scholarly journals NQPC-3 A short-time intensive rehabilitation for brain tumor patients with Karnofsky Performance Status of 60-30

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi22-vi22
Author(s):  
Sawane Tejima ◽  
Mai Ueyama ◽  
Daijiro Okamura ◽  
Makoto Ideguchi ◽  
Masao Matsutani
Keyword(s):  
Brain Tumor ◽  
Independent Living ◽  
Malignant Gliomas ◽  
Functional Independence ◽  
Stair Climbing ◽  
Vascular Tumors ◽  
Tumor Patients ◽  
Significant Difference ◽  
Intensive Rehabilitation ◽  
At Home

Abstract OBJECTIVE: Brain tumor patients with KPS of 60 to 30 after the initial treatment are not able to spend independent life at home. The goal of this study is to return these patients to their home with minimal family support by delivering intensive rehabilitation to them. Seventy-five brain patients were evaluated every 10 days from the beginning to the end of rehabilitation treatment, according to clinical scales of Functional Independence Measure (FIM) of 1–7 points depending on the degree of independence. The rehabilitation effect was judged by the degree of improvement of 11 out of 13 motor FIM items, excluding stair climbing and bathing movements. When more than half number of the 11 motor FIM items requiring physical assistance (4 points or less) improved up to non-assistance (5 points or more), it was judged as a significant effect. In addition, when all 11 items present with 6 points (independence possible) or more and all 5 of FIM recognition items are 5 points or more (understand the domestic rules), it was judged that the patients acquired independent living ability. RESULTS: 1. Of the 75 patients, 54 (72%) showed a significant effect, and 38 of them (50.7% of the total) aquired independence at home. The acquisition-rate of independent living ability by tumor was 44.7% for 38 malignant gliomas, 53.8% for 13 metastatic tumors, 50% for 14 meningiomas, and 71.4% for 7 vascular tumors, and there was no significant difference between them. 2. The median time to reach the maximum rehabilitation effect was 35 days. CONCLUSION: Intensive rehabilitation for brain tumor patients with KPS of 60 to 30 is effective and should be incorporated into the palliative treatments in the brain tumor treatment guidelines.

scholarly journals NQPC-12 SHORT-TIME INTENSIVE REHABILITATION FOR PATIENTS WITH NEWLY DIAGNOSED MALIGNANT GLIOMAS WITH SPECIAL REFERENCE TO MEDICAL COOPERATION TEAM

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
Takeshi Maeda ◽  
Masao Matsutani ◽  
Momoka Kato ◽  
Daijiro Okamura ◽  
Syoichi Muraya
Keyword(s):  
Radiation Therapy ◽  
Malignant Gliomas ◽  
Functional Independence ◽  
Rehabilitation Program ◽  
Maximum Point ◽  
Newly Diagnosed ◽  
Mri Imaging ◽  
Postoperative Radiation Therapy ◽  
Short Time ◽  
Intensive Rehabilitation

Abstract PURPOSE Many reports presented that patients with GBM had stable HRQoL during their remission time. However, there are few reports on the situation of ADL that is the basis of QOL. This prospective study was designed to evaluate the effectiveness of intensive rehabilitation for physically disabled patients with GBM after the initial treatment. PATIENTS and METHOD Twelve patients with newly-diagnosed glioblastoma presenting with severe physical disabilities were registered after the completion of postsurgical radiation therapy combined with TMZ. All patients were evaluated by means of a core set of clinical scales of Functional Independence Measure (FIM), Sitting Balance score, Standing Balance score, and Mini-mental State Examination (MMSE). Patients were evaluated before the beginning and at the end of rehabilitation treatment. The daily rehabilitation program consisted of individual 180-min. sessions of treatment, seven days a week, for four to six consecutive weeks. Speech therapy was included when aphasia was diagnosed. RESULTS Ten of 12 patients presented with mean increased FIM score of 26.6 points that reached the individual maximum point within 10 to 56 days. CONCLUSION A short-time intensive rehabilitation (4 to 6seeks) is effective for GBM patients during TMZ withdrawal period after the postoperative radiation therapy. This effective program requires close teamwork with the medical cooperation teams in the medical and rehabilitation hospitals: explanation to patients of the significance of the short-term rehabilitation, which is different from stroke rehabilitation, adjustment of hospitalization date considering radiotherapy and chemotherapy schedule, and adjustment of MRI imaging or bevacizumab administration schedule during rehabilitation.

