Understanding cancer and disability

Great Eastern invited Dr Richard Quek and Dr Gurpal Singh who are on their panel of specialists to share more on how cancer can cause  individuals to lose their ability to perform ADLs.  

Activities of daily living (ADLs) are essential activities individuals require to live independently within society.  However, critical illnesses such as cancer and its treatments may lead to side effects that can impair one’s ability to perform ADLs. 

Understanding Cancer 

Cancer is the uncontrolled growth of abnormal cells that grow and spread to other organs. The lifetime risk of developing cancer is now 40%, while the risk of dying from cancer is 20% (1 in 5 of the population).

Fortunately, advances in cancer management — from systemic treatment to newer treatment such as targeted therapy and immunotherapy — delivered by a multidisciplinary care team have improved patient outcomes, highlights Dr Quek. More patients are cured, while patients with advanced cancers have their disease controlled for a longer period with better quality of life.

However, disability arising from cancer is still a big problem, Dr Quek points out.

Causes of disabilities 

There are two key causes of disabilities arising from cancer, explains Dr Quek:

1. Disability due to cancer, and
2. Disability due to cancer treatment

To illustrate, he shared case studies of patients with disabilities arising from either one of the two key causes he highlighted.

A case in point is a young patient in the mid-20s with Ewing’s sarcoma illustrating how disability can arise from the cancer itself. This patient presented in early 2020 with low back pains and shooting pains down the leg. The patient was treated symptomatically, but the pain recurred and worsened in the following month, now affecting the opposite leg as well. Unfortunately, the diagnosis was delayed due to the COVID-19 pandemic.

When the patient finally consulted a specialist and underwent a MRI scan, the cancer had already spread to multiple bones, causing fractures and compression of the spinal nerves. A biopsy confirmed the disease to be Stage 4 Ewing’s sarcoma, with extensive involvement of the spine. To manage the cancer, the patient underwent chemotherapy, with good relief of symptoms.

Unfortunately, the disease recurred many months later, causing severe pain. In addition, the cancer had also metastasised to the lungs, causing fluid build-up in the lungs resulting in breathlessness. Together, these cancer-related symptoms left the patient confined to bed, breathless and unable to walk—essentially rendering the patient disabled.

Highlighting how cancer treatment can result in disability, Dr Quek shared a case of a 40-year old man with testicular cancer. This man first presented with a cough. A chest X-ray showed a large chest tumour. Subsequent scans and needle biopsy confirmed the diagnosis of testicular cancer.

Testicular cancers are exquisitely chemo-sensitive and he was started on a cocktail of drugs consisting of bleomycin, etoposide and cisplatin. The tumour responded very well to initial chemotherapy treatment and the patient then underwent subsequent surgery to remove any residual mass remaining post-chemotherapy.

Unfortunately, a well-known and common side effect of bleomycin is lung inflammation, which resulted in persistent cough, disabling breathlessness and long-term lung scarring. This left the patient unable to perform his ADLs normally, rendering him disabled in the short-term. Thankfully, with the appropriate medical treatment, he was able to recover and regain his lung function some months later.

In conclusion, cancer is a complex disease. While advances in cancer management have resulted in significant improvements in survival rates, cancer- and treatment-related complications remain a substantial health burden, some of which may lead to disability that can affect ADLs.

Disability in the orthopaedic context 

Besides cancer, sports injuries, arthritis (wear and tear) and infections comprise some of the common causes of joint pain and disability in the orthopaedic context, shares Dr Singh.

He emphasises that serious disability arising from cancer, arthritis or infection is often preventable when caught early.

To demonstrate how infection can cause disability, he shared a case study of a 50 year old man with a history of diabetes who got a small injury on the sole of his foot from stepping on a rock. The patient was admitted 5 days later as an emergency case due to infection worsened by diabetes. The patient had to undergo 3 surgeries and was disabled and unable to perform ADLs for more than 5 weeks. Fortunately the infection was caught early, otherwise it would have been a threat to his life and he may have needed an emergency amputation.

Dr Singh shared that some of the common cancer-related causes of disability in the orthopaedic context is cancer that has spread to, or arises from the bone and soft tissue.

He illustrated this with a case of a 59 year old lady with lung cancer which spread to the hip bone. She presented with pain in the left groin and thigh. Because she had successful past treatment for her cancer, she was treated with curative intent: a proximal femur replacement where the hip joint and part of the thigh bone are replaced with a metal prosthesis. The patient remained in hospital for 2 weeks followed by physiotherapy, and was slowly rehabilitated and eventually able to walk again.

Disability - often preventable 

Not all joint pain may be due to arthritis or wear and tear, Dr Singh concluded. As he had illustrated, cancer of the bone and soft tissues are a significant cause of disability. Similarly, infections can be difficult to treat and be potentially life threatening, especially when it is detected late.

What is key to note is that disability from orthopaedic conditions can be severe. Knowing that traumatic injuries, arthritis, infections and cancer are the main causes of disability, the take home message is that disability is often preventable and reversible if the condition is detected early and treated on time. 

Cancer is a chronic condition with long-term and life-changing effects for patients. That is why it is important to ensure you have the financial resources to support you in getting the best level of care. Having health and critical illness insurance coverage can be a good strategy for consideration.

About the Doctors: 

Dr Richard Quek

Senior Consultant

Medical Oncology Parkway Cancer Centre

MBBS (Singapore), MRCP (United Kingdom), FAMS (Medical Oncology)
Dr Quek is well versed in general medical oncology and his subspecialty interests are in the management of sarcomas, gastrointestinal stromal tumours (GIST), melanomas and lymphomas. Prior to joining PCC, he was the Deputy Head, Division of Medical Oncology at the NCCS from 2013–2018.

Dr Gurpal Singh - Guest Doctor 

Consultant Orthopaedic Surgeon

Specialist in Joint Replacement & Orthopaedic Oncology

MBBS (SG), MRCSEd,M Med (Ortho), FRCSEd (Orth), FAMS (Orthopaedics)
Dr Singh subspecialises in orthopaedic oncology, joint replacement and sports injuries. Prior to joining private practice, Dr Singh was serving as a consultant orthopaedic surgeon at NUH, and assistant professor and research director of the department of orthopaedic surgery at NUS.

This article was extracted from the January 2022 issue of HealthNews, a printed publication by Parkway Cancer Centre. Permission required for reproduction.