Neurorehabilitation in Neuro-Oncology

  • Michelangelo BartoloEmail author
  • Isabella Springhetti


Due to both the improved survival and the greater interest in enhancing the quality of patient’s residual life, rehabilitation has gained a growing role in the management of brain tumour (BT) patients in the last decades. BT patients can experience a wide range of symptoms and functional limitations, such as reduced mobility, cognitive and psychological problems, difficulties with self-care, relationship and work issues. As for other diseases/impairments, also disabilities caused by BT can be expressed within the conceptual framework of the International Classification of Functioning, Disability and Health (ICF) to describe health and the multidimensional health-related concerns of persons. Ultimately, all these symptoms and functional limitations can result in reduced ability in daily life activities and in performing (or maintaining) usual family and social roles, with a substantial impact on quality of life. Neuro-oncological rehabilitation refers to the process of assisting a person who has become disabled as a result of tumour (or therapies) to improve symptoms, and maximize functional independence, activity and participation, within the limits of the persisting impairment. Literature evidence suggests that despite rehabilitation in BT patients is not well established as it is for patients with other neurological conditions, symptoms and disabilities may be addressed through a “multidisciplinary rehabilitation” delivered in all the stages of the disease, by a team of different healthcare professionals working in an organized manner.


  1. 1.
    McFaline-Figueroa JR, Lee EQ. Brain tumors. Am J Med. 2018;22:pii:S0002-9343(18)30031-7.Google Scholar
  2. 2.
    Tabouret E, Chinot O, Metellus P, Tallet A, Viens P, Gonçalves A. Recent trends in epidemiology of brain metastases: an overview. Anticancer Res. 2012;32(11):4655–62.PubMedGoogle Scholar
  3. 3.
    Crocetti E, Trama A, Stiller C, Caldarella A, Soffietti R, Jaal J, et al. Epidemiology of glial and non-glial brain tumours in Europe. Eur J Cancer. 2012;48:1532–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, et al. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008–2012. Neuro Oncol. 2015;17(Suppl.4):iv1–62.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Sim HW, Morgan ER, Mason WP. Contemporary management of high-grade gliomas. CNS Oncol. 2018;7(1):51–65.PubMedCrossRefGoogle Scholar
  6. 6.
    Ostrom QT, Gittleman H, Stetson L, Virk S, Barnholtz-Sloan JS. Epidemiology of intracranial gliomas. Prog Neurol Surg. 2018;30:1–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Vargo M. Brain tumor rehabilitation. Am J Phys Med Rehabil. 2011;90(Suppl):S50–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Yabroff KR, Lawrence WF, Clauser S, Davis WW, Brown ML. Burden of illness in cancer survivors: findings from a population-based national sample. J Natl Cancer Inst. 2004;96(17):1322–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Mukand JA, Blackinton DD, Crincoli MG, Lee JJ, Santos BB. Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil. 2001;80:346–50.PubMedCrossRefGoogle Scholar
  10. 10.
    Schiffbauer H, Ferrari P, Rowley HA, Berger MS, Roberts TP. Functional activity within brain tumours: a magnetic source imaging study. Neurosurgery. 2001;49:1313–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Duffau H. Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity. Lancet Neurol. 2005;4(8):476–86.PubMedCrossRefGoogle Scholar
  12. 12.
    Russo M, Villani V, Taga A, Genovese A, Terrenato I, Manzoni GC, et al. Headache as a presenting symptom of glioma: a cross-sectional study. Cephalalgia. 2017;38(4):730–5.Google Scholar
  13. 13.
    Politsky JM. Brain tumor-related epilepsy: a current review of the etiologic basis and diagnostic and treatment approaches. Curr Neurol Neurosci Rep. 2017;17(9):70.PubMedCrossRefGoogle Scholar
  14. 14.
    Vecht C, Royer-Perron L, Houillier C, Huberfeld G. Seizures and anticonvulsants in brain tumours: frequency, mechanisms and anti-epileptic management. Curr Pharm Des. 2017;23(42):6464–87.PubMedCrossRefGoogle Scholar
  15. 15.
    Boele FW, Klein M, Reijneveld JC, Verdonck-de Leeuw IM, Heimans JJ. Symptom management and quality of life in glioma patients. CNS Oncol. 2014;3(1):37–47.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Hervey-Jumper SL, Berger MS. Role of surgical resection in low- and high-grade gliomas. Curr Treat Opt Neurol. 2014;16:284.CrossRefGoogle Scholar
  17. 17.
