A tailor-made physical therapy protocol for a rare pediatric tumor

Renu B Pattanshetty; Nikita Nitin Pawar; Mounica Srinivas Rao

doi:10.4103/bjhs.bjhs_117_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 7 | Issue : 2 | Page : 302-305

A tailor-made physical therapy protocol for a rare pediatric tumor

Renu B Pattanshetty¹, Nikita Nitin Pawar², Mounica Srinivas Rao²
¹ Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, KLE University, Belagavi, Karnataka, India
² Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	10-Nov-2021
Date of Decision	04-Dec-2021
Date of Acceptance	27-Dec-2021
Date of Web Publication	06-Dec-2022

Correspondence Address:
Renu B Pattanshetty
Department of Oncology Physiotherapy, KAHER Institute of Physiotherapy, KLE University, Belagavi, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/bjhs.bjhs_117_21

Abstract

Solid pseudopapillary carcinoma of pancreas is a cystic exocrine tumor of the pancreas which is common in females in the third and fourth decades. This report presents a rare case of an 11-year-old girl who operated for Frantz tumor and was referred for physical therapy. The therapy was beneficial in reducing the pain, improving the range of motion, and overall quality of life of the patient. To the best of our knowledge, this is the first case report found in the medical literature that reports of physical therapy management in a rare reported case of pediatric solid pseudopapillary carcinoma of pancreas.

Keywords: Carcinoma, exercises, pancreas, physical therapy, quality of life, transcutaneous electrical nerve stimulation

How to cite this article:
Pattanshetty RB, Pawar NN, Rao MS. A tailor-made physical therapy protocol for a rare pediatric tumor. BLDE Univ J Health Sci 2022;7:302-5

How to cite this URL:
Pattanshetty RB, Pawar NN, Rao MS. A tailor-made physical therapy protocol for a rare pediatric tumor. BLDE Univ J Health Sci [serial online] 2022 [cited 2023 Jun 3];7:302-5. Available from: https://www.bldeujournalhs.in/text.asp?2022/7/2/302/362832

In India, every year, 45,000 new cases of pediatric cancers are being diagnosed accounting for 5% of the overall cancer burden. In the Western world, recovery rates are as high as 80%, whereas in India, they are much lower.^[1] Solid pseudopapillary carcinoma of pancreas is a cystic exocrine tumor of the pancreas which is common in females in the third and fourth decades which is predominantly related to embryonic development.^[2] Despite being a low-grade malignancy, 5% of the patients develop metastasis.^[3] Being rare, only 0.2% of pediatric cancers comprise pancreatic malignancy. Children may present with similar symptoms of jaundice, pancreatitis, and choledochal cysts which makes it difficult to diagnose. Pancreatoduodenectomy is usually the surgery of choice which is seen to have low mortality and greater survival rate.^[4]

Case Report

An 11-year-old girl with no significant gestational, or prior medical or surgical history, was referred to a tertiary care hospital at the department of surgical oncology. The child had a 6-month history of frequent episodes of passing loose stools (about 5–7 times per day) immediately after the consumption of any dietary products and weight loss of 6 kg before reporting to the hospital. She was taken to a local pediatrician who suggested her high fiber and high protein diet. Despite the dietary modifications, her symptoms did not subside. On hospital admission, her vital signs were reported normal with blood pressure 120/80 mmHg, pulse 123 beats/min, and temperature 37°C. Palpatory findings of the abdomen demonstrated no abnormalities. Ultrasonography revealed a well-defined mixed echogenic lesion in the left lobe of the liver, and computed tomography scan of the abdomen and pelvis revealed ill-defined mixed density heterogeneously enhancing necrotic areas that likely suggested a primary pancreatic lesion suggestive of solid pseudopapillary carcinoma of the pancreas measuring 7.69 cm × 6.08 cm × 10.9 cm. She underwent pancreatojejunostomy, hepatojejunostomy, and gastrojejunostomy. In addition, feeding jejunostomy was fixed. The sutures extending from the right hypochondriac and epigastric region with chevron (rooftop) incision measuring 10 cm × 14 cm. The patient was referred to physical therapy on the fourth postoperative day for general mobility exercises, ambulation, and pain management. On initial physical therapy assessment, pricking pain was reported at the suture site with an intensity of 5 on 10 at rest and 8 on 10 during in-bed mobility on the Visual Analog Scale that was relieved on medication. No other complaints were noted [Table 1].

Table 1: Examination of the patient and physiotherapy intervention:

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Physical therapy intervention

The patient was treated for 5 consecutive days in the pediatric oncology ward. A tailor-made physical therapy protocol was administered to the patient that was well adhered to and completed by the patient to her stay in the hospital. Posttherapy, no fatigue was noted, sugar levels were normal, and with no side effects highlighted [Table 1].

Figure 1: Physiotherapy exercises. (a) Ambulation (b) Breathing exercises, (c) Dynamic quadriceps, (d) Static adductor

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Discussion

Pancreatic cancers are rare in children. The solid papillary tumor of the pancreas, pancreatoblastoma, islet cell tumor, and pancreatic carcinoma are the four main types of pancreatic cancer in children.^[7] Despite being rare, solid papillary tumor has a good prognosis among the four types of pancreatic cancer as in the present case. Surgery is considered the main treatment approach to treat pancreatic cancers with neoadjuvant or adjuvant chemoradiotherapy. The complications such as malnutrition, frailty, and sarcopenia, along with fat malabsorption, elevated systemic inflammation, release of cachexia factors, and frank obstruction of the gastrointestinal tract are common postsurgical resection of pancreas.^[8],[9]

