Journal of Neuro-Oncology

, Volume 103, Issue 3, pp 641–647

Current practices of driving restriction implementation for patients with brain tumors

  • Sayana Thomas
  • Minesh P. Mehta
  • John S. Kuo
  • H. Ian Robins
  • Deepak Khuntia
Clinical Study – Patient Study


Brain tumors may impair functioning in several neuro-cognitive domains and interfere with sophisticated tasks, such as driving motor vehicles. No formalized national guidelines or recommendations for driving restrictions in patients with brain tumors exist in the US. We created and administered a 24 question survey to 1,157 US medical practitioners, mostly neurosurgeons, radiation oncologists, and medical oncologists, to identify their knowledge of local driving restriction laws and their practice patterns regarding driving restriction instructions to brain tumor patients. Response were collected from 251 (21.7%) and analyzed from 221 (19%) recipients. Seventy-one percent of the respondents indicated they discuss driving recommendations/restrictions with brain tumor patients, with 82% primarily basing this on seizure activity. Approximately 28% of respondents were unsure if they are required by their State’s motor vehicle licensing authority to report medically impaired drivers. Respondents felt that longer periods of restriction prior to re-evaluation are warranted in patients with malignant versus benign brain tumors and high versus low grade gliomas. Only 25% of respondents use formal, standardized testing to determine driving eligibility and approximately 31% address driving restrictions in every patient with a brain tumor. This survey highlights the lack of consensus regarding the responsibilities of physicians treating brain tumor patients in designing and enforcing driving restrictions. We propose that a panel of experts generate driving restriction guidelines to be used in conjunction with objective testing of motor and sensory impairment. These would aid practitioners in developing individualized driving restrictions for every brain tumor patient.


Brain tumor Driving restrictions Driving impairment Seizure 


  1. 1.
    North American Brain Tumor Coalition (2009) Brain tumor facts. Accessed 18 Aug 2009
  2. 2.
    Baisden JM, Benedict SH, Sheng K, Read PW, Larner JM (2007) Helical TomoTherapy in the treatment of central nervous system metastasis. Neurosurg Focus 22:E8PubMedCrossRefGoogle Scholar
  3. 3.
    Mehta MP, Tsao MN, Whelan TJ, Morris DE, Hayman JA, Flickinger JC, Mills M, Rogers CL, Souhami L (2005) The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 63:37–46PubMedCrossRefGoogle Scholar
  4. 4.
    Douw L, Klein M, Fagel SS, van den Heuvel J, Taphoorn MJ, Aaronson NK, Postma TJ, Vandertop WP, Mooij JJ, Boerman RH, Beute GN, Sluimer JD, Slotman BJ, Reijneveld JC, Heimans JJ (2009) Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up. Lancet Neurol 8:810–818PubMedCrossRefGoogle Scholar
  5. 5.
    Calabrese P, Schlegel U (2009) Neurotoxicity of treatment. Recent Results Cancer Res 171:165–174PubMedCrossRefGoogle Scholar
  6. 6.
    Correa DD, Maron L, Harder H, Klein M, Armstrong CL, Calabrese P, Bromberg JE, Abrey LE, Batchelor TT, Schiff D (2007) Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines. Ann Oncol 18:1145–1151PubMedCrossRefGoogle Scholar
  7. 7.
    Mulhern RK, Merchant TE, Gajjar A, Reddick WE, Kun LE (2004) Late neurocognitive sequelae in survivors of brain tumours in childhood. Lancet Oncol 5:399–408PubMedCrossRefGoogle Scholar
  8. 8.
    APA (1995) Position Statement on the Role of Psychiatrists in Assessing Driving Ability. Am J Psychiatry 152:819Google Scholar
  9. 9.
    American Medical Association (2009) Physician’s guide to assessing and counseling older drivers. U.S. Department of Transportation, National Highway Traffic Administration, Washington, DC. Accessed 18 Aug 2009
  10. 10.
    Snyder K, Bloom JD (2004) Physician reporting of impaired drivers: a new trend in state law? J Am Acad Psychiatry Law 32:76–79PubMedGoogle Scholar
  11. 11.
    Cancer Research UK (2008) Brain tumors and driving. Accessed 18 Aug 2009
  12. 12.
    Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T, Kunkler I, Caudrelier JM, Eisenberg PD, Meerwaldt J, Siemers R, Carrie C, Gaspar LE, Curran W, Phan SC, Miller RA, Renschler MF (2004) Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22:157–165PubMedCrossRefGoogle Scholar
  13. 13.
    Chang EL, Wefel JS, Maor MH, Hassenbusch SJ 3rd, Mahajan A, Lang FF, Woo SY, Mathews LA, Allen PK, Shiu AS, Meyers CA (2007) A pilot study of neurocognitive function in patients with one to three new brain metastases initially treated with stereotactic radiosurgery alone. Neurosurgery 60:277–283; discussion 283-274PubMedGoogle Scholar
  14. 14.
    Pitkanen A, Schwartzkroin PA, Moshe SL (eds) (2006) Models of seizures and epilepsy. Elsevier, San DiegoGoogle Scholar
  15. 15.
    National Highway Traffic Safety Administration: Fatality analysis reporting system encyclopedia. 2010. Accessed Sep 19 2010
  16. 16.
    Siker MLD, Bernadine R, Vogelbaum, Michael A, Tome, Wolfgang A, Gilbert, Mark R, Mehta (2009) Principles and Practice of Radiation Oncology. Walters Kluwer, PhiladelphiaGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Sayana Thomas
    • 1
  • Minesh P. Mehta
    • 1
  • John S. Kuo
    • 2
  • H. Ian Robins
    • 3
  • Deepak Khuntia
    • 1
    • 4
  1. 1.Department of Human OncologyUniversity of WisconsinMadisonUSA
  2. 2.Department of Neurologic SurgeryUniversity of WisconsinMadisonUSA
  3. 3.Department of Human Oncology and MedicineUniversity of WisconsinMadisonUSA
  4. 4.Western Radiation OncologyMadisonUSA

Personalised recommendations