    Brown TJ, Brennan MC, Li M, Church EW, Brandmeir N, Rakszawski KL, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2:1460–9.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Lara-Velazquez M, Al-Kharboosh R, Jeanneret S, Vazquez-Ramos C, Mahato D, Tavanaiepour D, et al. Advances in brain tumor surgery for glioblastoma in adults. Brain Sci. 2017;7(12):166.PubMedCentralCrossRefGoogle Scholar
  19. 19.
    Asher A, Fu JB, Bailey C, Hughes JK. Fatigue among patients with brain tumors. CNS Oncol. 2016;5(2):91–100.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Kirshblum S, O’Dell MW, Ho C, Barr K. Rehabilitation of persons with central nervous system tumors. Cancer. 2001;92:1029–38.PubMedCrossRefGoogle Scholar
  21. 21.
    Behrend SW. Patients with primary brain tumors. Oncol Nurs Forum. 2014;41(3):335–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called “chemobrain” or “chemofog,” the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage. 2011;41(1):126–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Bower JE. Treating cancer-related fatigue: the search for interventions that target those most in need. J Clin Oncol. 2012;30(36):4449–50.PubMedCrossRefGoogle Scholar
  24. 24.
    de Raaf PJ, de Klerk C, van der Rijt CC. Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature. Psychooncology. 2013;22(9):1919–29.PubMedCrossRefGoogle Scholar
  25. 25.
    World Health Organization. International classification of functioning, disability, and health (ICF). Geneva: WHO; 2001.Google Scholar
  26. 26.
    Bornbaum CC, Doyle PC, Skarakis-Doyle E, Theurer JA. A critical exploration of the international classification of functioning, disability, and health (ICF) framework from the perspective of oncology: recommendations for revision. J Multidiscip Healthc. 2013;6:75–86.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of standardized outcome measures in physical therapist practice: perceptions and applications. Phys Ther. 2009;89(2):125–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Potter K, Fulk GD, Salem Y, Sullivan J. Outcome measures in neurological physical therapy practice, part I: making sound decisions. J Neurol Phys Ther. 2011;35(2):57–64.PubMedCrossRefGoogle Scholar
  29. 29.
    Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: McLeod CM, editor. Evaluation of chemotherapeutic agents. New York: Columbia University Press; 1949. p. 191–205.Google Scholar
  30. 30.
    Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.PubMedCrossRefGoogle Scholar
  31. 31.
    Mahoney FI, Barthel D. Functional evaluation: the Barthel Index. Mar St Med J. 1965;14:61–5.Google Scholar
  32. 32.
    Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool in rehabilitation. Adv Clin Rehabil. 1987;1:6–18.PubMedGoogle Scholar
  33. 33.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European organization for research and treatment of cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85:365–76.PubMedCrossRefGoogle Scholar
  34. 34.
    Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK, et al. The development and psychometric validation of a brain cancer quality-of-life questionnaire for use in combination with general cancer-specific questionnaires. Qual Life Res. 1996;5(1):139–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Taphoorn MJ, Claassens L, Aaronson NK, Coens C, Mauer M, Osoba D, et al. An international validation study of the EORTC brain cancer module (EORTC QLQ-BN20) for assessing health-related quality of life and symptoms in brain cancer patients. Eur J Cancer. 2010;46(6):1033–40.PubMedCrossRefGoogle Scholar
  36. 36.
    Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976;2:175–84.PubMedCrossRefGoogle Scholar
  37. 37.
    Keele KD. The pain chart. Lancet. 1948;2:6–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Downie WW, Leatham PA, Rhind VM, Wright V, Branco JA, Anderson JA. Studies with pain rating scales. Ann Rheum Dis. 1978;37(4):378–81.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975;1(3):277–99.PubMedCrossRefGoogle Scholar
  40. 40.
    Bruera E, Kuehn N, Miller MJ, Selmser P, Macmillan K. The Edmonton Symptom Assessment System (ESAS): a simple method of the assessment of palliative care patients. J Palliat Care. 1991;7:6–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10:799–812.CrossRefGoogle Scholar
  42. 42.
    Ownsworth T, Hawkes A, Steginga S, Walker D, Shum D. A biopsychosocial perspective on adjustment and quality of life following brain tumor: a systematic evaluation of the literature. Disabil Rehabil. 2009;31:1038–55.PubMedCrossRefGoogle Scholar
  43. 43.
    Khan F, Amatya B. Use of the international classification of functioning, disability and health (ICF) to describe patient-reported disability in primary brain tumour in an Australian community cohort. J Rehabil Med. 2013;45(5):434–45.PubMedCrossRefGoogle Scholar
  44. 44.
