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neuroreha 2022; 14(03): 136-141
DOI: 10.1055/a-1891-1966
Originalarbeit

Neurorehabilitation zerebraler Gliome: Implikationen für die soziale und berufliche Integration

Neurorehabilitation of Cerebral Gliomas: Implications for Social and Occupational Integration
B. Bujan
1   Fachklinik für Neurologie, MediClin Reha-Zentrum Bad Orb
2   Klinik Lengg, Neurorehabilitation Zürich
,
P. Ziecina
3   Military Institute of Medicine in Warsaw
,
E. Ginzburg
1   Fachklinik für Neurologie, MediClin Reha-Zentrum Bad Orb
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Zusammenfassung

Die glialen Tumoren gehören zu den häufigsten primären Tumoren des zentralen Nervensystems und weisen ein variables biologisches und klinisches Verhalten abhängig vom Malignitätsgrad (WHO-Grad) auf. Im Rahmen einer retrospektiven Studie wurden 350 Patienten mit der Diagnose zerebrale Gliome im Alter zwischen 22 und 84 Jahren rekrutiert, die in der Klinik für Neurologie des Reha-Zentrums Bad Orb stationär behandelt wurden. In die Studie eingeschlossen wurden alle Patienten mit histologisch gesicherten zerebralen Gliomen und vorliegender Graduierung der Malignität nach der WHO-Klassifikation (n=333). Unsere retrospektive Analyse legte nahe, dass der höhere Malignitätsgrad (WHO-Grad III und IV bei 86% der Patienten mit Leistungseinschränkungen), das Alter (56,4±3,46; p≤0,005 vs. 48,3±1,53; p≤0,005) sowie kognitive Defizite (71% der Patienten mit Leistungseinschränkungen) prognostisch als entscheidende limitierende Faktoren für die erfolgreiche berufliche Integration sowie die Aufrechterhaltung von Alltagskompetenzen zu identifizieren sind. Diese Arbeit trägt zu einem besseren Verständnis der Komplexität neuroonkologischer und sozialmedizinischer Versorgung im Rahmen der stationären Neurorehabilitation bei. Die Analyse und unsere Erfahrung zeigen, dass die zeitnahe Beurteilung der umweltbezogenen Kontextfaktoren, der psychosozialen Krankheitsfolgen sowie der Leistungsfähigkeit und Alltagskompetenzen enorm wichtig für die langfristige, erfolgreiche neuroonkologische Betreuung ist.

Abstract

Gliomas are among the most frequent primary brain tumors. Treatment expenses, early retirement and need of long-term care result in rising public healthcare expenditures. This retrospective study includes 333 patients with a histological confirmed diagnosis of cerebral gliomas according to the WHO-classification, who underwent a rehabilitation therapy in the Neurology Department of Clinic Bad Orb, Bad Orb, Germany. Higher age (56,4±3,46; p≤0,005 vs. 48,3±1,53; p≤0,005), glioma malignancy (WHO III and IV in 86% of disabled patients) and cognitive limitations (71% of disabled patients) were identified as risk factors for limitations with respect to activities of everyday life and occupational reintegration. Not only do standardised concepts of care improve the quality of patient-centred care, but they also help to minimize consequential costs. Their implementation requires profound knowledge of therapeutic strategies and sociomedical regulations. Medical treatment and sociomedical care have to be regularly reevaluated and adapted to the patient’s needs and disease severity. An optimal concept of therapy ensures the patients’ long-term social integration and improves compliance and occupational integration.

Schlüsselwörter

Zerebrale Gliome - Integration - Neurorehabilitation

Key words

gliomas - integration - neurorehabilitation


Publication History

Article published online:
09 September 2022

© 2022. Thieme. All rights reserved.

