Does anyone know of any research that looks into whether it is safe to use electrical stimulation on one part of the body if another part of the body is currently being treated for cancer? I have found that some resources say to not do electrical stimulation on or in the area of a malignant tumor, however other sources go as far as to state not to do electrical stimulation on any part of the body (even outside the area near the diagnosed malignancy) if someone is diagnosed with cancer. For example, if someone is coming to PT for their ankle and they are being treated for breast cancer, or they are being treated for neck pain but have prostate cancer, can you do electrical stimulation to the ankle or neck safely?
Joined: March 15, 2006
I don't have the research, but I did speak with an oncologist at the Mayo clinic in Rochester MN about that very question. He said that the notion that estim and cancer are a bad combination is an urban legend based upon defensive medicine and lawsuit prevention on the part of the manufacturers. Of course I can't remember the oncologist's name but I would speak with one in your area or perhaps your patient's oncologist. That is the stuff that they read. The one i spoke to said that there was absolutely no research to support withholding such treatments if it is thought to be of benefit to them.
I forget the name of the book, but it was based on evidence based practice and it stated that electrical stimulation in the area of a malignant tumor is a precaution. The reason was that electrical stimulation has been shown to stimulate tissue growth but there is nothing definitive to show that it will worsen a tumor. I had a patient recently who had severe pain due to a bony met and after discussing this issue we determined that the benefit outweighed the potential risk. If quality of life is the goal then it will likely not be an issue with the patient or oncologist.
Joined: March 9, 2008
We were told in class not to use ES with a pt. dx with CA. However, in my state board review book it just states that a contraindication to ES would be a malignancy. I'm under the impression that this means directly over the malignancy, as you stated above. I treated a pt. s/p TKR who was then dx with a cancerous tumor around her new knee replacement. At the time I was using stim and heat at the beginning of each Rx session, but consulted with the PT regarding her new dx with CA and suggested heat and stim d/c. Therapist agreed. Hope I could be of some help.
< Message edited by annpsu25 -- November 9, 2008 5:39:05 AM >
Joined: February 14, 2003
From: Madison WI USA
I actually think that all of this paranoia regarding modalities creating further metastasis is complete hogwash. If it were true, shouldnt the patient then be advised to stop moving, as this creates increase in local tissue metabolism, stop taking hot showers, for the same reason, never get into a hot tub, again for the same reason, and the list goes on. Tom describes this best as urban legends and the like.
Joined: March 15, 2006
We were taught to avoid estim and US on those patients because no manufacturer wanted to be put on the stand when some pig attorney tries to blame Chatanooga for the death of Grandpa of lung cancer, or the miscarraige when microcurrent was used on the pregnant woman's sprained ankle. Even though there is no science, the specter of litigation affects our practice. Defensive medicine. Lay jurors are not going to "get" the science, they will just hear the fancy words of the attorney of the survivors and dig into the deep pockets of the manufacturer and the hospital/clinic/therapist and give to the percieved victim.
As long as you speak with the patient's oncologist and get clearance it should be fine. Don't we read from time to time about how effective TENS is with some cancer pain?
< Message edited by Tom Reeves DPT ATC -- November 10, 2008 8:46:22 PM >
I found the book Contraindications in Physical Therapy: Do No Harm by Mitchell Batavia (thanks jma). It referenced an FDA document titled: U.S. Food and Drug Adminstration: Guidance document for powered muscle stimulator 510 (k)s. you can access it at: http://www.fda.gov/cdrh/ode/2246.pdf
This document said not to use electrical stimulation over or in proximity to a cancerous lesion.
Joined: February 14, 2003
From: Madison WI USA
"1This document is intended to provide guidance. It represents the Agency?s current thinking on this topic. It does not create or confer any rights for or on any person and does not operate to bind FDA or the public. An alternative approach may be used if such approach satisfies the requirements of the applicable statute, regulations, or both."
This really does not add evidence to the argument, as there are no specific references cited regarding their "current thinking". This becomes nothing more than an educated opinion. Better than an uneducated opinion, but still no hard evidence shown of harmful effects. So to avoid all Estim in someone who happens to have CA is probably not necessary. I think one would have to be very cautious and judicious to perform this over a known malignancy, but it comes down to the intent, whether the patient is in palliative care, and would need to be accompanied by a whole lot of informed consent, to be safe.
I tend to believe that we have an inaccurate perception of the role any physical therapy modality may have - I highly doubt that the modalities we use clinically has an effect on tumors metastasizing and I highly doubt they increase the size of tumors. Look at the current research and explain exactly how our modalities have an effect on genes, gene expressions, proteins....
Joined: October 27, 2002
From: New York, NY
Haven't had much time to check the Edge these days but I hope you are all well. This one grabbed my attention because it was my Master' thesis. We were growing cancer cells in culture and were going to apply e-stim to them. But, our culture got infected and we couldn't do it. A nice introduction for me into how often research goes smoothly - NEVER!
The answer to your question is 2 fold. First, there is no evidence as to why you can't do e-stim with a CA patient. There have been no studies that prove you can't. And there is little in the way of biological theory that would give us a reason to avoid it. Many contraindications for modalities are just there from tradition and fear - nothing else. There is actually a case for E-Stim and cancer pain. Cancer patients often have so much anxiety that Cortisol binds to their opiate receptors. This makes traditional opiates less effective. I think it used by physicians more often than we may think.
The second answer however, is unless you think a modality will have a profound effect, why risk it? If something goes wrong with a patient's disease, you can get sued whether E-stim or U/S was the reason or not. So, although I hate to be defensive, you have to ask whether the benefit is worth the reliability risk. If it takes away their pain substantially perhaps. If it equates to 20 minutes of feeling good after a treatment then it doesn't.