Exploring access to rehabilitation services from allied health professionals for patients with primary high-grade brain tumours

Rehabilitation in People Living with Glioblastoma: A Narrative Review of the Literature

Glioblastoma is the most common primary malignant brain tumor. While preliminary data point to the positive effects of rehabilitation for patients with glioblastoma, there are unique challenges for clinicians working with this population, including limited life expectancy and/or rapid neurological deterioration. The aim of this article is to review the literature on rehabilitation of adults with glioblastoma, including the feasibility of interventions, their effectiveness, as well as the current clinical practice. The reviewed literature suggests that rehabilitation has been found beneficial for improving the functional prognosis and quality of life of adults with glioblastoma and is desired by patients. We summarize the qualitative evidence regarding healthcare professionals' and patients' perspectives on the use of supportive care services. We conclude there is a need for the design of effective rehabilitation programs for patients with glioblastoma, as well as for the development of glioblastoma-specific clinical guidelines for rehabilitation practitioners.

The importance of a continuum of rehabilitation from diagnosis of advanced cancer to palliative care

PURPOSE

Identifying the evidence found in the international scientific literature, referring to the concept of rehabilitation in the setting of oncologic palliative care.

METHODS

Integrative literature review based on articles published in indexed journals on the electronic databases: LILACS, CINAHL and PubMed/MEDLINE, WEB OF SCIENCE, OTSEEKER and PEDRO, following the PRISMA criteria. The quantitative articles were evaluated using the McMaster form for quantitative studies and the qualitative studies were assessed by the Critical Appraisal Skills Program. The studies were inserted in the Rayyan™ application.

RESULTS

The final sample was composed of 21 qualitative and quantitative articles published in the period from 2004 to 2021, in nine different countries. Three thematic units were defined addressing the interface between palliative care and rehabilitation, the concept of palliative rehabilitation and the barriers to its implementation. The quality of the articles reviewed varied from 31% to 100% of the criteria met.

CONCLUSION

The international scientific production reinforces the importance of including rehabilitation in care in oncologic palliative care, highlighting the concept of palliative rehabilitation, but there is a need for expanding and divulging new research on the theme and the results.IMPLICATIONS FOR REHABILITATIONPalliative care services and rehabilitation services should take and create opportunities to promote rehabilitation for people living with incurable cancer.Palliative rehabilitation has an important role in the treatment of people with advanced cancer, helping increase the quality of life, relief of pain, symptoms, and distress.It is considered an integral part of palliative care, given that rehabilitation and palliative care are related to the continuum of care.It is important to understand this gap in the international literature on the continuum between rehabilitation and palliative rehabilitation to improve the provision of this approach in both rehabilitation and palliative care services.

Neurorehabilitation in brain tumours: evidences and suggestions for spreading of knowledge and research implementation

PURPOSE OF REVIEW

The last few decades have seen an increase in life expectancy in brain tumour patients; however, many patients report sensory-motor and cognitive disabilities due to the tumour itself, but also to the effect of anticancer treatments (surgery, radiotherapy, chemotherapy), supportive treatments, as well as individual patient factors. This review outlines the principles on which to base neurorehabilitation treatments, with the aim of stimulating an early rehabilitative management, in order to reduce disability and functional limitation and improve the quality of life of the persons affected by brain tumour.

RECENT FINDINGS

Although not definitive, evidences suggest that an early neurorehabilitative evaluation, performed with a multidisciplinary approach, may identify the different functional impairments that can affect people with brain tumour. Furthermore, identifying and classifying the person's level of functioning is useful for designing achievable recovery goals, through the implementation of tailored multidisciplinary rehabilitation programs. The involvement of different professional figures allows to treat all the components (physical, cognitive, psychological and participation) of the person, and to redesign one's life project, lastly improving the quality of life.

SUMMARY

Overall, the evidences suggest a critical need for the development of this clinical area by spreading the concept of rehabilitation among neuro-oncologists and producing high quality research.

Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients

Intrinsic brain tumors often occur within functional neural networks, leading to neurological impairment and disability of varying degrees. Advances in our understanding of tumor-network integration, human cognition and language processing, and multiparametric imaging, combined with refined intraoperative tumor resection techniques, have enhanced surgical management of intrinsic brain tumors within eloquent areas. However, cognitive symptoms impacting health-related quality of life, particularly processing speed, attention, concentration, working memory, and executive function, often persist after the postoperative recovery period and treatment. Multidisciplinary cognitive rehabilitation is the standard of care for addressing cognitive impairments in many neurological diseases. There is promising research to support the use of cognitive rehabilitation in adult brain tumor patients. In this review, we summarize the history and usefulness of postacute cognitive rehabilitation for adult brain tumor patients.