    Langbecker D, Yates P. Primary brain tumor patients’ supportive care needs and multidisciplinary rehabilitation, community and psychosocial support services: awareness, referral and utilization. J Neurooncol. 2016;127(1):91–102.PubMedCrossRefGoogle Scholar
  45. 45.
    Khan F, Amatya B, Ng L, Drummond K, Galea M. Multidisciplinary rehabilitation after primary brain tumour treatment. Cochrane Database Syst Rev. 2015;23(8):CD009509.Google Scholar
  46. 46.
    Meyers FJ, Linder J. Simultaneous care: disease treatment and palliative care throughout illness. J Clin Oncol. 2003;21:1412–5.PubMedCrossRefGoogle Scholar
  47. 47.
    Bartolo M, Zucchella C, Pace A, Lanzetta G, Vecchione C, Bartolo M, et al. Early rehabilitation after surgery improves functional outcome in inpatients with brain tumours. J Neurooncol. 2012;107(3):537–44.PubMedCrossRefGoogle Scholar
  48. 48.
    Pace A, Metro G, Fabi A. Supportive care in neurooncology. Curr Opin Oncol. 2010;22:621–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Giordana MT, Clara E. Functional rehabilitation and brain tumour patients. A review of outcome. Neurol Sci. 2006;27:240–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Wolff G, Toborek M. Targeting the therapeutic effects of exercise on redox-sensitive mechanisms in the vascular endothelium during tumor progression. IUBMB Life. 2013;65(7):565–71.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Correa DD. Neurocognitive function in brain tumors. Curr Neurol Neurosci Rep. 2010;10:232–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Back M, Back E, Kastelan M, Wheeler H. Cognitive deficits in primary brain tumours: a framework for management and rehabilitation. J Cancer Ther. 2014;5:74–81.CrossRefGoogle Scholar
  53. 53.
    Taphoorn MJ, Klein M. Cognitive deficits in adult patients with brain tumors. Lancet Neurol. 2004;66:159–68.CrossRefGoogle Scholar
  54. 54.
    Giovagnoli AR. Investigation of cognitive impairments in people with brain tumors. J Neurooncol. 2012;108(2):277–83.PubMedCrossRefGoogle Scholar
  55. 55.
    Martino J, Honma SM, Findlay AM, Guggisberg AG, Owen JP, Kirsch HE, et al. Resting functional connectivity in patients with brain tumors in eloquent areas. Ann Neurol. 2011;69(3):521–32.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Harris RJ, Bookheimer SY, Cloughesy TF, Kim HJ, Pope WB, Lai A, et al. Altered functional connectivity of the default mode network in diffuse gliomas measured with pseudo-resting state fMRI. J Neurooncol. 2014;116(2):373–9.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Ghumman S, Fortin D, Noel-Lamy M, Cunnane SC, Whittingstall K. Exploratory study of the effect of brain tumors on the default mode network. J Neurooncol. 2016;128(3):437–44.PubMedCrossRefGoogle Scholar
  58. 58.
    Bahrami N, Seibert TM, Karunamuni R, Bartsch H, Krishnan A, Farid N, et al. Altered network topology in patients with primary brain tumors after fractionated radiotherapy. Brain Connect. 2017;7(5):299–308.PubMedPubMedCentralCrossRefGoogle Scholar
  59. 59.
    Gehrke AK, Baisley MC, Sonck ALB, Wronski SL, Feuerstein M. Neurocognitive deficits following primary brain tumour treatment: systematic review of a decade of comparative studies. J Neurooncol. 2013;115(29):135–42.PubMedCrossRefGoogle Scholar
  60. 60.
    Day J, Gillespie DC, Rooney AG, Bulbeck HJ, Zienius K, Boele F, et al. Neurocognitive deficits and neurocognitive rehabilitation in adult brain tumours. Curr Treat Options Neurol. 2016;18(5):22.PubMedCrossRefGoogle Scholar
  61. 61.
    Klein M, Duffau H, Hamer PD. Cognition and resective surgery for diffuse infiltrative glioma: an overview. J Neurooncol. 2012;108:309–18.PubMedPubMedCentralCrossRefGoogle Scholar
  62. 62.
    Piil K, Jarden M, Jakobsen J, Christensen KB, Juhler M. A longitudinal, qualitative and quantitative exploration of daily life and need for rehabilitation among patients with high- grade gliomas and their caregivers. BMJ Open. 2013;3(7):e003183.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Sterckx W, Coolbrandt A, Dierckx de Casterlé B, Van den Heede K, Decruyenaere M, Borgenon S, et al. The impact of a high-grade glioma on everyday life: a systematic review from the patient’s and caregiver’s perspective. Eur J Oncol Nurs. 2013;17(1):107–17.PubMedCrossRefGoogle Scholar
  64. 64.
