Changing Paradigms in the Rehabilitation of Inpatients with Brain Tumors

  • Jack B. Fu
  • Shinichiro Morishita
  • Rajesh Yadav
Cancer Rehabilitation (MD Stubblefield, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cancer Rehabilitation


Neurologic tumors account for over 50% of American acute inpatient rehabilitation facility cancer admissions. WHO grade IV astrocytoma (also known as glioblastoma multiforme, high-grade glioma or GBM) is the most common primary brain tumor in adults and is invariably fatal. The majority of primary brain tumor patients experience neurologic deficits. However, under-referral from oncology to rehabilitation has been reported. This brief narrative review article covers functional, medical, and regulatory considerations when rehabilitating brain tumor inpatients.


Inpatient Rehabilitation Brain Astrocytoma Glioma Glioblastoma 


Funding information

This work is supported in part by the M.D. Anderson Cancer Center Support Grant CA 016672.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


  1. 1.
    Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008;26(16):2621–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Cheville AL, Beck LA, Petersen TL, Marks RS, Gamble GL. The detection and treatment of cancer-related functional problems in an outpatient setting. Support Care Cancer. 2009;17(1):61–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Cheville AL, Rhudy L, Basford JR, Griffin JM, Flores AM. How receptive are patients with late stage cancer to rehabilitation services and what are the sources of their resistance? Arch Phys Med Rehabil. 2017;98(2):203–10.CrossRefPubMedGoogle Scholar
  4. 4.
    Lin HF, Wu YT, Tsauo JY. Utilization of rehabilitation services for inpatient with cancer in Taiwan: a descriptive analysis from national health insurance database. BMC Health Serv Res. 2012;12:255.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Movsas SB, Chang VT, Tunkel RS, Shah VV, Ryan LS, Millis SR. Rehabilitation needs of an inpatient medical oncology unit. Arch Phys Med Rehabil. 2003;84:1642–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Pace A, Villani V, Parisi C, Di Felice S, Lamaro M, Falcicchio C, et al. Rehabilitation pathways in adult brain tumor patients in the first 12 months of disease. A retrospective analysis of services utilization in 719 patients. Support Care Cancer. 2016;24(11):4801–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Mukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB. Incidence of neurological deficits and rehabilitation of patients with brain tumours. Am J Rehab Med. 2001;80:346–50.CrossRefGoogle Scholar
  8. 8.
    Piil K, Juhler M, Jakobsen J, Jarden M. Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: a systematic review. BMJ Support Palliat Care. 2016;6(1):27–34.CrossRefPubMedGoogle Scholar
  9. 9.
    Cheville AL. Cancer rehabilitation. Semin Oncol. 2005;32:219–24.CrossRefPubMedGoogle Scholar
  10. 10.
    Lehmann JF, DeLisa JA, Warren CG, deLateur BJ, Bryant PL, Nicholson CG. Cancer rehabilitation: assessment of need, development, and evaluation of a model of care. Arch Phys Med Rehabil. 1978;59(9):410–9.PubMedGoogle Scholar
  11. 11.
    Mix JM, Granger CV, LaMonte MJ, Niewczyk P, DiVita MA, Goldstein R, et al. Characterization of cancer patients in inpatient rehabilitation facilities: a retrospective cohort study. Arch Phys Med Rehabil. 2017;98(5):971–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Sliwa JA, Shahpar S, Huang ME, Spill G, Semik P. Cancer rehabilitation: do functional gains relate to 60 percent rule classification or to the presence of metastasis? PM R. 2016;8(2):131–7.CrossRefPubMedGoogle Scholar
  13. 13.
    Shin KY, Guo Y, Konzen B, Fu J, Yadav R, Bruera E. Inpatient cancer rehabilitation: the experience of a national comprehensive cancer center. Am J Phys Med Rehabil. 2011;90(5 Suppl 1):S63–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Centers for Medicare & Medicaid Services, Department of Health and Human Services. Inpatient Rehabilitation Facility Prospective Payment System. Available at Accessed January 12, 2017.
  15. 15.
    Fu JB, Raj VS, Guo Y. A guide to inpatient cancer rehabilitation: focusing on patient selection and evidence-based outcomes. PM R. 2017;9S2(9):S324–34.CrossRefGoogle Scholar
  16. 16.
    Central Brain Tumor Registry of the United States, 2016 CBTRUS Fact Sheet. Available at Accessed 6/22/2017.
  17. 17.
    Ostrom QT, Gittleman H, Farah P, Ondracek A, Chen Y, Wolinsky Y, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2006–2010. Neuro-Oncology. 2013;15(Suppl 2):ii1–56.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sawaya R, Suki D. Long-term survival in patients with glioblastoma multiforme: frequency and prognostic factors. April 15, 2016, ARS 2016) Gross total resection has been associated with increased survival.Google Scholar
  19. 19.
    Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2(11):1460–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Wong J, Hird A, Kirou-Mauro A, Napolskikh J, Chow E. Quality of life in brain metastases radiation trials: a literature review. Curr Oncol. 2008;15(5):25–45.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Groves MD. Leptomeningeal disease. Neurosurg Clin N Am. 2011;22(1):67–78.CrossRefPubMedGoogle Scholar
  22. 22.
    Huang ME, Cifu DX, Keyser-Marcus L. Functional outcomes in patients with brain tumor after inpatient rehabilitation: comparison with traumatic brain injury. Am J Phys Med Rehabil. 2000;79:327–35.CrossRefPubMedGoogle Scholar