scholarly journals NQPC-07 IMMEDIATE POSTOPERATIVE REHABILITATION FOR PATIENTS WITH NEWLY-DIAGNOSED GLIOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
Mitsuyo Ikeda ◽  
Shin Yamada ◽  
Yasutomo Okajima ◽  
Kuniaki Saito ◽  
Keiichi Kobayashi ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
Tumor Type ◽  
Postoperative Rehabilitation ◽  
Cognitive Improvement ◽  
Post Surgery ◽  
Before And After ◽  
Comprehensive Rehabilitation ◽  
Intensive Rehabilitation

Abstract BACKGROUNDS Importance of early intensive rehabilitation is recently emphasized not only for Stroke Unit but for Intensive Care Unit. We have started such early comprehensive rehabilitation for patients after brain tumor surgery. Rehabilitation therapists were specially assigned to our brain surgery unit as members of the ward staffers. The purpose of this study is to show how this rehabilitation trial works for post-surgery patients with glioma. METHODS Thirty-two patients with glioma (20 males and 12 females) who were admitted to our institution in the year of 2018 were included. Mean age was 61.8±13.3 years; glioblastoma was the major tumor type (24 patients). We retrospectively analyzed rehabilitation outcome focusing on improvement of the Functional Independence Measure (FIM) scores during hospitalization. RESULTS Mean duration from surgery to the first rehabilitation intervention was 2.4±1.2 days, and mean hospital stay was 74.4±31.4days. Twenty patients were discharged to home (62 %) and 12 were transferred to other hospitals for convalescence. Motor, cognitive and total FIM scores were 41.0±22.2, 18.0±7.5, and 59.1±27.3 before surgery, whereas they were 61.4±28.6, 21.8±9.4, and 83.2±36.9, respectively, at discharge. Motor FIM items revealed more remarkable improvement than those of cognitive ones. Since starting the early intensive rehabilitation trial, patients with brain tumor have been systematically rehabilitated with an organized manner before and after surgery. CONCLUSION Early intensive rehabilitation for patients with brain tumor is recommended to be done by on-ward therapists who are assigned to work specially as members of the ward. Both motor and cognitive improvement is expected during hospitalization even in patients with malignant brain tumor.

Combination of bevacizumab, a monoclonal antibody to vascular endothelial growth factor (VEGF), and temozolomide: Study of cases

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 11522-11522 ◽  
Author(s):  
J. Kirkpatrick ◽  
A. Desjardins ◽  
J. J. Vredenburgh ◽  
J. A. Quinn ◽  
J. N. Rich ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Brain Tumor ◽  
Glioblastoma Multiforme ◽  
Malignant Gliomas ◽  
Malignant Brain Tumor ◽  
Phase Iii ◽  
New Combination ◽  
Dramatic Improvement ◽  
Vegf Receptor ◽  
Tumor Patients

11522 Background: The prognosis for glioblastoma multiforme remains poor. Survival is generally limited to less than 1 year. Currently available standard treatments have not allowed, thus far, to prolong survival significantly. Response rates observed in clinical trials evaluating glioblastoma multiforme are usually less than 20%. Knowing that malignant gliomas have high concentrations of VEGF receptors, and the higher the VEGF receptor concentration, the worse the prognosis, we decided to evaluate the efficacy of bevacizumab in malignant brain tumor patients. Bevacizumab is a humanized IgG1 monoclonal antibody to VEGF, which is synergistic with chemotherapy for most malignancies. We performed a phase II study combining bevacizumab with irinotecan for patient with malignant gliomas and observed an unprecedented response rate of 63%. Methods: Building of those results, we decided to treat a number of our patients with voluminous unresectable disease with bevacizumab and temozolomide as an upfront regimen. Temozolomide is an oral methylating agent known effective for primary malignant brain tumor patients. A phase III trial, first presented at the ASCO meeting of 2003, demonstrated the efficacy of temozolomide for newly diagnosed glioblastoma multiforme patients, establishing temozolomide as the new standard of care. Given the known results with temozolomide as monotherapy and the combination of bevacizumab with irinotecan, we treated patients with temozolomide and bevacizumab upfront. Results: With this new combination, some patients demonstrated dramatic improvement clinically and radiographically. The combination has been well tolerated thus far, with no incidence of hemorrhage or arterial thrombosis observed. Conclusions: Results will be updated at the time of presentation. [Table: see text]