    Flechl B, Sax C, Ackerl M, Crevenna R, Woehrer A, Hainfellner J, et al. The course of quality of life and neurocognition in newly diagnosed patients with glioblastoma. Radiother Oncol. 2017;125(2):228–33.PubMedCrossRefGoogle Scholar
  65. 65.
    Meyers CA, Hess KR. Multifaceted end points in brain tumour clinical trials: cognitive deterioration precedes MRI progression. Neuro Oncol. 2003;5:89–95.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    Wilson BA. Neuropsychological rehabilitation. Ann Rev Clin Psychol. 2008;4:141–62.CrossRefGoogle Scholar
  67. 67.
    Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, et al. Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil. 2011;92(4):519–30.PubMedCrossRefGoogle Scholar
  68. 68.
    Bergo E, Lombardi G, Pambuku A, Della Puppa A, Bellu L, D'Avella D, et al. Cognitive rehabilitation in patients with gliomas and other brain tumors: state of the art. Biomed Res Int. 2016;2016:3041824.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Chan V, Xiong C, Colantonio A. Patients with brain tumors: who receives postacute occupational therapy services? Am J Occup Ther. 2015;69(2):1–6.CrossRefGoogle Scholar
  70. 70.
    Richter A, Woernle CM, Krayenbühl N, Kollias S, Bellut D. Affective symptoms and white matter changes in brain tumor patients. World Neurosurg. 2015;84(4):927–32.PubMedCrossRefGoogle Scholar
  71. 71.
    Molassiotis A, Wilson B, Brunton L, Chaudhary H, Gattamaneni R, McBain C. Symptom experience in patients with primary brain tumours: a longitudinal exploratory study. Eur J Oncol Nurs. 2010;14:410–6.PubMedCrossRefGoogle Scholar
  72. 72.
    Rosenblum ML, Kalkanis L, Goldberg W, Rock J, Mikkelsen T, Remer S, et al. Odyssey of hope: a physician’s guide to communicating with brain tumor patient across the continuum of care. J Neurooncol. 2009;92:241–51.PubMedCrossRefGoogle Scholar
  73. 73.
    Janda M, Steginga S, Langbecker D, Dunn J, Walker D, Eakin E. Quality of life among patients with a brain tumor and their carers. J Psychosom Res. 2007;63:617–23.PubMedCrossRefGoogle Scholar
  74. 74.
    Schubart JR, Kinzie MB, Farace E. Caring for the brain tumor patient: family caregiver burden and unmet needs. Neuro Oncol. 2008;10(1):61–72.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Ford E, Catt S, Chalmers A, Fallowfield L. Systematic review of supportive care needs in patients with primary malignant brain tumors. Neuro Oncol. 2012;14:392–404.PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Fox S, Lantz C. The brain tumor experience and quality of life: a qualitative study. J Neurosci Nurs. 1998;30(4):245–52.PubMedCrossRefGoogle Scholar
  77. 77.
    Sherwood PR, Cwiklik M, Donovan HS. Neurooncology family caregiving: review and directions for future research. CNS Oncol. 2016;5(1):41–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Wideheim AK, Edvardsson T, Pählson A, Ahlström G. A family’s perspective on living with a highly malignant brain tumor. Cancer Nurs. 2002;25(3):236–44.PubMedCrossRefGoogle Scholar
  79. 79.
    Schmer C, Ward-Smith P, Latham S, Salacz M. When a family member has a malignant brain tumor: the caregiver perspective. J Neurosci Nurs. 2008;40(2):78–84.PubMedCrossRefGoogle Scholar
  80. 80.
    Sherwood PR, Given BA, Doorenbos AZ, Given CW. Forgotten voices: lessons from bereaved caregivers of persons with a brain tumour. Int J Palliat Nurs. 2004;10(2):67–75.PubMedCrossRefGoogle Scholar
  81. 81.
    McConigley R, Halkett G, Lobb E, Novak A. Caring for someone with high grade glioma: a time of rapid change for caregivers. Palliat Med. 2010;24(5):473–9.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Rehabilitation, Neurorehabilitation UnitHABILITABergamoItaly
  2. 2.Functional Recovery and Rehabilitation Unit, Neuromotor/Oncologic SectionsFondazione Salvatore MaugeriPaviaItaly

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