Physical therapy and solid tumors

As a (pediatric) physical therapist affiliated with KinderOncoNet, you may treat a child with different types of solid tumors. These are tumors of organs, soft tissues, and bones.

Of the 600 children diagnosed with cancer each year, about 30% (approximately 180 children) have a solid tumor. Solid tumors can be divided into bone tumors and non-bone tumors.

As a (pediatric) physical therapist, you work on physical fitness, muscle strength, coordination, or mobility. Our introductory training includes a case focused on solid tumors, and the learning portal offers several e-learning modules on (pediatric) physical therapy for solid tumors.

(Pediatric) physical therapy care depends on the type of cancer. An overview of the different types of solid tumors can be found here.

Bone tumors

Each year, about twenty-five to thirty children in the Netherlands are diagnosed with a malignant bone tumor. In most cases, this is an osteosarcoma or Ewing sarcoma. Bone tumors mainly occur in adolescents. The tumor often originates in the bone of the upper or lower leg. Bone tumors can metastasize to the lungs, other bones, lymph nodes, and or bone marrow. Treatment depends on the type of tumor, its location, and whether metastases are present. Almost all children with a bone tumor undergo surgery. In osteosarcoma or Ewing sarcoma, a child almost always receives chemotherapy before and after surgery. In Ewing sarcoma, radiation therapy may also be required.

Non-bone tumors

Non-bone tumors include neuroblastomas, liver tumors, kidney tumors, germ cell and gonadal tumors, soft tissue tumors, and melanomas. Depending on the type of tumor, (pediatric) physical therapy may focus on neuromotor function, for example in neuroblastoma, or on endurance and physical fitness after a period of prolonged hospital admission and bed rest.

Side effects

Neuroblastoma is a malignant tumor of the sympathetic nervous system. Neuroblastoma can lead to various limitations in physical functioning. In practice, you may encounter impairments in motor skills, movement disorders, and reduced physical fitness.
In the Netherlands, about twenty-five children are diagnosed with neuroblastoma each year. As a pediatric physical therapist, you may support neuromotor development, treat movement disorders caused by a spinal cord lesion or opsoclonus–myoclonus–ataxia syndrome, address peripheral neuropathy, or provide treatment for scoliosis that has developed. In addition, you focus on physical functioning and fitness during and after treatment.
Would you like to learn more about neuroblastoma and physical activity? Take a look at the e-learning.
Because most bone tumors are located around the knee, a tool has been developed to help children and parents choose between different treatment options, such as amputation, an (endo)prosthesis, or rotationplasty.
The chemotherapy, surgery, and rehabilitation that a child with a bone tumor must undergo are very intensive. An important decision has to be made, and depending on the type and stage of the cancer, parents can take part in deciding on the treatment of the bone tumor. This is known as shared decision making. Each treatment option has its own advantages and disadvantages, which is why it is important to consider which option best fits the wishes and preferences of the child.
To enable parents and children to take part in this important decision, an online decision aid has been developed. You can read more about this in this article.
Polyneuropathy may develop during or after pediatric oncology treatment. This can result in sensory, motor, and autonomic impairment, causing children to experience symptoms such as tingling sensations and loss of muscle strength in the hands and feet.
Polyneuropathy can occur as a result of treatment with vincristine, which affects the peripheral nerves. Polyneuropathy usually resolves within several months after treatment is stopped. About 25% of children continue to experience long-term symptoms, such as reduced reflex activity and impaired motor function. Vincristine is a chemotherapy drug prescribed for several types of cancer. Conditions for which vincristine is used include:
Symptoms may occur in the motor, sensory, and autonomic domains. As a (pediatric) physical therapist, you may therefore encounter children with an abnormal gait pattern. This may present as a slower walking speed, shorter step length, or a wider base of support. Possible contributing factors include impaired balance, reduced strength of the ankle dorsiflexors, or reduced muscle length of the gastrocnemius muscle. Muscle shortening can also occur in the wrist and hand flexors. Weakness in the upper extremities is mainly seen during wrist and or finger abduction and extension.
You can read more about polyneuropathy in this folder and in the presentation available in our learning portal.
Fatigue is a complex and common symptom in children with cancer and in adults who had cancer during childhood. It can occur as a side effect during and after oncological treatment, but also as a late effect.
Fatigue is seen across different childhood cancer treatment trajectories. Examples include specific chemotherapy regimens, but children who have received radiation therapy also frequently experience fatigue. Fatigue is more common in adolescents.
Exercise interventions can help reduce experienced fatigue. At the Princess Máxima Center, we follow the principle of Maximal Movement. Moving as much as possible during and after treatment means being physically active within the child’s individual limits. These limits differ for each child, situation, and phase of treatment. Maximal movement can range from sitting upright in bed to intensive walking and or strength training.
You, as a pediatric physical therapist, can play an important role in this. You can read more about this on the website of the Dutch Childhood Cancer Association.
Literature
Patel, P., et al. (2023). Guideline for the management of fatigue in children and adolescents with cancer or pediatric hematopoietic cell transplant recipients: 2023 update. EClinicalMedicine, 63, 102147.
https://doi.org/10.1016/j.eclinm.2023.102147
A toe-walking deformity can limit a child’s ability to walk, participate in sports, and play. In addition, toe walking can be painful.
Toe walking may develop in children with a brain tumor, referred to as neurological toe walking, or in children with a bone tumor, referred to as non-neurological toe walking.
Neurological toe walking
- * Hypertonia as a result of a brain tumor
- * Muscle weakness caused by a central brain tumor or a tumor in or around the peripheral nervous system, such as chemotherapy-induced peripheral neuropathy (CIPN) or hourglass-shaped neuroblastoma
Non-neurological toe walking
- Prolonged bed rest or inactivity
- Development of a toe-walking position after cast immobilization for bone tumors
If preventive measures during the hospital admission period have not been sufficient to avoid toe walking, several treatment options are available. These include active movement and weight bearing, passive movement and manual stretching, the use of insoles or heel lifts, splints or ankle–foot orthoses, serial casting to correct the toe-walking position, or surgical intervention.
A goniometer is used to evaluate the effectiveness of the intervention.

Physical therapy and solid tumors

Bone tumors

Non-bone tumors

Side effects

Physical therapy and neuroblastoma

Shared decision-making in the treatment of a tumor in the leg

Physical therapy and polyneuropathy

Physical therapy and fatigue

Literature

Physical therapy for toe walking

Neurological toe walking

Non-neurological toe walking