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  • Literatur

  • 1 McNeill KA. Epidemiology of brain tumors. Neurol Clin 2016; 34: 981-998
    CrossrefPubMedGoogle Scholar
  • 2 Ostrom QT. et al. The epidemiology of glioma in adults: A „state of the science“ review. Neuro Oncol 2014; 16: 896-913
    CrossrefPubMedGoogle Scholar
  • 3 Vargo M, Henriksson R, Salander P. Rehabilitation of patients with glioma. Handb Clin Neurol 2016; 134: 287-304
    CrossrefPubMedGoogle Scholar
  • 4 Weller M, Le Rhun E, Preusser M. et al. How we treat glioblastoma. ESMO Open 2019; 4: e000520
    CrossrefPubMedGoogle Scholar
  • 5 Le Rhun E. et al. Molecular targeted therapy of glioblastoma. Cancer Treat Rev 2019; 80: 101896 DOI: 10.1016/j.ctrv.2019.101896.
    CrossrefPubMedGoogle Scholar
  • 6 Wick A. et al. Superiority of temozolomide over radiotherapy for elderly patients with RTK II methylation class, MGMT promoter-methylated malignant astrocytoma. Neuro Oncol 2020; 22: 1162-1172 DOI: 10.1093/neuonc/noaa033.
    CrossrefPubMedGoogle Scholar
  • 7 Steinbach JP. et al. Surviving glioblastoma for more than 5 years: The patient’s perspective. Neurology 2006; 66: 239-242
    CrossrefPubMedGoogle Scholar
  • 8 Hertler C. et al. End-of-life care for glioma patients: The caregivers’ perspective. J Neurooncol 2020; 147: 663-669
    CrossrefPubMedGoogle Scholar
  • 9 Roberts PS. et al. The impact of inpatient rehabilitation on function and survival of newly diagnosed patients with glioblastoma. PM R 2014; 6: 514-521
    CrossrefPubMedGoogle Scholar
  • 10 Greenberg E, Treger I, Ring H. Rehabilitation outcomes in patients with brain tumors and acute stroke: Comparative study of inpatient rehabilitation. Am J Phys Med Rehabil 2006; 85: 568-573
    CrossrefPubMedGoogle Scholar
  • 11 Russell B. et al. Living longer with adult high-grade glioma: Setting a research agenda for patients and their caregivers. J Neurooncol 2014; 120: 1-10
    CrossrefPubMedGoogle Scholar
  • 12 Brown TJ. et al. Management of low-grade glioma: A systematic review and meta-analysis. Neurooncol Pract 2019; 6: 249-258
    PubMedGoogle Scholar
  • 13 Aprile I. et al. Occurrence and predictors of the fatigue in high-grade glioma patients. Neurol Sci 2015; 36: 1363-1369
    CrossrefPubMedGoogle Scholar
  • 14 Bartolo M. et al. Improving neuro-oncological patients care: Basic and practical concepts for nurse specialist in neuro-rehabilitation. J Exp Clin Cancer Res 2012; 31: 82
    CrossrefPubMedGoogle Scholar
  • 15 Gehring K. et al. Predictors of neuropsychological improvement following cognitive rehabilitation in patients with gliomas. J Int Neuropsychol Soc 2011; 17: 256-266
    CrossrefPubMedGoogle Scholar
  • 16 Sterckx W. et al. The impact of a high-grade glioma on everyday life: A systematic review from the patient's and caregiver’s perspective. Eur J Oncol Nurs 2013; 17: 107-117
    CrossrefPubMedGoogle Scholar
  • 17 Khan F. et al. Effectiveness of integrated multidisciplinary rehabilitation in primary brain cancer survivors in an Australian community cohort: A controlled clinical trial. J Rehabil Med 2014; 46: 754-760
    CrossrefPubMedGoogle Scholar
  • 18 Piil K. et al. Controlled rehabilitative and supportive care intervention trials in patients with high-grade gliomas and their caregivers: A systematic review. BMJ Support Palliat Care 2016; 6: 27-34
    CrossrefPubMedGoogle Scholar
  • 19 Taphoorn MJ. et al. Assessment of quality of life in patients treated for low-grade glioma: A preliminary report. J Neurol Neurosurg Psychiatry 1992; 55: 372-376
    CrossrefPubMedGoogle Scholar
  • 20 Seidel C. et al. Does age matter? A MRI study on peritumoral edema in newly diagnosed primary glioblastoma. BMC Cancer 2011; 11: 127
    CrossrefPubMedGoogle Scholar
  • 21 Eisele G. et al. Complementary and alternative medicine use by glioma patients in Switzerland. Neurooncol Pract 2019; 6: 237-244
    PubMedGoogle Scholar
  • 22 Mukand JA. et al. Incidence of neurologic deficits and rehabilitation of patients with brain tumors. Am J Phys Med Rehabil 2001; 80: 346-350
    CrossrefPubMedGoogle Scholar