Cancer patients suffer malnutrition which may worsen depending on the patients' tolerance and response. A preexisting poor nutritional status can cause low-surgical outcomes and makes the patient subject to immunocompromised status.^[10] Therefore, a balanced nutrition pre- and postsurgical intervention is essential since the condition may further deteriorate and lead to cancer cachexia, as this can lead to the development of cancer cachexia. Frailty is the physical and mental functional decline with or without the presence of the disease. This may lead to increased susceptibility to chronic disease. Association between physical frailty and cognitive function may be present among childhood cancer survivors.^{[11],[12],[13],[14]} Sarcopenia is the loss of lean muscle mass which is a distinct entity from cancer-related weight loss and cachexia and is associated with frailty.^[15] There is a significant correlation between poor postoperative diagnosis and sarcopenia in cancer patients.^[16]

Physical therapy has been a part of cancer rehabilitation and has benefited both cancer patients and survivors. The complications of cancer treatment can be minimized and maintained with physical therapy by reducing the length of hospital stay. Strengthening of the respiratory muscles by deep breathing exercises and thoracic expansion exercises helps in maintaining the respiratory functions and also has a relaxation effect on the patient. The mobility exercise helps in maintaining the physical activity and functioning of the body. Ambulating the patient helps to maintain the muscle integrity, prevent cardiorespiratory complications such as deep-vein thrombosis, and maintain the overall quality of life.^[17],[18] The present case report focuses on a tailor-made protocol that could suffice the physical needs of the child in terms of alleviation of pain, improving bed mobility, and ambulation.

The tailor-made protocol was found to be well adhered to by the child and caregivers. The child never denied the physical therapy treatment suggesting its suitability in the pediatric population in similar conditions. The limitation was that only a 5-day protocol was followed as the patient was discharged. However, the protocol was well adhered to, and a follow-up could not be done due to logistic reasons. Despite the short duration of the physical therapy protocol, it has helped in reducing the pain, improving the range of motion, fatigue levels, and overall quality of life of the patient.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Pandey A, Singh A, Kumar V, Prakash J, Runu R, Thakur V, et al. Pediatric cancers in Bihar: A retrospective tertiary cancer center study. South Asian J Cancer 2020;9:53-5. [PUBMED] [Full text]
2.	Kosmahl M, Seada LS, Jänig U, Harms D, Klöppel G. Solid-pseudopapillary tumor of the pancreas: Its origin revisited. Virchows Arch 2000;436:473-80.
3.	Yagcı A, Yakan S, Coskun A, Erkan N, Yıldırım M, Yalcın E, et al. Diagnosis and treatment of solid pseudopapillary tumor of the pancreas: Experience of one single institution from Turkey. World J Surg Oncol 2013;11:308.
4.	Meriam S, Ines B, Fatma BF, Fatma K, Dhafer H, Imen H, et al. Atypical solid pseudopapillary tumor of the pancreas in a 14-year-old. Clin Case Rep 2021;9:1716-20.
5.	Cho I, Son Y, Song S, Bae YJ, Kim YN, Kim HI, et al. Feasibility and effects of a Postoperative Recovery Exercise Program developed specifically for Gastric Cancer Patients (PREP-GC) undergoing minimally invasive gastrectomy. J Gastric Cancer 2018;18:118-33.
6.	Lander J, Fowler-Kerry S. TENS for children's procedural pain. Pain 1993;52:209-16.
7.	Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: Radiologic-pathologic correlation. Radiographics 2006;26:1211-38.
8.	Yeo TP. Demographics, epidemiology, and inheritance of pancreatic ductal adenocarcinoma. Semin Oncol 2015;42:8-18.
9.	Duggan W, Hannan E, Brosnan C, O'Sullivan S, Conlon K. Conservative management of complete traumatic pancreatic body transection; A case report. Int J Surg Case Rep 2020;71:222-4.
10.	Sungurtekin H, Sungurtekin U, Balci C, Zencir M, Erdem E. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr 2004;23:227-32.
11.	Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56.
12.	Hoffman MC, Mulrooney DA, Steinberger J, Lee J, Baker KS, Ness KK. Deficits in physical function among young childhood cancer survivors. J Clin Oncol 2013;31:2799-805.
13.	Edelstein K, Spiegler BJ, Fung S, Panzarella T, Mabbott DJ, Jewitt N, et al. Early aging in adult survivors of childhood medulloblastoma: Long-term neurocognitive, functional, and physical outcomes. Neuro Oncol 2011;13:536-45.
14.	Lurz E, Quammie C, Englesbe M, Alonso EM, Lin HC, Hsu EK, et al. Frailty in children with liver disease: A prospective multicenter study. J Pediatr 2018;194:109-15.e4.
15.	Cooper C, Dere W, Evans W, Kanis JA, Rizzoli R, Sayer AA, et al. Frailty and sarcopenia: Definitions and outcome parameters. Osteoporos Int 2012;23:1839-48.
16.	Meza-Junco J, Montano-Loza AJ, Baracos VE, Prado CM, Bain VG, Beaumont C, et al. Sarcopenia as a prognostic index of nutritional status in concurrent cirrhosis and hepatocellular carcinoma. J Clin Gastroenterol 2013;47:861-70.
17.	Richter S, Uslar V, Tabriz N, Mueser T, Weyhe D. Progressive Postresection Program (pPRP) after pancreatic resection: Study protocol for a randomized controlled trial. Trials 2016;17:74.
18.	Bui Ngoc T. Prehabilitation in Patients Undergoing Surgery for Hepatobiliary or Pancreatic Cancer. Montreal, Quebec, Canada: Doctoral Dissertation, Concordia University; 2019.