Challenges of rehabilitation for patients with primary malignant glioma – a review of recent literature

Katarzyna Hojan


Primary malignant glioma is one of the greatest challenges in contemporary rehabilitation. Due to the introduction of newer and newer methods of oncological treatment the overall survival in this group of patients retrospectively increased. This article is a review of the scientific literature of recent years concerning the principles of clinical assessment of patients with primary glioblastoma and the selection of methods in rehabilitation programs based on general condition. In the last years, there has been an increase in the results of clinical studies on the implementation of rehabilitation treatment in primary malignant glioma patients after oncological treatment. Thus, identification of accurate functional performance, behavior changes, evaluation of cognitive function, and cancer markers and oncological treatment as well as quality of life outcomes in this population are of major clinical importance. Primary malignant glioma patients represent a unique patient population with distinctive functional impairments and limitations to physical exercise. Therefore, individual comprehensive rehabilitation treatment may be useful in improving the physical and cognitive functioning as well as decreasing the fatigue syndrome. Such a therapy allows this group of patients to participate in society despite the consequences of cancer treatment.


brain tumor; exercise; oncology

Full Text:



Park CK, Lee SH, Kim TM, Choi SH, Park SH, Heo DS, et al. The value of temozolomide in combination with radiotherapy during standard treatment for newly diagnosed glioblastoma. Journal of neuro‑oncology. 2013;112:277–83.

Chaudhry NS, Shah AH, Ferraro N, Snelling BM, Bregy A, Madhavan K, et al. Predictors of long‑term survival in patients with glioblastoma multiforme: advancements from the last quarter century. Cancer investigation. 2013;31:287–308.

Parks C, Heald J, Hall G, Kamaly‑Asl I. Can the prognosis of individual patients with glioblastoma be predicted using an online calculator? Neuro‑oncology. 2013;15:1074–8.

Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC‑NCIC trial. Lancet Oncol. 2009;10:459–466.

Reardon DA, Desjardins A, Rich JN, Vredenburgh JJ. The emerging role of anti‑angiogenic therapy for malignant glioma. Curr Treat Options Oncol. 2008;9:1–22.

Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR.. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol. 2009;10(6):598–605.

Jones LW, Cohen RR, Mabe SK, West MJ, Desjardins A, Vredenburgh JJ, et al. Assessment of physical functioning in recurrent glioma: preliminary comparison of performance status to functional capacity testing. J Neurooncol. 2009;94:79–85.

Verger E1, Salamero M, Conill C. Can Karnofsky performance status be transformed to the Eastern Cooperative Oncology Group scoring scale and vice versa? Eur J Cancer. 1992;28:1328–30.

Roila F, Lupattelli M, Sassi M, Basurto C, Bracarda S, Picciafuoco M, et al. Intra and interobserver variability in cancer patients' performance status assessed according to Karnofsky and ECOG scales. Ann Oncol. 1991;2:437–9.

de Kock I, Mirhosseini M, Lau F, Thai V, Downing M, Quan H,et al; Conversion of Karnofsky Performance Status (KPS) and Eastern Cooperative Oncology Group Performance Status (ECOG) to Palliative Performance Scale (PPS), and the interchangeability of PPS and KPS in prognostic tools. J Palliat Care. 2013;29:163–9.

Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS. Cardiorespiratory exercise testing in clinical oncology research: Systematic review and practice recommendations. Lancet Oncol. 2008;9(8):757–765.

Ruden E, Reardon DA, Coan AD, Herndon JE, Hornsby WE, West M, et al. Exercise behavior, functional capacity,and survival in adults with malignant recurrent glioma. J Clin Oncol. 2011;29:2918–23.

Jones LW, Guill B, Keir ST, Carter BSK, Friedman HS, Bigner DD, et al. Patterns of exercise across the cancer trajectory in brain tumor patients. Cancer. 2006;106:2224–32.