Recovery in glioblastoma multiforme during inpatient rehabilitation is equivalent in first versus repeat resection: A 10-year retrospective analysis

BACKGROUND

Inpatient rehabilitation improves function in people with brain tumors, including glioblastoma multiforme (GBM) but there are limited data on the impact of multiple resections on outcomes. We hypothesize that outcomes will be more favorable for those patients with a single resection when compared to those with more than one resection.

OBJECTIVE

To examine functional outcomes in inpatient rehabilitation for people with GBM who underwent one or more resections prior to admission.

DESIGN

Retrospective analysis.

SETTING

Inpatient rehabilitation unit within a large, urban, academic medical center.

PARTICIPANTS

Patients who were admitted to our institution for the treatment of initial GBM or GBM recurrence necessitating surgical resection or repeat resection.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Total FIM Change, Total Functional Independence Measure (FIM) Efficiency, Motor and Cognitive FIM efficiency, and proportion discharged home.

RESULTS

From 2006 to 2016, 94 persons with GBM were admitted. Eight were readmissions classified as "repeat" and another seven transferred to the medical floor and excluded. Of the 79 patients included, 56 were first and 23 second resections, with a group mean age of 62.7 + 12.2 years and were 51% male. On analysis of covariance, change in FIM score from admission to discharge was insignificant between groups, adjusted for age and acute care length of stay (17.1 vs. 17.4, F[1, 75] = 0.027, P = .871). Likewise, the proportion of home discharge was not significant between groups (chi-square, 75.0% vs. 78.3%, P = .758).

CONCLUSIONS

Patients who have undergone second resections for GBM are reasonable candidates for admission to the inpatient rehabilitation units despite carrying a poor prognosis and having multiple exposures to surgical morbidity. Factors to take into account are that candidates considered for a second resection may be relatively younger or healthier and therefore may perform better from a functional standpoint. In addition, postoperative steroid administration may play a role in the similarities the authors noted. A larger, multicenter study should validate our findings (limited by sample size and a single location) and identify factors predicting a successful outcome.

Quality of online self-management resources for adults living with primary brain cancer, and their carers: a systematic environmental scan

Background

A primary brain cancer diagnosis is a distressing, life changing event. It adversely affects the quality of life for the person living with brain cancer and their families (‘carers’). Timely access to evidence-based information is critical to enabling people living with brain cancer, and their carers, to self-manage the devastating impacts of this disease.

Method

A systematic environmental scan of web-based resources. A depersonalised search for online English-language resources published from 2009 to December 2019 and designed for adults (> 25 years of age), living with primary brain cancer, was undertaken using the Google search engine. The online information was classified according to: 1) the step on the cancer care continuum; 2) self-management domains (PRISMS taxonomy); 3) basic information disclosure (Silberg criteria); 4) independent quality verification (HonCode); 5) reliability of disease and treatment information (DISCERN Sections 1 and 2); and readability (Flesch-Kincaid reading grade).

Results

A total of 119 online resources were identified, most originating in England (n = 49); Australia (n = 27); or the USA (n = 27). The majority of resources related to active treatment (n = 76), without addressing recurrence (n = 3), survivorship (n = 1) or palliative care needs (n = 13). Few online resources directly provided self-management advice for adults living with brain cancer or their carers. Just over a fifth (n = 26, 22%) were underpinned by verifiable evidence. Only one quarter of organisations producing resources were HonCode certified (n = 9, 24%). The median resource reliability as measured by Section 1, DISCERN tool, was 56%. A median of 8.8 years of education was required to understand these online resources.

Conclusions

More targeted online information is needed to provide people affected by brain cancer with practical self-management advice. Resources need to better address patient and carer needs related to: rehabilitation, managing behavioural changes, survivorship and living with uncertainty; recurrence; and transition to palliative care. Developing online resources that don’t require a high level of literacy and/or cognition are also required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00715-4.

Rehabilitation of Adult Patients with Primary Brain Tumors: A Narrative Review

Rehabilitative measures have been shown to benefit patients with primary brain tumors (PBT). To provide a high quality of care, clinicians should be aware of common challenges in this population including a variety of medical complications, symptoms, and impairments, such as headaches, seizures, cognitive deficits, fatigue, and mood changes. By taking communication and family training into consideration, clinicians can provide integrated and patient-centered care to this population. This article looks to review the current literature in outpatient and inpatient rehabilitation options for adult patients with PBTs as well as explore the role of the interdisciplinary team in providing survivorship care.

