Patients with cancer of the spinal cord experience some of the most debilitating complications, including pain, pathologic fractures, and spinal cord compromise. These issues, which may be related to the cancer and the effects of treatment, can lead to devastating consequences if not managed with a multidisciplinary team that includes physiatrists.
Kristen de Vries, DO, MS, physiatrist at NewYork-Presbyterian and Weill Cornell Medicine, recently coauthored an article in the American Journal of Physical Medicine and Rehabilitation as part of a series by cancer rehabilitation physicians to promote knowledge about the field, including the types of conditions they manage and how the approach of a cancer rehabilitation specialist differs from a traditional physiatrist.
Below, Dr. de Vries discusses the important role of physiatrists in determining the underlying causes of complications associated with spinal cancer and in the management of patient care to improve symptom management and quality of life.
What prompted you to co-author this comprehensive article on the management of patients with spinal cancer?
Cancer rehabilitation is a fairly new field, and cancer physiatrists are a small subset of physiatrists. There are not nearly enough of these specialists to meet the needs of cancer patients and, likewise, there are few centers that are able to support this subspecialty. NewYork-Presbyterian and Weill Cornell Medicine is unique in that the hospital recognizes the value of cancer rehabilitation, and our oncology departments appreciate our role and routinely refer patients to us. However, this is not the norm nationwide.
The purpose of our article was to promote awareness of the contributions of our subspecialty to managing spinal cancer that can benefit patients and colleagues alike. Complications for patients with spinal tumors are associated with impaired mobility and reduced quality of life – the purview of our specialty. Our expertise focuses on pain and symptom relief, preserving neurologic function, and maintaining spinal stability. While patients can benefit from such rehabilitation efforts, they are not regularly admitted to inpatient rehabilitation units or referred for outpatient cancer rehabilitation. Ongoing efforts are needed to promote the role of rehabilitation medicine in improving functional outcomes and quality of life for cancer patients with spine involvement.
What are the symptoms and comorbidities associated with spinal tumors?
Patients can present with either a primary spine tumor or direct compression of the spinal cord due to metastatic disease. The spine is a frequent and early site of metastases, affecting approximately 40% of individuals with cancer, which can spread to the thoracic, lumbar, or cervical spine. They can experience a range of symptoms, including ambulation issues and gait abnormality, weakness, bowel and bladder dysfunction, and neuropathic pain or pain within the spine itself. The origins are not always apparent, especially when a patient has a history of spine degeneration and other causes of back pain. Spinal tumors can also lead to sensory deficits, lymphedema, radiation fibrosis, cancer-related fatigue, pressure injuries and skin breakdowns, pelvic pain, and mental health concerns. It is truly a complex pattern of clinical presentations.
What is the role of cancer rehabilitation specialists in the management of these patients?
A cancer physiatrist can play a meaningful role in any setting whether outpatient, inpatient, or on a consult service. Patients are primarily referred to us from the oncology, radiation oncology, or surgical oncology teams. We are generally called in to help with functional recovery and pain and symptom management related to chemotherapy, radiation, surgery, or a combination thereof. However, we are also called upon to help determine what symptoms may be indicative of a biologic, mechanical, or neuropathic presentation depending on where the tumor is located.
Our approach is comprehensive and beneficial when parsing out the primary driver of a patient’s symptoms, providing insight on treatment decisions, and by overseeing their functional recovery. From evaluating patients to establishing underlying causes of symptoms to working as part of a collaborative team, cancer rehabilitation specialists are key to optimizing patient function and quality of life.
What is your overarching message to physiatrists who encounter patients with spinal tumors in their practice?
Timely and careful rehabilitation management can help reduce the devastating complications of spinal tumors and improve patient outcomes. Special attention should be paid to treatment coordination among all the involved specialists caring for cancer patients to maximize the impact of rehabilitation. Previous research shows that patients with metastatic spinal cord compression who underwent rehabilitation had longer survival, fewer deaths from myelopathic complications, less pain, lower levels of depression, and higher life satisfaction.
We also want to emphasize that as cancer rehabilitation specialists, we are available to assist oncologists in understanding the origin of symptoms, consulting on plans of care, and optimizing function and independence for patients. By integrating rehabilitation at any point throughout the cancer care continuum, our hope is to augment functional progress and ultimately improve survivorship and cancer outcomes.
