Other / General Medicine
Sophia A. Artamendi, BS
Medical Student
Florida International University Herbert Wertheim College of Medicine
Lauderhill, Florida, United States
Jonathan Paul, MD
Resident Physician
University of Miami / Jackson Memorial Hospital
Miami, Florida, United States
Diana Molinares, MD
Attending Physician
University of Miami
Miami, Florida, United States
Sophia A. Artamendi, BS
Florida International University Herbert Wertheim College of Medicine
Lauderhill, Florida, United States
Metastatic rhabdomyosarcoma
Case Description:
The patient is a 75-year-old female with a history of metastatic breast carcinoma who was subsequently diagnosed with thoracic spine rhabdomyosarcoma. Her acute hospital course was notable for the administration of multiple cycles of chemotherapy and was complicated by neutropenic fever, bacteremia, atrial fibrillation, and significant fatigue. On admission to acute inpatient rehabilitation, profound cancer-related fatigue represented the greatest barrier to recovery, limiting motivation, endurance, and resulting in dependence at a total to maximal assist level for all activities of daily living (ADLs). Modafinil was initiated to enhance wakefulness and therapy participation. Rehabilitation initially focused on shorter, more frequent therapy sessions, which were progressively lengthened to 45 minutes as her endurance improved. At the time of discharge, she demonstrated functional gains to the level of minimal to moderate assistance for ADLs and mobility.
Discussions:
Cancer-related fatigue is a major barrier to rehabilitation. This case demonstrates that utilizing therapy sessions structured in shorter intervals, which incorporate rest, can increase participation despite medical complexity. Adjunctive use of neurostimulants enhances wakefulness and may improve motivation, further supporting therapy participation. Together, these strategies show the value of an individualized, endurance-based approach to rehabilitation for oncologic patients. It is imperative to maximize the time cancer patients have in acute rehabilitation, as those with plans to continue active treatment rely on this time to optimize their Eastern Cooperative Oncology Group (ECOG) Performance Status scale, which guides oncologists decision-making for the suitability of treatment.
Conclusions:
Targeted rehabilitation strategies and pharmacologic management of cancer-related fatigue are necessary not only to maximize functional mobility but also to allow patients the best opportunity to continue to seek life-saving oncologic treatment.