Trajectories of Rehabilitation across Complex Environments (TRaCE): design and baseline characteristics for a prospective cohort study on spinal cord injury and acquired brain injury

PURPOSE

Trajectories of Rehabilitation across Complex Environments (TRaCE), a consented prospective cohort study, addresses a critical need to better understand access to the healthcare system after acute treatment and specialist inpatient rehabilitation for acquired disability. It is expected that this study will produce new knowledge on access to healthcare through the linkage of administrative, survey, and spatial datasets on the one cohort. This paper outlines the study design and baseline characteristics of the cohort.

METHODS

The TRaCE cohort is comprised of 165 inpatients who are currently being followed up for 12 months after discharge from specialist rehabilitation for acquired brain injury (ABI) and spinal cord injury (SCI). This project combines a data linkage framework on health service use with a prospective survey on psychosocial wellbeing, geographical information systems to examine spatial accessibility to services, and qualitative interviews with a sub-cohort on experiences of service access.

CONCLUSION

Ultimately, TRaCE will have strong translational impact on strategies for more targeted interventions to improve the healthcare system and support individuals with acquired disabilities in the long-term.

Exploring the impact of brain cancer on people and their participation

Introduction

Brain cancer diagnoses are rising, and the prognosis is commonly life-limiting. Brain cancer symptoms and the side effects of treatment are imposing and harmful. Little is known about the effect of these symptoms and treatments on occupational participation or about the role that occupational therapy can play for people with brain cancer.

Methods

Sixteen participants with brain cancer were purposively recruited from a single site. Data was collected using semi-structured interviews. Interviews were analysed thematically.

Results

Three overarching themes were identified: (a) ‘there’s a lot of things that I can’t do anymore’: adverse effects of tumour and treatments; (b) ‘you adjust with adversity’: accepting altered occupational participation levels; (c) occupational therapy: ‘why is she here?’

Conclusions

Findings highlight a connection between brain cancer symptoms, treatment side effects and occupational participation. A disconnect was found between occupational therapy services and occupational needs. Further research could explore whether realigning occupational therapy services to address the concerns identified in this study leads to enhanced occupational participation through the journey of brain cancer.

Brain Tumors and Metastases

Patients with brain tumor exhibit wide-ranging prognoses and functional implications of their disease and treatments. In general, the supportive care needs of patients with brain tumor, including disabling effects, have been recognized to be high. This review (1) briefly summarizes brain tumor types, treatments, and prognostic information for the rehabilitation clinician; (2) reviews evidence for rehabilitation, including acute inpatient rehabilitation and cognitive rehabilitation, and the approaches to selected common symptom and medical management issues; and (3) examines emerging data about survivorship, such as employment, community integration, and fitness.

Disability concentration and access to rehabilitation services: a pilot spatial assessment applying geographic information system analysis

Purpose: Due to geographical disparities, many people with profound or severe disabilities experience considerable delays in rehabilitation treatment, resulting in threats to quality of life. This pilot study aims to identify areas in Greater Brisbane, Australia, with a higher concentration of people with profound or severe disabilities and to evaluate access to rehabilitation services in these areas. Methods: Data came from the 2016 Australian Census of Population and Housing and the National Health Services Directory. Four frequently used rehabilitation services by individuals with profound or severe disabilities (i.e., occupational therapy, physiotherapy, speech pathology and psychology) were the focus of the analysis. The data were analyzed using geospatial analysis methods (e.g., spatial scan statistic and network analysis). Results: A higher concentration of rehabilitation services was found in the regions with lower disability prevalence and lower potential demand for rehabilitation services. In contrast, the regions with higher disability prevalence and higher potential demand for rehabilitation services experienced poorer access to rehabilitation services. Conclusion: The findings are expected to inform policy decisions about the prioritization of rehabilitation resources and derive evidence for planning more responsive service delivery. Implications for rehabilitation The current study has demonstrated the utilization of geographic information system methods to facilitate rehabilitation service planning. Identification of disability concentration may inform locally responsive rehabilitation service delivery. Spatial assessment of mismatch between supply and potential demand may assist policy makers and service providers in the prioritization of rehabilitation resources. The current study contributes to the World Health Organization's call for action to ensure adequate access to rehabilitation services by people with profound or severe disabilities.

