Letter: Postacute Cognitive Rehabilitation for Adult Brain Tumor Patients.

Abstract

To the Editor: We read with renewed enthusiasm the paper published by Weyer-Jamora et al.1 In this paper, the authors provide a comprehensive review of the impact of cognitive rehabilitation in patients with brain tumor after surgery. They suggest a patient-centered framework supported in the Tripe A model—acquisition, application, and adaptation—to address the different needs in the cognitive, emotional, psychosocial, and physical domains. We agree with the commitment to cognitive rehabilitation for the patient with brain tumor in the acute, postsurgical, inpatient setting and the outpatient, postacute setting. This is particularly important, given the improved overall survival rates for patients with primary and metastatic brain tumors. We share in our center the same challenges with identifying the optimal timing for cognitive rehabilitation postsurgery, particularly given the pressure to start adjuvant treatments. We believe that prehabilitation can further enhance postoperative cognitive rehabilitation in patients with brain tumor. Therefore, our center holds a clinic and program dedicated to preoperative and postoperative rehabilitation for this group of patients. The core clinicians include a neurosurgeon who subspecializes in neuro-oncology, a neuro-oncology nurse consultant, and a neuropsychologist with a specialist interest. Extended members who attend as required include a speech and language therapist, a neurophysiotherapist, and an occupational therapist. The clinic runs every 2 weeks ensuring that there is minimal waiting time from referral. Patients are selected from our weekly neuro-oncology multidisciplinary team meeting. This clinic and program are designed to reduce the level of anxiety and depression in this population, which the evidence recognizes to be particularly high,2 and enhance their cognitive rehabilitation. The program is delivered through a variable number of sessions adjusted to patients' needs. We use a combination of techniques to prepare them for surgery, diagnosis, and adjuvant treatment as well as coming to accept the diagnosis of a brain tumor and be able to live well with it. The tools we use include the BRIAN app,3 developed by The Brain Tumour Charity, the PEAK brain training app,4 and the EORTC quality of life questionnaire.5 Throughout the sessions, these tools are used to monitor patient progress and see how interventions and treatments are affecting their physical and psychological health. The team responsible for this clinic has access to these reports and can act upon significant variations as required. This paper is welcomed and supported by our group because we agree this is one of the avenues neuro-oncology has to pursue. Cognitive, emotional, psychosocial, and physical domains should be part of the treatment plan from the first moment the patient meets the neuro-oncology team. We believe integrated transhabilitation—prehabilitation and rehabilitation during and after treatment—will establish a new paradigm between the patient and the treating team. It will increase our understanding of the effects of surgical and oncological treatments and ultimately improve quality of life.