  23. 23.
    Huang ME, Cifu DX, Keyser-Marcus L. Functional outcome after brain tumor and acute stroke: a comparative analysis. Arch Phys Med Rehabil. 1998;79:1386–90.CrossRefPubMedGoogle Scholar
  24. 24.
    Greenberg E, Treger I, Ring H. Rehabilitation outcomes in patients with brain tumors and acute stroke: comparative study of inpatient rehabilitation. Am J Phys Med Rehabil. 2006;85:568–73.CrossRefPubMedGoogle Scholar
  25. 25.
    O’Dell MW, Barr K, Spanier D, et al. Functional outcome of inpatient rehabilitation in persons with brain tumors. Arch Phys Med Rehabil. 1998;79:1530–4.CrossRefPubMedGoogle Scholar
  26. 26.
    Marciniak CM, Sliwa JA, Heinemann AW, et al. Functional outcomes of persons with brain tumors after inpatient rehabilitation. Arch Phys Med Rehabil. 2001;82:457–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Fu JB, Parsons HA, Shin KY, Guo Y, Konzen BS, Yadav RR, et al. Comparison of functional outcomes in low- and high-grade astrocytoma rehabilitation inpatients. Am J Phys Med Rehabil. 2010;89(3):205–12.CrossRefPubMedGoogle Scholar
  28. 28.
    Fu JB, Rao G, Rexer JL: Rehabilitation of patients with brain tumors. In: Stubblefield MD, editor. Cancer rehabilitation: principles & practice, 3rd edition. Demos Medical; 2018. In Press.Google Scholar
  29. 29.
    Alam E, Wilson RD, Vargo MM. Inpatient cancer rehabilitation: a retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients. Arch Phys Med Rehabil. 2008;89(7):1284–9.CrossRefPubMedGoogle Scholar
  30. 30.
    Fu JB, Lee J, Shin BC, Silver JK, Smith DW, Shah JJ, et al. Return to the primary acute care service among patients with multiple myeloma on an acute inpatient rehabilitation unit. PM R. 2017;9(6):571–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Fu JB, Lee J, Smith DW, Shin K, Guo Y, Bruera E. Frequency and reasons for return to the primary acute care service among patients with lymphoma undergoing inpatient rehabilitation. PM R. 2014;6(7):629–34.CrossRefPubMedGoogle Scholar
  32. 32.
    Fu JB, Lee J, Smith DW, Bruera E. Frequency and reasons for return to acute care in patients with leukemia undergoing inpatient rehabilitation: a preliminary report. Am J Phys Med Rehabil. 2013;92(3):215–22.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Fu JB, Lee J, Smith DW, Guo Y, Bruera E. Return to primary service among bone marrow transplant rehabilitation inpatients: an index for predicting outcomes. Arch Phys Med Rehabil. 2013;94(2):356–61.CrossRefPubMedGoogle Scholar
  34. 34.
    Stineman MG, Ross R, Maislin G, Fiedler RC, Granger CV. Risks of acute hospital transfer and mortality during stroke rehabilitation. Arch Phys Med Rehabil. 2003;84(5):712–8.PubMedGoogle Scholar
  35. 35.
    Deshpande AA, Millis SR, Zafonte RD, Hammond FM, Wood DL. Risk factors for acute care transfer among traumatic brain injury patients. Arch Phys Med Rehabil. 1997;78(4):350–2.CrossRefPubMedGoogle Scholar
  36. 36.
    Lovely MP, Miaskowski C, Dodd M. Relationship between fatigue and quality of life in patients with glioblastoma multiformae. Oncol Nurs Forum. 1999;26(5):921–5.PubMedGoogle Scholar
  37. 37.
    Meyers CA, Weitzner MA, Valentine AD, Levin VA. Methylphenidate therapy improves cognition, mood, and function of brain tumor patients. J Clin Oncol. 1998;16(7):2522–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Guo Y, Young BL, Hainley S, Palmer JL, Bruera E. Evaluation and pharmacologic management of symptoms in cancer patients undergoing acute rehabilitation in a comprehensive cancer center. Arch Phys Med Rehabil. 2007;88(7):891–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Fu JB, Lee J, Tran KB, Siangco CM, Ng AH, Smith DW, et al. Symptom burden and functional gains in a cancer rehabilitation unit. Int J Ther Rehabil. 2015;22(11):517–23.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Brandes AA, Scelzi E, Salmistraro G, Ermani M, Carollo C, Berti F, et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer. 1997;33(10):1592–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Streiff MB, Ye X, Kickler TS, Desideri S, Jani J, Fisher J, et al. A prospective multicenter study of venous thromboembolism in patients with newly-diagnosed high-grade glioma: hazard rate and risk factors. J Neuro-Oncol. 2015;124(2):299–305.CrossRefGoogle Scholar
  42. 42.
    Perry JR, Julian JA, Laperriere NJ, Geerts W, Agnelli G, Rogers LR, et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost. 2010;8(9):1959–65.CrossRefPubMedGoogle Scholar
  43. 43.
    Ruff RL, Posner JB. Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol. 1983;13(3):334–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982;10(4):437–44.CrossRefPubMedGoogle Scholar
  45. 45.
    Mandybur TI. Intracranial hemorrhage caused by metastatic tumors. Neurology. 1977;27(7):650–5.CrossRefPubMedGoogle Scholar
  46. 46.
    Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77S.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459–66.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Jack B. Fu
    • 1
  • Shinichiro Morishita
    • 2
  • Rajesh Yadav
    • 1
  1. 1.Department of Palliative, Rehabilitation and Integrative MedicineUniversity of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Institute for Human Movement and Medical SciencesNiigata University of Health and WelfareNiigataJapan

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