Don't need help, don't want help, can't get help: How patients with brain tumors account for not using rehabilitation, psychosocial and community services

OBJECTIVE

To understand why some adults with primary brain tumors do not use support services despite indications of a need for help.

METHODS

Nineteen adults recently diagnosed with primary brain tumors participated in semi-structured interviews. Thematic analysis was used to identify recurrent ways participants explained their non-use of support services.

RESULTS

Some patients indicated that they did not use support services as they did not need help, in particular reporting positive experiences relative to their expectations or to others, that their needs were met, or difficulties recognizing their needs. Some patients reported not wanting help, citing preferences to self-manage, other priorities, or negative perceptions of the services available. Many patients identified barriers to support service utilization, particularly problems recognizing that services could address their needs and that their needs were valid concerns.

CONCLUSION

The gap between patients' needs and their service use may result from patients' expectations from the medical system, shifting of standards for well-being, cognitive changes, and access issues.

PRACTICE IMPLICATIONS

Addressing knowledge barriers and perceptions relating to help-seeking, as well as recognizing the challenges specific to this patient group in terms of need recognition and access issues, may assist in improving patients' physical, psychological and social well-being.

The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer

BACKGROUND

Occupational and physical therapy (OT/PT) services seek to reduce morbidity, mortality, and improve the quality of life of individuals; however, little is known about the needs and use of OT/PT for older adults with cancer. The goal of this study was to describe the functional deficits and their associations with other factors, and to examine the use of OT/PT after a noted functional deficit.

MATERIALS AND METHODS

This study analyzed data from an institution-based registry that included geriatric assessments of older adults with cancer linked to billing claims data. Logistic regression was used to model predictors of functional deficits. Use of OT/PT was determined and validated with medical chart review.

RESULTS

529 patients with cancer, a median age of 71, 78% were female, 87% Caucasian, 57% married, 53% post-secondary education, and 63% with breast cancer were included. In a multivariable model, the odds of having any functional deficits increased with age [5 year OR: 1.31, 95% CI: (1.10, 1.57)] were higher for those with a high school diploma versus those with advanced degrees [OR: 1.66, 95% CI: (1.00, 2.77)] and were higher for patients with comorbidities [OR: 1.15, 95% CI: (1.10, 1.21)]. Of patients with functional deficits only 9% (10/111) received OT/PT within 12 months of a noted deficit.

DISCUSSION

The odds of having any potentially modifiable functional deficit were higher in patients with increasing age, comorbid conditions, and with less than a college degree. Few were referred for OT/PT services suggesting major underutilization of these potentially beneficial services.

Occupational therapy use by older adults with cancer

Occupational therapy may significantly improve cancer survivors' ability to participate in activities, thereby improving quality of life. Little is known, however, about the use of occupational therapy services by adults with cancer. The objective of this study was to understand what shapes patterns of occupational therapy use to help improve service delivery. We examined older (age >65 yr) adults diagnosed with breast, prostate, lung, or melanoma (skin) cancer between 2004 and 2007 (N = 27,131) using North Carolina Central Cancer Registry data linked to Medicare billing claims. Survivors who used occupational therapy within 1 yr before their cancer diagnosis were more likely to use occupational therapy after diagnosis but also experienced the highest levels of comorbidities. Survivors with Stage 4 cancers or lung cancer were less likely to use occupational therapy. These findings suggest possible disparities in utilization of occupational therapy by older adults with cancer.

Finding the right kind of support: a study of carers of those with a primary malignant brain tumour

PURPOSE

Caring for someone with a primary malignant brain tumour is very demanding due to the dynamic situation involving changes to personality, short term memory loss and changes in family relationships. The purpose of this qualitative study is to examine the support needs of carers of those with a primary malignant brain tumour. METHODS & SAMPLE: 22 Carers who were currently caring for someone with a primary malignant brain tumour were recruited from one specialist cancer centre in the south east of England. The study took a grounded theory approach and data were analysed using the constant comparative method generating categories and themes that are grounded in the data.

KEY RESULTS

A key concept that emerged from the data was: 'Connecting on the caring journey'. The themes that emerged from the key concept were: building helpful relationships; safe places and comfort zones; and threats to connecting.

CONCLUSIONS

Many carers do find a great deal of support within the family and from their relationships with friends as well as from cancer and carer support groups. However this is by no means universal and many carers experience a lack of timely access to good quality supportive care services. For some carers supportive care services do not meet their expectations so they spend valuable time searching for the connections they need to continue to care combined with feeling frustrated and under pressure.