REHABILITATION AFTER BONE MARROW TRANSPLANTATION
A. Ishida (Tokai University, Kanagawa, Japan)
Bone marrow transplantation (BMT) is the treatment of' choice in severe leukemia, aplastic anemia and immunodeficiency which have been unresponsive to the medical therapy. This treatment has been making a steady progress. The number of patients who were cured gradually increased. However high dose of anticancer drugs, total body irradiation are necessary to the pretreatment for BMT and furthermore, patients must be isolated for a long period in a bioclean room. These lower the systemic function and cause new complications such as GVHD and isolation syndrome. Such morbidity remains after discharge and quality of life in patients is lowered, even if BMT is successful.
From the rehabilitation point of view, team approach for miscellaneous problems in BMT was started in 1982. 0ne hundred seventy six patients has undergone BMT between 1982 to 1995. The evaluation by physiatrist, PT and OT was performed prior to BMT. Following BMT, physical and occupational therapy were started in a bioclean room and they were continued after transferring to the general ward. At the time of discharge, home program was prescribed. The results revealed that most of patients had decreased % vital capacity after BMT but it returned to normal value during follow up period. No distinct limitation of motion in extremities was recognized at the time of discharge. All school-aged patients could return to school within an average of 2.5 months.
It is fully realized that the rehabilitation approach is necessary for the patients who undergo BMT.
FATIGUE IN CANCER PATIENTS: A REHABILITATION ISSUE
Uma Monga; (Radiation Oncology, VA Medical Center; Department of Radiology, Baylor College of Medicine, Houston, Texas, USA)
Cancer and its treatment may cause a variety of symptoms such as pain, decreased appetite, ulcers in the mouth, hair loss, nausea and vomiting, shortness of breath, and fatigue. Of all these, fatigue is the symptom most commonly experienced. Fatigue has detrimental effects on the patient's quality of life, self care activities and social activities and as such may influence functional outcomes with rehabilitation. Prevalence of fatigue in cancer patients varies from 45-93%. Despite a high prevalence rate, little is known regarding the nature of fatigue, its etiology and management. While several correlates of fatigue have been postulated, research to date has found no consistent relationships among such correlates as weight loss, anemia, or psychological distress. Recently we have reported a decrease in neuromuscular efficiency, a parameter of muscular function, of the fast twitch tibialis anterior muscle in prostate cancer patients undergoing radiotherapy. In another prospective study of 22 prostate cancer patients, no significant changes in psychological subjective fatigue were noted during radiotherapy as compared to pre-treatment. This presentation will discuss various causes of fatigue in cancer patients and briefly describe some of the measurement instruments. Possible management strategies will also be presented.