Dutta D, Vanere P, Gupta T, Munshi A, Jalali R. Factors influencing activities of daily living using FIM‑FAM scoring system before starting adjuvant treatment in patients with brain tumors: results from a prospective study. J Neurooncol. 2009;94:103–10.

Meyers CA, Hess KR, Yung WK, Levin VA. Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol. 2000;18:646–650.

Taphoorn MJ, Klein M. Cognitive deficits in adult patients with brain tumours. Lancet Neurol. 2004;3:159–68.

Fox SW, Mitchell SA, Booth‑Jones M. Cognitive impairment in patients with brain tumors: assessment and intervention in the clinic setting. Clin J Oncol Nurs. 2006;10: 169–76.

Taylor BV, Buckner JC, Cascino TL, O’Fallon JR, Schaefer PL, Dinapoli RP, Schomberg P. Effects of radiation and chemotherapy on cognitive function in patients with high‑grade glioma. J Clin Oncol. 1998;16:2195–2201.

Lezak MD. Neuropsychological assessment. New York: Oxford University Press; 1995.

Dietz J. Adaptive rehabilitation in cancer: a program to improve quality of survival. Postgrad Med. 1980;68:145–147.

Porter KR, Menon U, Vick NA, Villano JL, Berbaum ML, Davis FG. Assessment of clinical and nonclinical characteristics associated with health‑related quality of life in patients with high‑grade gliomas: a feasibility study. Support Care Cancer. 2014;22:1349–62.

Heimans JJ, Martin J, Taphoorn B. Impact of brain tumour treatment on quality of life. J Neurol. 2000;249:955–960.

Hahn CA, Dunn RH, Logue PE, King JH, Edwards CL, Halperin EC. Prospective study of neuropsychologic testing and quality‑of‑life assessment of adults with primary malignant brain tumors. Int J Radiat Oncol Biol Phys. 2003;55:992–999.

Salo J, Niemela A, Joukamaa M, Koivukangas J. Effect of brain tumour laterality on patients’ perceived quality of life. J Neurol Neurosurg Psychiatry. 2002;72:373–377.

Walker M, Brown J, Brown K,, Gregor A, Whittle IR, Grant R. Practical problems with the collection and interpretation of serial quality of life assessments in patients with malignant glioma. J Neurooncol. 2003;63(2):179–186

Reijneveld JC, Klein M, Taphoorn MJ, Postma TJ, Heimans JJ. Improved, personalized treatment of glioma necessitates long‑term follow‑up of cognitive functioning. Pharmacogenomics. 2012;13(15):1667–9.

Taphoorn MJ, Stupp R, Coens C, Osoba D, Kortmann R, van den Bent MJ, et al. Health‑related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol. 2005;6(12):937–944.

Brada M, Hoang‑Xuan K, Rampling R, Dietrich PY, Dirix LY, Macdonald D, et al. Multicenter phase II trial of temozolomide in patients with glioblastoma multiforme at first relapse. Ann Oncol. 2001;12:259–266

Berger AM, Abernethy AP, Atkinson A, Barsevick AM, Breitbart WS, Cella D, et al. Cancer‑related fatigue. J Natl Compr Canc Netw. 2010;8(8):904–931.

Jones LW, Mourtzakis M, Peters KB, Friedman AH, West MJ, Mabe SK, et al. Changes in functional performance measures in adults undergoing chemoradiation for primary malignant glioma: a feasibility study. Oncologist. 2010;15(6):636–47.

Jones LW, Friedman AH, West MJ, Mabe SK, Fraser J, Kraus WE, et al. Quantitative assessment of cardiorespiratory fitness, skeletal muscle function, and body composition in adults with primary malignant glioma. Cancer. 2010;116(3):695–704.

Powell C, Guerrero D, Sardell S, Cumins S, Wharram B, Traish D, et al. Somnolence syndrome in patients receiving radical radiotherapy for primary brain tumours: a prospective study. Radiother Oncol. 2011;100(1):131–136.

