1. Brain/CNS Cancer and Rehabilitation
Report to Brain/CNS NSSG
Sally Donaghey
Macmillan AHP Lead, Ang CN

2. Brain/CNS and Rehabilitation
Variable survivorship – timing of rehabilitation
Frequency and severity of disablement arising from surgery, oncological treatment and disease itself
Setting of rehabilitation – specialist neuro in-patient rehab; community; self-management.

3. Complications in Brain Tumour Patients
Cognitive deficits 80%
Weakness 78%
Visual perceptual deficit 53%
Sensory loss 38%
Bowel/bladder 37%
Cranial nerve palsy 29%
Dysarthria 27%
Dysphagia 26%
Aphasia 24%
Ataxia 20%
Diplopia 10%
Mukand et. al.
American Journal of Physical Medicine & Rehabilitation (5),

4. Issues and Initiatives in Rehabilitation
Cancer rehabilitation nationally is poorly developed, evidenced and under recognised/utilised.
Publication of National Cancer Rehabilitation pathways and evidence guide.
Development of tumour specific local rehabilitation pathways
Need for pathways to be integrated into main care pathway and practice.

5. Workforce Mapping

6. Workforce Mapping cont..

7. Workforce Mapping cont..

8. Findings
Relatively low numbers of AHP’s for population against national average
Unmet need or
Need provided by generalist workforce?
Variablity in specialist service provision between localities
Consider referral pathways
Setting - 53% Acute figures indicate slightly higher then national average cancer rehab services in community
Care closer to home?

9. Workforce Modelling – Brain/CNS ANG CN Incidence 2008 = 227

10. Rehabilitation Triggers

11. Rehabilitation Triggers ..
Physiotherapy – Difficulties with function, movement and symptom control, neurological rehab, muscle tone, fatigue, exercise advise and information.
OT – Difficulties with ADL, leisure and work, functional assessment, equipment needs
Dietietics – Nutrition, appetite, nausea, weight loss/gain, fatigue, swallowing
SLT – Communication strategies, swallowing, impaired speech, intraoperative communication assessment for awake craniotomy, language skills/cognitive impairment
Lymphoedema – Skin/tissue assessment

12. Barriers AHP attendance at MDT/clinics
Equity of service in acute and community setting
Awareness of rehabilitation needs
Co-ordination of rehabilitation needs
Lack of resources
Engagement with Cancer Network MDT

13. What Can the NSSG Do? NSSG Workplan
Brain/CNS Care pathway – specific reference to rehab
Locality/clinician engagement
Audit of referrals/interventions/patient surveys

14. Useful Links
National Brain/CNS Rehabilitation Pathway:
Local Colorectal Rehabilitation Pathway:
NCAT. Supporting and Improving Commissioning of Cancer Rehabilitation Services Guidelines:
NCAT. Cancer Rehabilitation Services Evidence Review: