Medical and Surgical Management of Oncologic Conditions
You must understand the major treatment modalities and their rehabilitation implications. Surgery ranges from lumpectomy to radical resection and reconstruction; know precautions after breast reconstruction (avoid prolonged pressure or aggressive stretching on flaps, follow surgeon protocols), after lymph node dissection (lymphedema precautions), and after limb-salvage or amputation (weight-bearing and prosthetic timelines). Radiation causes acute skin reaction and fatigue and late fibrosis, joint stiffness, and lymphedema; tissues in the field may have reduced flexibility and healing capacity. Chemotherapy brings fatigue, peripheral neuropathy, cardiotoxicity (anthracyclines), and myelosuppression; know neutropenic precautions and when to defer treatment during nadir counts. Hormonal therapy and immunotherapy have distinct side-effect profiles, including arthralgias and immune-related inflammatory events.
Traps
- Ignoring platelet and neutrophil counts before exercise or manual therapy; thrombocytopenia contraindicates aggressive techniques.
- Treating chemotherapy-induced peripheral neuropathy as purely strength-limited when balance and sensory safety are the priority.
- Forgetting that bone-modifying agents and metastatic bone disease raise fracture risk with high-load exercise.
Rule of thumb
Before any session, ask: what treatment is active, what are the counts, and what tissue precautions apply?
Worked example
A patient on chemotherapy presents with a platelet count of 40,000/µL and fatigue. Defer resistive and manual intervention, provide gentle mobility and education, and coordinate with the oncology team.