Barriers to rehabilitation of the neurosurgical spine cancer patient

Abstract

The treatment of metastatic spine tumors has evolved significantly over the past 20 years due largely to improvements in magnetic resonance imaging; decompressive surgical techniques, spinal instrumentation, and high-dose conformal radiation. These advances have improved our ability to provide meaningful palliation for patients who often have significant medical and cancer-related issues. Despite technical advances that have improved our ability to maintain neurologic function, stabilize the spine, and prevent local tumor recurrences, significant barriers to rehabilitation remain. This article reviews these primary barriers to rehabilitation of the cancer patient following spine surgery and emphasizes the importance of diagnostic accuracy and a comprehensive team approach to the treatment of pain and other disorders in this population.

Treatment of spinal cord tumors

“…Special points Barriers to effective rehabilitation include poor neurologic function, comorbid diseases, overall poor prognosis, and inadequate pain control [31]. Patients who receive rehabilitation have increased life satisfaction, reduced depression, and decreases in pain [12•].…”

International comparison of the organisation of rehabilitation services and systems of care for patients with spinal cord injury

“…It has been reported that the primary barriers to rehabilitation for cancer patient were the neurological status, their oncologic and medical conditions (in particular their prognosis and the medical stability) and pain. 19 Some of these criteria also represented part of the screening parameters of the units. Obviously the neurological status and the presence of pain do not represent a limitation to the admission of NTSCI patients and this is an advantage of referring patients to specialised SCI units.…”

Rehabilitation of people with spinal cord damage due to tumor: literature review, international survey and practical recommendations for optimizing their rehabilitation

“…19,20 These form the acronym NOMPS -Neurological, Oncologic, Medical, Pain and Support status of the patient. The key aspects of the NOMPS criteria are summarized as follows:…”

“…5,10,[12][13][14][15][16][17] It is acknowledged that the rehabilitation of patients with tumor presents unique challenges, 18 and this applies especially for those with tumor as the cause of SCDys. 10,16,[19][20][21] Despite the high proportion of people with tumor causing SCDys there has been relatively little written about these patients in terms of the ideal setting for their rehabilitation or recommendations for rehabilitation teams caring for them. 10,16,19,20,22 The objectives of this project were: 1) to provide a brief review of the epidemiology, clinical features and outcomes for patients with SCDys due to tumor, 2) to survey participants attending a workshop on the rehabilitation of people with SCDys due to tumor about the admission practices of their SRU regarding these people and the services available for their rehabilitation, and 3) based on evidence from the literature and our expert opinion, propose practical considerations for staff working in SRU when managing people with SCDys due to tumor.…”

“…14,19,20,22,32 Survey There were 40 workshop participants who worked as health care professionals in rehabilitation who completed the survey. It is estimated that the response rate was close to 100%.…”