scholarly journals QOL-57. AT HOME NEUROCOGNITIVE TESTING IS POSSIBLE IN PEDIATRIC BRAIN TUMOR PATIENTS

2018 ◽  
Vol 20 (suppl_2) ◽  
pp. i169-i169
Author(s):  
Amy Rosenfeld ◽  
Michael Etzl ◽  
Annie Gieseking ◽  
Amanda Goodman ◽  
Dianne Peterson ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Neurocognitive Testing ◽  
Tumor Patients ◽  
Pediatric Brain ◽  
At Home

scholarly journals Impact of Anticipated Awake Surgery on Psychooncological Distress in Brain Tumor Patients

2022 ◽  
Vol 11 ◽  
Author(s):  
Franziska Staub-Bartelt ◽  
Oliver Radtke ◽  
Daniel Hänggi ◽  
Michael Sabel ◽  
Marion Rapp
Keyword(s):  
Brain Tumor ◽  
Significant Influence ◽  
Tumor Resection ◽  
Statistical Analyses ◽  
Distress Thermometer ◽  
Awake Surgery ◽  
Anxiety And Depression ◽  
Cerebral Lesions ◽  
Tumor Patients ◽  
Significant Difference

BackgroundBrain tumor patients present high rates of distress, anxiety, and depression, in particular perioperatively. For resection of eloquent located cerebral lesions, awake surgery is the gold standard surgical method for the preservation of speech and motor function, which might be accompanied by increased psychological distress. The aim of the present study was to analyze if patients who are undergoing awake craniotomy suffer from increased prevalence or higher scores in distress, anxiety, or depression.MethodsPatients, who were electively admitted for brain tumor surgery at our neurooncological department, were perioperatively screened regarding distress, anxiety, and quality of life using three established self-assessment instruments (Hospital Anxiety and Depression Scale, distress thermometer, and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30-BN20). Screening results were correlated regarding operation technique (awake vs. general anesthesia). Retrospective statistical analyses for nominal variables were conducted using chi-square test. Metric variables were analyzed using the Kruskal–Wallis test, the Mann–Whitney U-test, and independent-samples t-tests.ResultsData from 54 patients (26 male and 28 female) aged 29 to 82 years were available for statistical analyses. A total of 37 patients received primary resection and 17 recurrent tumor resection. Awake surgery was performed in 35 patients. There was no significant difference in awake versus non-awake surgery patients regarding prevalence (of distress (p = 0.465), anxiety (p = 0.223), or depression (p = 0.882). Furthermore, awake surgery had no significant influence on distress thermometer score (p = 0.668), anxiety score (p = 0.682), or depression score (p = 0.630) as well as future uncertainty (p = 0.436) or global health status (p = 0.943). Additionally, analyses revealed that primary or recurrent surgery also did not have any significant influence on the prevalence or scoring of the evaluated items.ConclusionAnalyses of our cohort’s data suggest that planned awake surgery might not have a negative impact on patients concerning the prevalence and severity of manifestation of distress, anxiety, or depression in psychooncological screening. Patients undergoing recurrent surgery tend to demonstrate increased distress, although results were not significant.

scholarly journals Fertility preservation in primary brain tumor patients

2016 ◽  
Vol 4 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Jacqueline B. Stone ◽  
Joanne F. Kelvin ◽  
Lisa M. DeAngelis
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Fertility Preservation ◽  
Primary Brain Tumor ◽  
Nurse Specialist ◽  
Tumor Patients ◽  
Related Factors ◽  
Patients Âgés ◽  
Primary Brain Tumors ◽  
Significant Difference

