Prognosis, Risk Factors, and Prevention
Prognosis questions test whether you can translate disease and treatment factors into realistic rehabilitation goals and timeframes. Key concepts: stage and grade, performance status (ECOG/Karnofsky), comorbidity burden, and treatment intent (curative vs. palliative). A patient on curative-intent therapy with good performance status can tolerate progressive loading; a patient on palliative therapy is better served by function-preserving, symptom-focused goals.
Risk factors split into modifiable (tobacco, alcohol, obesity, physical inactivity, UV exposure, HPV status, diet) and non-modifiable (age, genetics such as BRCA1/2, family history, prior radiation). Physical therapists contribute to prevention through activity counseling, lymphedema risk education, and survivorship exercise prescription. Know that exercise reduces cancer-related fatigue and improves quality of life across many diagnoses, and that survivorship guidelines generally recommend 150 minutes of moderate activity weekly plus twice-weekly resistance training, adapted to tolerance.
Traps
- Equating prognosis with a fixed timeline; questions often want goal-setting implications, not a survival estimate.
- Missing that prior radiation raises risk for late effects (fibrosis, lymphedema, secondary malignancy) and alters tissue tolerance.
- Overlooking that lymphedema risk education is prevention, not treatment.
Rule of thumb
Match intervention intensity to treatment intent and performance status, not to chronologic age.
Worked example
A patient with metastatic disease, ECOG 3, and fatigue asks about exercise. Recommend short, frequent, low-intensity bouts (e.g., seated activity, brief walks) with energy conservation, rather than a high-intensity program.