Burns, Endocrine/Metabolic & Medical Complications Rehabilitation

12 Chapter 12: Cardiopulmonary Rehabilitation

12.1 Cardiac Rehabilitation Phases & Metabolic Equivalents 12.2 Pulmonary Rehabilitation & COPD Management

13 Chapter 13: Foundational Rehabilitation Concepts

13.1 Kinesiology, Biomechanics & Functional Anatomy 13.2 Rehabilitation Pharmacology & Medication Management 13.3 Research Methodology, Biostatistics & Evidence-Based Practice 13.4 Nutrition, Metabolism & Energy Expenditure in Rehabilitation 13.5 Diagnostic Procedures: Imaging, MSK Ultrasound, Urodynamics & Neuropsych Assessment

11.5 Cancer Rehabilitation & Oncologic Rehabilitation

Key Takeaways Explain This Topic AI

Cancer rehabilitation improves function, fatigue, pain, and quality of life across the cancer continuum (prehabilitation before treatment, during treatment, post-treatment survivorship, and end-of-life); early physiatric involvement is now a quality standard.

Cancer-related fatigue is the most prevalent symptom and responds to moderate aerobic and resistance exercise—exercise is one of the few evidence-based interventions for it.

Common rehab-relevant impairments include post-surgical deficits (mastectomy, neck dissection, thoracotomy), chemotherapy peripheral neuropathy (oxaliplatin, vincristine, taxanes), radiation plexopathy/fibrosis, lymphedema, bone metastases/pathologic fracture risk, and steroid myopathy.

Exercise is safe in patients with bone metastases when modified to avoid high-load on affected sites; caution with thrombocytopenia, neutropenic precautions, and central lines guides activity prescription.

Last updated: July 2026

Cancer Rehabilitation & Oncologic Rehabilitation

Cancer rehabilitation is a Domain E topic (cancer, transplant, postinfectious). Physiatric involvement across the cancer continuum is an evolving quality standard: prehabilitation before treatment, rehab during treatment, survivorship, and palliative/end-of-life care.

The Cancer Rehabilitation Continuum

Phase Goals Common Issues

Prehabilitation (pre-treatment) Optimize baseline fitness, nutrition, psychological readiness Deconditioning, anxiety, baseline deficits

During treatment Maintain function, mitigate treatment toxicity Fatigue, cytopenias, neuropathy, deconditioning

Post-treatment survivorship Restore function, late-effect management Lymphedema, radiation fibrosis, neuropathy, osteoporosis

Palliative / end-of-life Maximize comfort and independence, caregiver training Pain, weakness, transfers, dyspnea

Treatment-Related Impairments

Surgery : mastectomy/axillary dissection → shoulder ROM restriction, lymphedema risk; neck dissection → accessory nerve palsy, shoulder dysfunction; thoracotomy/laparotomy → respiratory and core impairments; limb-sparing resection or amputation → prosthetic/orthotic needs.

Chemotherapy-induced peripheral neuropathy (CIPN) : oxaliplatin (acute cold-triggered and chronic), vincristine, taxanes (paclitaxel, docetaxel), bortezomib, platinum agents; presents with sensory loss, paresthesias, proprioceptive deficits, and falls; managed with desensitization, balance training, AFOs for foot drop, and activity adaptation.

Radiation : radiation fibrosis syndrome (contracture, lymphedema, weakness), brachial/lumbosacral plexopathy (often delayed, painless weakness distinguishing from tumor recurrence), osteoradionecrosis, radiation myelopathy.

Steroid myopathy : proximal weakness from prolonged corticosteroids; improve with taper and progressive resistance.

Hormonal therapy : aromatase inhibitors cause arthralgias; androgen deprivation causes osteoporosis and metabolic syndrome.

