The Effect of Cancer Rehabilitation on Functional Outcomes in a Patient With Stage IV Melanoma With Subsequent Brain Metastases: A Case Report

Background and Purpose: Malignant melanoma has a high propensity to metastasize, specifically to the brain. Research has shown that incorporating oncology rehabilitation as part of the interdisciplinary care team promotes independence in functional mobility that leads to an improvement in a patient's quality of life. Case Description: A 70-year-old man presented with recurrent melanoma to the brain 10 years after initial diagnosis. Multiple brain metastases led to left hemiparesis of the arm and leg. Left-sided weakness affected his ability to perform activities of daily living and exercise regularly. The confounding impairments in balance resulted in multiple falls at home. Interventions: Interventions included balance training on various surfaces, core and proximal lower extremity strengthening, aerobic conditioning, and implementation of a home exercise program. Outcomes: The patient attended outpatient cancer rehabilitation for 19 weeks and discharged from physical therapy with a reported 47.7% improvement in global physical health and 26.7% improvement in global mental health on the PROMIS tool. At discharge, performance on the Five Times Sit to Stand Test, Timed Up and Go Test, and Dynamic Gait Index was below cutoff scores, indicating the patient was no longer a high risk for falls at home. Discussion: Physical therapy specifically tailored for the oncology patient allows for a customized rehabilitation approach that incorporates oncologic medical history and treatment into the episode of care, with the ultimate goal of improving quality of life and function throughout the patient's cancer journey.