Abstract Background Fertility preservation (FP) is an infrequently addressed issue for young adults with primary brain tumors. Given the improved prognosis and enhanced technology in reproductive medicine, more primary brain tumor patients see procreation as feasible, making the discussion of FP increasingly important. The goals of this study were to describe patients who received FP counseling by a fertility nurse specialist (FNS) and determine which sociodemographic and disease-related factors predict acceptance of referral to a reproductive specialist. Methods Institutional review board-approved retrospective review of primary brain tumor patients, ages 18 to 45, who were referred for FP counseling with a FNS from 2009 to 2013. Results Seventy patients were referred for FP counseling: 38 men, 32 women, with a median age of 32 years and median KPS of 90. Eighty-nine percent had gliomas; 58% grade III, 17% grade IV. Sixty-seven percent were referred for counseling at initial diagnosis. Of those referred, 73% accepted referral to a sperm bank (87% of men) or reproductive endocrinologist (56% of women). Patients were more likely to accept referral if they had no prior children (P = .048). There was no statistically significant difference in referral acceptance by age, race/ethnicity, marital status, religion, or tumor grade. After treatment, 3 men conceived naturally, 2 men conceived using banked sperm, and 2 women conceived naturally. Conclusions Despite the historically poor prognosis of patients with primary brain tumors, there is significant interest in FP among these patients, particularly if they have no prior children. Clinicians should develop strategies to incorporate FP counseling into practice.

scholarly journals Home care for brain tumor patients

2014 ◽  
Vol 1 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Andrea Pace ◽  
Veronica Villani ◽  
Antonella Di Pasquale ◽  
Dario Benincasa ◽  
Lara Guariglia ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Home Care ◽  
Health System ◽  
Positive Impact ◽  
Control Group ◽  
Tumor Patients ◽  
Rehospitalization Rate ◽  
The Impact ◽  
At Home

Abstract Background Brain tumor patients are quite different from other populations of cancer patients due to the complexity of supportive care needs, the trajectory of disease, the very short life expectancy, and resulting need for a specific palliative approach. Methods A pilot program of comprehensive palliative care for brain tumor patients was started in the Regina Elena National Cancer Institute of Rome in October 2000, supported by the Lazio Regional Health System. The aim of this model of assistance was to meet patient's needs for care in all stages of disease, support the families, and reduce the rehospitalization rate. The efficacy of the model of care was evaluated analyzing the place of death, caregiver satisfaction, rehospitalization rate, and the impact on costs to the health system. Results From October 2000 to December 2012, 848 patients affected by brain tumor were enrolled in a comprehensive program of neuro-oncological home care. Out of 529 patients who died, 323 (61%) were assisted at home until death, 117 (22.2%) died in hospital, and 89 (16.8%) died in hospice. A cost-effectiveness analysis demonstrated a significant reduction in hospital readmission rates in the last 2 months of life compared with the control group (16.7% vs 38%; P < .001). Conclusions Our findings concerning death at home, rehospitalization rate, quality of life, and satisfaction of patients and their relatives with the care received suggest that a neuro-oncologic palliative home-care program has a positive impact on the quality of care for brain tumor patients, particularly at the end of life.

scholarly journals P03.04 Signaling questions assessing brain tumor patients’ distress in clinical routine - a feasibility study

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii25-iii25 ◽  
Author(s):  
A Hartoyo ◽  
K Lichtenthaeler ◽  
E Kurz ◽  
T Pantel ◽  
C Richter ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Patient Group ◽  
Malignant Gliomas ◽  
Outpatient Setting ◽  
Neurological Deficits ◽  
Clinical Routine ◽  
Tumor Patients ◽  
Disease Trajectory ◽  
Patient Reported ◽  
Physical Changes