Peters KB, West MJ, Hornsby WE, Waner E, Coan AD, McSherry F, et al. Impact of health‑related quality of life and fatigue on survival of recurrent high‑grade glioma patients. J Neurooncol. 2014;120(3):499–506.

Galvao DA, Newton RU. Review of exercise intervention studies in cancer patients. J Clin Oncol. 2005;23:899–909.

Thompson HJ, Wolfe P, McTiernan A, Jiang W, Zhu Z. Wheel running‑induced changes in plasma biomarkers and carcinogenic response in the 1-methyl-1-nitrosourea‑induced rat model for breast cancer. Cancer Prev Res (Phila) 2010;3(11):1484–1492.

Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment‑related complications after high dose chemotherapy. Blood. 1997;90:3390–3394.

Schmitz KH, Courneya KS, Matthews C, Demark‑Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42:1409–26.

Hansen A, Rosenbek Minet LK, Søgaard K, Jarden JO. The effect of an interdisciplinary rehabilitation intervention comparing HRQoL, symptom burden and physical function among patients with primary glioma: an RCT study protocol. BMJ Open. 2014;4(10):e005490.

Knols R, Aaronson NK, Uebelhart D, Fransen J, Aufdemkampe G. Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol. 2005;23:3830–3842.

Gomez‑Pinilla F, Hillman C. The influence of exercise on cognitive abilities. Compr Physiol. 2013;3(1):403–28.

Massa E, Madeddu C, Lusso MR, Gramignano G, Mantovani G. Evaluation of the effectiveness of treatment with erythropoietin on anaemia, cognitive functioning and functions studied by comprehensive geriatric assessment in elderly cancer patients with anaemia related to cancer chemotherapy. Crit Rev Oncol Hematol. 2006;57:175–82.

Zucchella C, Capone A, Codella V, De Nunzio AM, Vecchione C, Sandrini G. Cognitive rehabilitation for early post‑surgery inpatients affected by primary brain tumor: a randomized, controlled trial. J Neurooncol. 2013;114(1):93–100.

Gehring K, Sitskoorn MM, Gundy CM, Sikkes SA, Klein M, Postma TJ, et. al. Cognitive rehabilitation in patients with gliomas: a randomized, controlled trial. J Clin Oncol. 2009;27(22):3712–22.

Alvarez J, Meyer FL, Granoff DL, Lundy A.The effect of EEG biofeedback on reducing post cancer cognitive impairment. Integr Cancer Ther. 2013;12(6):475–87.

Yoon J, Chun MH, Lee SJ, Kim BR. Effect of virtual reality‑based rehabilitation on upper‑extremity function in patients with brain tumor: controlled trial. Am J Phys Med Rehabil. 2015;94(6):449–59.

Hojan K. Contemporary rehabilitation at cancer centres. Journal of Medical Science. 2014;2(83):156–160.

Kirshblum S, O’Dell MW, Ho C, Barr K. Rehabilitation of persons with central nervous system tumors. Cancer. 2001;92:1029–1038.

Giordana MT, Clara E. Functional rehabilitation and brain tumour patients. A review of outcome. Neurol Sci. 2006;27:240–244.

World Health Organization. International Classification of Functioning, Disability, and Health (ICF). Geneva: WHO, 2001.

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;31:1038–1055.

Dimeo F, Schwartz S, Fietz T, Wanjura T, Boning D, Thiel E. Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy. Support Care Cancer. 2003;11:623–628.

Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol. 2001;19:657–665.

Santiago‑Palma J, Payne R. Palliative Care and Rehabilitation. Cancer. 2001;92:1049–52.

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;107:537–544.

Korstjens I, Mesters I, Gijsen B, van den Borne B. Cancer patients’ view on rehabilitation and quality of life: a programme audit. Eur J Cancer Care (Engl) 2008;17:290–297.



  • There are currently no refbacks.

Copyright (c) 2016 Journal of Medical Science

Copyright 2018 by Journal of Medical Sciences