Role of Inpatient Rehabilitation after Radical Vulvectomy and Vaginectomy for Recurrent Vulvar Cancer: A Case Report

Case Diagnosis: 86-year-old female with recurrent vulvar carcinoma.

Case Description or Program Description: The patient underwent elective robotic abdominal perineal resection with end colostomy and radical vulvectomy/vaginectomy followed by gracilis myocutaneous flap due to history of radiation. She was admitted to inpatient rehab with mobility restrictions of 20 minutes out of bed 3 times per day. This parameter increased by 5 minutes every 48 hours.

Setting: Inpatient

Assessment/Results: Due to extensive surgeries, the patient was limited in her time out of bed, which started with 5 minutes 3 times a day immediately post op. Her mobility restraints were decreased every 48 hours; therefore, she was allowed out of bed for 20 minutes 3 times a day upon admission. She obtained a care tool score of 56 within 5 days of admission and discharged with a care tool score of 69 after a 15-day stay. Nutrition, pain control, wound care, colostomy and foley management, as well as family training were provided to ensure a smooth transition to daily life.

Discussion (relevance): Primary curative treatment of gynecologic malignancies commonly includes surgery and definitive or post-operative radiotherapy or definitive radio-chemotherapy (Meixner et al). It has been shown that exercise during cancer treatment has had a positive effect on anxiety, depression, physical function, fatigue, and lymphedema, improving overall quality of life (McKenzie and Ahmad). Inpatient rehabilitation provides a setting for cancer patients to maintain function and mobility while assessing needs in nutrition, pain, wound care, and neuropsychology which may result from a patient’s cancer or treatment.

Conclusions: Common side effects of cancer and treatment are fatigue, pain, mobility issues, and cognitive challenges, which can make daily activities difficult. Inpatient rehab provides an opportunity to address these challenges early on, helping patients restore function and independence and improving overall quality of life.