Abstract BACKGROUND Approximately 20%-35% of patients with intracranial tumors show depressive symptoms and distress. Assessment in these patients remains challenging due to cognitive and/or neurological deficits. We developed 3 signaling questions in order to assess patients during patient-doctor consultation. The aim is to implement them in clinical routine and to compare the results with patient reported outcome measures (PROMs) along disease trajectory. MATERIAL AND METHODS Patients were prospectively examined in a structured interview applying the 3 following questions: 1),Has your mood worsened? (I)”; 2),Are you strained by physical changes? (II)”; 3),Has your faculty of thought decreased? (III)”. Simultaneously, patients filled in the Distress Thermometer (DT) and the EORTC QLQ-C30 + BN20. The first patient group was assessed twice pre- and postoperatively in the very early disease trajectory (A), the second patient group once in the outpatient setting during adjuvant therapy or follow-up (B). The results of the 3 signaling questions were compared to the results of the PROMs. RESULTS A total of n=62 patients gave informed consent and n= 61 were assessed so far. In general, the signaling questions were feasible to answer for all patients. However, patients frequently needed more detailed examples for symptoms emphasizing the intention of the question. In group A (n= 20), patients had a mean age of 59 years, n= 12 (60%) were male. Main diagnoses were glioblastomas, meningiomas and metastases. The results of the signaling questions did not reflect the screening by DT: N= 11 (55%) reported that their mood has worsened (I) prior to the operation, which then improved to n= 5 (31%) patients afterwards. The same applied to physical changes (II, 10 (50%) vs. 7 (44%), as well as lower cognition (III, 7 (35%) vs. 4 (25%) respectively). In contrast, mean DT (5.7 vs. 6 after) as well as the mean number of positive responses to the problem lists on the DT was similar pre- and postoperatively (8.7 pre-op vs. 9.4 post-op). Group B, (n= 41) consisted of patients harboring malignant gliomas, n= 27 (66%) were male. Patients had a mean DT score = 6.8, n= 22 (53%) named a worse mood (I), n= 23 (56%) patients reported physical changes (II) and n= 22 (54%) patients reported lower cognition (III), global health scale (GHS) according to the EORTC instrument was 60 (0–100). The majority of patients with a DT ≥6 also reported strain in the signaling questions and had a lower mean GHS = 54,8. DT ≥ 6 was linked to worse mood (I, Fishers exact, p=0.02). CONCLUSION According to our preliminary data, the signaling questions seem to be more useful in the outpatient setting in glioma patients than perioperatively. “Has your mood worsened” was associated with higher burden according to DT. Screening in brain tumor patients could probably complemented by direct questions in order to avoid missing patients who are not able to fill in questionnaires.

scholarly journals The 5-factor modified frailty index: an effective predictor of mortality in brain tumor patients

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Adham M. Khalafallah ◽  
Sakibul Huq ◽  
Adrian E. Jimenez ◽  
Henry Brem ◽  
Debraj Mukherjee
Keyword(s):  
Brain Tumor ◽  
Frailty Index ◽  
Postoperative Mortality ◽  
Roc Curves ◽  
Study Cohort ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Tumor Patients ◽  
Significant Difference ◽  
Modified Frailty Index

OBJECTIVEHealth measures such as the Charlson Comorbidity Index (CCI) and the 11-factor modified frailty index (mFI-11) have been employed to predict general medical and surgical mortality, but their clinical utility is limited by the requirement for a large number of data points, some of which overlap or require data that may be unavailable in large datasets. A more streamlined 5-factor modified frailty index (mFI-5) was recently developed to overcome these barriers, but it has not been widely tested in neuro-oncology patient populations. The authors compared the utility of the mFI-5 to that of the CCI and the mFI-11 in predicting postoperative mortality in brain tumor patients.METHODSThe authors retrospectively reviewed a cohort of adult patients from a single institution who underwent brain tumor surgery during the period from January 2017 to December 2018. Logistic regression models were used to quantify the associations between health measure scores and postoperative mortality after adjusting for patient age, race, ethnicity, sex, marital status, and diagnosis. Results were considered statistically significant at p values ≤ 0.05. Receiver operating characteristic (ROC) curves were used to examine the relationships between CCI, mFI-11, and mFI-5 and mortality, and DeLong’s test was used to test for significant differences between c-statistics. Spearman’s rho was used to quantify correlations between indices.RESULTSThe study cohort included 1692 patients (mean age 55.5 years; mean CCI, mFI-11, and mFI-5 scores 2.49, 1.05, and 0.80, respectively). Each 1-point increase in mFI-11 (OR 4.19, p = 0.0043) and mFI-5 (OR 2.56, p = 0.018) scores independently predicted greater odds of 90-day postoperative mortality. Adjusted CCI, mFI-11, and mFI-5 ROC curves demonstrated c-statistics of 0.86 (CI 0.82–0.90), 0.87 (CI 0.83–0.91), and 0.87 (CI 0.83–0.91), respectively, and there was no significant difference between the c-statistics of the adjusted CCI and the adjusted mFI-5 models (p = 0.089) or between the adjusted mFI-11 and the adjusted mFI-5 models (p = 0.82). The 3 indices were well correlated (p < 0.01).CONCLUSIONSThe adjusted mFI-5 model predicts 90-day postoperative mortality among brain tumor patients as well as our adjusted CCI and adjusted mFI-11 models. The simplified mFI-5 may be easily integrated into clinical workflows to predict brain tumor surgery outcomes in real time.

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