Apart from the nasty side effects from cancer treatment, there are some red flags or what we term medically as 'oncologic emergencies' to watch out for in the cancer population.

1. Cancer pain

Cancer pain or pain caused by the cancer itself could be tricky to assess and challenging to treat. It is inflammatory in nature, often worse at night, is persistent and persistently worsens when not adequately treated. Cancer pain does not respond to normal intervention like what you do with joint or muscle pains and aches. There is frequent breakthrough pain, that means sudden and severe spikes in pain throughout the day. If this occurs, please inform your primary oncologist to adjust your pain medications.

In some situations, people with cancer experience complex pain where the pain sources come from the cancer, from immobility or even from anxiety. The role of other healthcare professionals like a physiotherapist or psychologist are to provide interventions to address other root causes that are magnifying the individual's pain.

2. Cachexia

(pronounced kuh-KEK-see-uh)

Cachexia is a disorder that causes extreme weight loss and muscle wasting, including the loss of body fat. This disorder is associated with an underlying illness typically cancer, chronic renal failure and HIV. Cachexia in the cancer population could be both treatment-related (stress from chemo and radiation therapy) and disease-related (break down of muscle and fatty tissues consumed by the tumor). Signs of cachexia include involuntary weight loss (despite nutrition), muscle wasting, loss of appetite, swelling, low energy levels and fatigue.

3. Bone metastasis

When cancer cells spread into the bones, it is a red flag as there are fracture risks involved. Bones commonly affected are the spine, pelvis, ribs and long bones (thigh or arm). This is more likely to occur with breast, prostate, lung and kidney cancers.

In some cases, if the bone metastasis pose a high risk for fractures, the oncologist will advise surgical intervention to prevent a fracture. While in other cases, if surgery is not indicated, there are weight bearing precautions and exercise guidelines to be followed. A cancer-trained physiotherapist will be able to help you exercise safely.

4. Hypercalcemia

This refers to an elevated calcium level in the blood stream and is associated with bone metastasis. Symptoms include lethargy, restlessness, confusion, nausea, frequent urination or constipation. This red flag is diagnosed through blood test. It is an emergency and medical intervention is required.

5. Cord compression

This refers to a pending or actual spinal cord compression due to an increasing tumor size or pathological fractures in the spinal bones (caused by the cancer) that may be pressing against the spinal cord. Signs and symptoms include unrelenting pain particularly at night, sensory disturbances and sudden weakness of any limb(s). Cord compression is often confirmed through MRI. There is a need to wait for medical intervention and clearance before rehab.

If you are a healthcare provider working with the cancer population or a caregiver, watch for these red flags. You could alleviate someone's suffering, prevent complications and potentially save a life.

The above are also summarized in a reader-friendly format in my Instagram @rehabmatters, link here: https://www.instagram.com/p/CXdYBnlFJVJ/?utm_source=ig_web_copy_link . Feel free to share to somebody who may benefit from it.