MEDREH-03 · Cancer Rehabilitation

Cancer Rehabilitation. Topics: Fatigue, Lab-Value Precautions, Plexopathy, Lymphedema, Mirels Scoring, and Paraneoplastic Syndromes. Part of the Medical Rehabilitation series of the Reflex PM&R Board Review podcast. Audio corrections: (1) In the audio: You must never place a blood pressure cuff, perform venipuncture, or place an IV line on the affected limb. The tourniquet effect, or local trauma, can instantly trigger a massive exacerbation of the swelling. — Correct: Prospective breast-cancer cohorts found no significant association between arm-volume increase and ipsilateral blood draws, injections, blood-pressure readings, or air travel; observational null findings do not prove zero risk and do not establish blanket safety for intravenous infusions. Prefer an alternative site when practical if consistent with the care plan, but do not delay necessary care. Individualize vascular access, especially for chemotherapy. Skin care and prompt assessment of infection remain important; treatment extent, higher BMI, and cellulitis are among supported risk factors. (2) In the audio: Vincristine produces a predominantly motor-axonal neuropathy. While taxanes cause sensory burning, vincristine causes profound motor weakness. — Correct: Vincristine can cause a sensorimotor axonal neuropathy with prominent motor and autonomic features. Relative sensory and motor involvement varies by age, exposure and clinical setting; motor weakness can be prominent. Constipation or ileus is a useful contextual clue, not an exclusive diagnostic test. Motor predominance itself is not an error; the prior sensory-predominant correction overstated the evidence. (3) In the audio: The clinical rule is absolute. Myokymia equals radiation. Myokymic discharges are the definitive signature of radiation plexopathy, and they are absolutely never seen in tumor plexopathy. — Correct: Myokymia strongly favors radiation injury in context, but does not exclude concurrent or recurrent malignancy. Its absence does not exclude radiation injury. Interpret the clinical course, examination, imaging and EMG together; reassess new or worsening symptoms. The written chapter is correct. Full correction register: https://www.reflexpmr.com/errata. The full companion chapter and a linked board-style Q-bank set for this topic are at https://www.reflexpmr.com/read/MEDREH-03.