Oncological Rehabilitation Assessment
Form Filling and Clinical Assessment Guidance for Physiotherapists
Purpose of the Form
This form is designed to support safe, individualized, and stage-appropriate rehabilitation for patients with cancer across the care continuum, including prehabilitation, active treatment, survivorship, and palliative care. It integrates oncological treatment history, symptom burden, functional status, impairment assessment, and risk stratification to guide physiotherapy decision-making.
The form enables:
- Identification of cancer- and treatment-related impairments
- Screening for oncological red flags and rehabilitation contraindications
- Risk stratification for safe exercise prescription
- Goal-oriented, MDT-coordinated rehabilitation planning
- Medico-legal documentation and continuity of care
S – SUBJECTIVE ASSESSMENT
The subjective section establishes the oncological context, symptom profile, and patient-reported functional impact, often in collaboration with caregivers.
Patient Identification
How to fill
- Tick the care setting (OPD, IPD, day-care, rehab, palliative).
- Record patient name, UHID, age, sex, and date/time of assessment.
Clinical guidance
The care setting strongly influences rehabilitation intensity. Palliative and day-care patients require symptom-led, energy-conserving approaches, whereas OPD and rehab patients may tolerate structured progression.
Primary Cancer Diagnosis and Site
How to fill
- Record the primary cancer diagnosis.
- Tick the cancer site(s) involved.
Clinical interpretation
Cancer type and site determine expected impairments, precautions (e.g., bone metastasis risk), and prognosis. Hematological and CNS malignancies require heightened vigilance for fatigue, neuropathy, and neurological deficits.
Referral Source
How to fill
Tick the referring service (medical oncology, surgical oncology, radiation oncology, ICU, physician).
Clinical guidance
Referral source indicates treatment phase and expected precautions or goals.
Chief Complaints
How to assess
Elicit symptoms from both patient and caregiver, allowing open-ended reporting before structured questioning.
How to fill
Tick all reported complaints such as fatigue, pain, weakness/deconditioning, breathlessness, balance issues, lymphedema, or reduced activity tolerance.
Clinical interpretation
Cancer-related fatigue and deconditioning are often multifactorial and central to rehabilitation planning.
History of Presenting Complaint
How to assess
Clarify timing relative to cancer treatment.
How to fill
- Tick onset (sudden, gradual, post-treatment).
- Record duration.
- Tick course (improving, static, worsening).
- Tick cancer treatments received or ongoing.
- Describe current functional limitations in narrative form.
Clinical interpretation
Post-treatment onset often reflects cumulative treatment toxicity, whereas worsening course during therapy may indicate progressive disease or complications.
Past Medical History (PMH)
How to assess
Review medical records and patient interview.
How to fill
Tick relevant comorbidities and cancer-related complications such as neuropathy, lymphedema, osteoporosis, DVT, anemia, or bleeding risk. Tick current rehabilitation-relevant medications.
Clinical interpretation
Comorbidities and medications directly influence exercise tolerance, bleeding risk, and monitoring requirements.
Subjective Symptom Assessment
How to fill
- Tick primary symptoms.
- Record pain presence and intensity using NPRS/VAS.
- Tick fatigue severity (mild, moderate, severe).
Clinical interpretation
Severe fatigue may necessitate interval-based, symptom-limited exercise rather than traditional conditioning.
Functional & Participation Status
How to assess
Determine independence level and real-world participation.
How to fill
- Tick difficulties with mobility, self-care, household tasks, work, or social participation.
- Tick mobility status and assistive device use.
Clinical interpretation
Participation restriction severity guides goal prioritization and discharge planning.
O – OBJECTIVE ASSESSMENT
The objective section focuses on oncology-specific safety, impairments, and surgical consequences.
Oncology Treatment Profile
How to fill
- Tick current phase of care.
- Tick treatments received or ongoing and specify surgical type.
- Record date of last treatment.
- Tick oncology-advised precautions.
Clinical interpretation
Active treatment and recent chemotherapy or radiotherapy require conservative progression and close monitoring.
Medical & Safety Screen (Oncology-Specific)
How to assess
Review vitals, labs (if available), and clinical status.
How to fill
- Tick medical stability.
- Tick red flags such as unexplained severe pain, new neurological deficit, fracture risk, febrile neutropenia, bleeding, or infection.
- Record action taken.
Clinical interpretation
Presence of any red flag mandates deferral, modification, or medical referral before rehabilitation.
Impairment-Level Assessment
How to assess
Perform functional strength, ROM, balance, and sensory screening.
How to fill
Tick severity of weakness, ROM limitation, balance impairment, and sensory changes.
Clinical interpretation
Balance deficits and neuropathy significantly increase fall risk and must be addressed early.
Cancer-Specific Physiotherapy Assessment
Lymphedema Screening
How to fill
- Tick swelling status.
- Identify affected region.
- Tick limb girth difference category and document details.
Clinical interpretation
Early identification enables preventive education and timely management.
Scar Status
How to assess
Inspect and palpate surgical scars.
How to fill
Tick healed, hypersensitive, or adherent.
Clinical interpretation
Scar adhesions may limit ROM and contribute to pain and dysfunction.
Regional Surgery–Specific Screening
How to use this section
Only complete the subsection relevant to the patient’s surgical site.
Clinical guidance
Each subsection links surgical impact to rehabilitation focus:
- Head & neck: cervical ROM, shoulder dysfunction, dysphagia risk
- Breast/axillary: shoulder mobility, scar tightness, lymphedema risk
- Thoracic: breathing mechanics, cough effectiveness
- Abdominal/pelvic: core function, pressure management, stoma care
- Orthopaedic/limb-salvage: weight-bearing, prosthetic needs
- Neuro/spinal: motor/sensory deficits, spinal precautions
Tick applicable impairments and rehab focus areas.
Surgery-Related Impact on Rehab Intensity
How to fill
Tick mild, moderate, or severe impact.
Clinical interpretation
Severity determines session duration, intensity, and progression rate.
Outcome Measures (Core Component)
Functional Performance
How to fill
Record Timed Up and Go (TUG) time if safe.
Symptom & Quality of Life
How to fill
Record Brief Fatigue Inventory (BFI) score and tick functional interpretation.
Clinical interpretation
Outcome measures provide objective baselines for tracking rehabilitation effectiveness.
A – ASSESSMENT
Primary Rehab Needs and Risk
How to fill
Tick dominant rehab needs and assign overall rehab risk (low, moderate, high).
Clinical Impression and Rehabilitation Potential
How to fill
Summarize key findings in a concise narrative and assign rehabilitation potential (good, fair, guarded).
Clinical interpretation
Potential depends on disease stage, symptom burden, motivation, and medical stability.
P – PLAN
Rehabilitation Goals
How to fill
Tick appropriate short-term and long-term goals and expected outcome improvements.
Oncological Rehabilitation Plan
How to fill
Tick physiotherapy interventions, MDT inputs, frequency, and session duration.
Clinical interpretation
Exercise prescription should be symptom-guided, flexible, and closely coordinated with oncology care.
Education & Self-Management
How to fill
Tick all education provided, including energy conservation, home exercise, lymphedema precautions, and fall prevention.
Assessor Authentication and MDT Inputs
Record assessor name, signature, date/time, and MDT involvement to ensure accountability and coordinated care.
Clinical Summary
The Initial Oncological Rehabilitation Assessment form functions as a risk-aware, patient-centered clinical reasoning tool, integrating oncological treatment status, symptom burden, functional capacity, and rehabilitation planning. Accurate completion of this form is essential for delivering safe, effective, and compassionate oncology rehabilitation across all phases of cancer care