Jason Wang, BA
Medical Student
Rutgers Robert Wood Johnson Medical School
Bridgewater, New Jersey, United States
Daniel S. Marte, MD
PGY-2 Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
Kevin Chun, BA
Medical Student
NSU-KPCOM
Atlanta, Georgia, United States
Julia Marx, BS
Medical Student
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey, United States
Miguel X. Escalon, MD
Program Director
Icahn School of Medicine at Mount Sinai
NY, New York, United States
Mucinous adenocarcinoma of the lung with metastasis to the brain and spine
Case Description: A 23-year-old male with stage 4 mucinous lung adenocarcinoma metastatic to the brain and spine presented to acute rehab for diffuse pain, multiple cranial nerve palsies, and lower extremity weakness after right mediastinal mass resection and three cycles of chemotherapy. During the rehab course, the patient was noted to have worsening weakness of his lower extremity strength during physical therapy. This prompted repeat MRI imaging which showed progression of the patient’s spinal metastasis and new compression fracture deformities. After discussion with neurosurgery, no acute interventions or spinal precautions were required. Therapy was continued with further awareness of the patient’s disease progression, and the patient was able to improve his leg mobility, ambulating without difficulty at the time of discharge.
Discussions: Patients with cancer require a tailored, multimodal approach to manage their pain, intake, chemotherapy, and future needs, all of which depends on the ability to reliably monitor disease progression. Changes in this patient’s pain and weakness were more detectable when he was participating in physical activity as opposed to when he was bedbound. Acute rehab provided this patient with the equipment necessary to participate in more complex iADLs while under daily supervision of therapists, who promptly noticed changes in performance that warranted medical intervention.
Conclusions: This case demonstrates the usefulness of acute rehabilitation as a form of functional monitoring for changes in neuromuscular status for patients with complex terminal conditions such as metastatic cancer. Monitoring patients’ physical performance in structured daily therapy helps inform disease progression and improve functional outcomes. From both ethical and safety standpoints, these patients should be offered acute rehabilitation as a supplement to typical palliative care management.
