P23.03.A CURRENT PATHWAYS OF REHABILITATION FOR PATIENTS WITH HIGH GRADE GLIOMAS: INSIGHTS FROM AINO (ASSOCIAZIONE ITALIANA DI NEUROONCOLOGIA), SINCH (SOCIETÀ ITALIANA DI NEUROCHIRURGIA) AND SIRN (SOCIETÀ ITALIANA DI RIABILITAZIONE NEUROLOGICA)
Authors: Di Stefano A , Rudà R , Pace A , Santonocito O , Silvani A , Ius T , Zampolini M , Bartolo M ,   High grade glioma Rehab Group
Published: October 2024

Abstract

BACKGROUND
In the management of patients diagnosed with high-grade glioma (HGG), practices and rehabilitation programs display significant variability in real-world settings. The HGG Rehab survey aimed to glean insights from physicians specialized in neuro-oncology and affiliated with two prominent scientific societies in Italy: AINO (Associazione Italiana di Neurooncologia), SINch (Società Italiana di Neurochirurgia), and from neurorehabilitation specialists from the SIRN (Società Italiana di Riabilitazione Neurologica).

MATERIALS AND METHODS
The questionnaire was released in June 2023, and responses were recorded until February 2024.

RESULTS
Ninety-six responses were collated, representing a diverse cohort comprising neurosurgeons (62%), neuro-oncologists/oncologists (18%), neurorehabilitation specialists/physiatrists (17%), and radiotherapists (2%). A median value of 40% of HGG patients from Neurosurgical and Neuro-oncologic/Oncologic Divisions were evaluated for rehabilitation by physiatrists/neurorehabilitation specialists, and a median value of 20% were deemed eligible for a rehabilitation program. The rate of requests for physiatric evaluation was progressively higher as KPS increased, especially patients with KPS 60-70 (80%). The median time to commence rehabilitation exceeded 14 days from discharge in 40% of cases, with 80% of cases starting within 30 days. Over 50% of responders reported viable outpatient rehabilitation programs during adjuvant radio-chemotherapy, with practitioners citing good tolerance (&gt;55%). Seventy percent of practitioners recommended rehabilitation evaluation for newly diagnosed GBM patients and over 50% for those with recurrent GBM. Clinical benefits were observed in a median of 80% of patients, ranging from 30% to 100%. Recognized benefits of rehabilitation encompassed facilitating home discharges (82%), psychological benefits (65%), aiding the progress of adjuvant oncologic therapies (58%), and enhancing quality of life (40%). Unanimously, all respondents agreed that when indicated, rehabilitation should promptly commence after the onset of neurological deficits. Neurorehabilitation specialists/physiatrists’ involvement in multidisciplinary tumor boards resulted in very limited participation (10-25%). Key rehabilitation time points for newly diagnosed HGG patients included 5 days post-surgery, after histo-molecular diagnosis/treatment plan definition, and at recurrence.

CONCLUSIONS
The HGG Rehab Survey offers invaluable insights shared by three scientific societies into rehabilitation pathways for HGG patients in Italy. It highlights the usual criteria employed for the selection of patients and time points for outcome evaluation. The interval to start rehabilitation, as well as inpatient programs simultaneous with oncologic therapies, emerged as critical issues.