Cancer-Related Fatigue & Exercise

Cancer-related fatigue is the most prevalent cancer symptom and is one of the few conditions for which exercise has strong evidence . Moderate aerobic and resistance exercise improves fatigue, physical function, depression, and quality of life across many cancer types and stages. Cancer + Treatment ──► Fatigue + Deconditioning ──► ↓Activity (Vicious Cycle)

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└── Moderate Aerobic + Resistance Exercise ──► ↑Function, ↓Fatigue, ↑QoL
Bone Metastases & Safety Modifications

Patients with bone metastases can and should exercise, with modifications:

Risk Consideration Modification

Spinal/lower-limb lytic metastases Avoid high-impact loading, heavy resistance on affected sites; substitute non-impact aerobics (cycle, aquatic), seated exercise

Pathologic fracture risk Screen for pain on loading; avoid end-range rotation under load
Thrombocytopenia Hold contact/impact exercise when platelets very low (< 20-50k depending on activity)
Neutropenia Avoid group/public exercise during severe neutropenia; consider home program
Central venous catheters Avoid upper-extremity heavy load; protect port site
Lymphedema

Lymphedema—common after axillary/groin dissection and radiation—presents with unilateral swelling, pitting then non-pitting, stemmer sign. Management: complete decongestive therapy (manual lymphatic drainage, multilayer bandaging, compression garments, exercise, skin care). Modern evidence supports progressive resistance exercise (even after breast cancer axillary surgery) and does not show exercise worsens lymphedema when properly progressed.

Transplant & Postinfectious Rehab Adjuncts

Hematopoietic stem cell transplant recipients face profound deconditioning, graft-vs-host disease, cytopenias, and steroid myopathy; rehab is staged by engraftment status and immune reconstitution. Postinfectious rehab (post-COVID, encephalitis, polio/post-polio, Guillain-Barre sequelae) addresses residual weakness, dysautonomia, and cognitive impairment.

Cancer Prehabilitation & Survivorship Models

Prehabilitation—intervening between diagnosis and cancer treatment—optimizes cardiopulmonary fitness, nutritional status, psychological readiness, and baseline function to reduce post-treatment complications and length of stay. Survivorship rehabilitation addresses late and long-term effects: radiation fibrosis (often years later), chemotherapy-induced peripheral neuropathy, cardiotoxicity (anthracyclines, trastuzumab), endocrine effects (aromatase inhibitor arthralgia, androgen deprivation osteoporosis), and secondary cancers. The rehab plan adapts across the continuum and anticipates late effects rather than reacting to them.

Pain in Cancer Rehabilitation

Cancer pain is multifactorial: nociceptive (tumor invasion, bone metastases, surgical), neuropathic (plexopathy, CIPN, postsurgical nerve injury), and mixed. Management follows the WHO analgesic ladder (non-opioids → weak opioids → strong opioids; adjuvants for neuropathic/bone pain), with disease-directed therapy (radiation for bone metastases, systemic therapy), interventional options (nerve blocks, neuraxial, intrathecal pumps), and rehabilitation (positioning, modalities, desensitization, assistive devices). Bone metastases pain often responds to palliative radiation; pathologic fracture risk is managed with orthopedic stabilization (prophylactic fixation) and modified activity.

Palliative Rehabilitation

Palliative rehab maximizes comfort, dignity, and independence in advanced disease: positioning to prevent contractures and pressure injuries, breathing techniques and energy conservation for dyspnea, transfer and mobility training for safe caregiver-assisted care, splinting for edema and comfort, and management of lymphedema, secretions, and pain. The goals shift from restoration to symptom control and quality of life, but rehabilitation remains active—not abandoned—through end of life.

Exercise Prescription & Surveillance Pre-treatment ──► During treatment ──► Survivorship ──► Palliative
Prehab Maintain function Late effects Comfort/positioning
Fitness ↑ Fatigue ↓ Neuropathy Transfers

Surveillance includes monitoring for recurrence, late treatment effects (cardiotoxicity, neuropathy, osteoporosis, second cancers), psychosocial health, and return to work. Exercise is prescribed across this continuum with stage-specific modifications (cytopenia precautions, central lines, bone metastasis loading limits), and is now recognized as standard supportive cancer care.