TY - JOUR
T1 - A Case Report on the Communication between Oncologists and Physiatrists in the Establishment of Functional Prognosis while Undergoing Chimeric Antigen Receptor T-cell Therapy
AU - Gupta, Ekta
AU - Fu, Jack B.
AU - Bruera, Eduardo
N1 - Publisher Copyright:
© 2020, Carol Davila University Press. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Chimeric Antigen Receptor (CAR) T-cell therapy can have severe toxicities, which include CAR-T-cell-related encephalopathy syndrome (CRES). The patient may present with altered mental status, encephalopathy, seizures, and cerebral edema. Depending on the severity, the recovery process will require rehabilitation. We present a case and explain how communication between cancer physiatrists, oncologists, and patients can affect the expectations for functional recovery, and the importance of setting goals for recovery in a medically complex population. We present a patient who underwent aggressive chimeric antigen receptor T cell therapy, causing encephalopathy and complications. He initially required total assistance for mobility and activities of daily living. Physiatry was consulted to assist with the rehabilitation plan of care and disposition. Initially, the oncologist conveyed to the patient he would be walking in two weeks, which was unrealistically optimistic. The patient’s physiatrist intervened and discussed these expectations with him, alleviating his emotional distress. His condition improved with inpatient rehabilitation, and he was able to ambulate short distances with modified independence in four weeks. The involvement of a cancer physiatrist allows for recognition and treatment of complications related to cancer and aggressive ther-apies, along with an accurate functional prognosis assessment. With improved communication and patient involvement, the patient underwent a successful rehabilitation.
AB - Chimeric Antigen Receptor (CAR) T-cell therapy can have severe toxicities, which include CAR-T-cell-related encephalopathy syndrome (CRES). The patient may present with altered mental status, encephalopathy, seizures, and cerebral edema. Depending on the severity, the recovery process will require rehabilitation. We present a case and explain how communication between cancer physiatrists, oncologists, and patients can affect the expectations for functional recovery, and the importance of setting goals for recovery in a medically complex population. We present a patient who underwent aggressive chimeric antigen receptor T cell therapy, causing encephalopathy and complications. He initially required total assistance for mobility and activities of daily living. Physiatry was consulted to assist with the rehabilitation plan of care and disposition. Initially, the oncologist conveyed to the patient he would be walking in two weeks, which was unrealistically optimistic. The patient’s physiatrist intervened and discussed these expectations with him, alleviating his emotional distress. His condition improved with inpatient rehabilitation, and he was able to ambulate short distances with modified independence in four weeks. The involvement of a cancer physiatrist allows for recognition and treatment of complications related to cancer and aggressive ther-apies, along with an accurate functional prognosis assessment. With improved communication and patient involvement, the patient underwent a successful rehabilitation.
KW - Activities of daily living (ADLs)
KW - CAR-T-cell-related encephalopathy syndrome (CRES)
KW - Chimeric antigen receptor (CAR)
KW - Communication
KW - Cytokine-release syndrome (CRS)
KW - activities of daily living
KW - goals
KW - medical oncology
KW - oncologists
KW - physiatrists
UR - http://www.scopus.com/inward/record.url?scp=85084107623&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85084107623&partnerID=8YFLogxK
U2 - 10.25122/jml-2019-0077
DO - 10.25122/jml-2019-0077
M3 - Article
C2 - 32341708
AN - SCOPUS:85084107623
SN - 1844-122X
VL - 13
SP - 94
EP - 97
JO - Journal of medicine and life
JF - Journal of medicine and life
IS - 1
ER -