Neuro Oncology Therapy Update - PowerPoint Presentation

1. Neuro Oncology Therapy UpdateMarch 2019Cecily Moore – PhysiotherapistHelen Spear – Speech and Language TherapistHelen Marshall – Occupational Therapist

2. Current OT/PT Service Physiotherapy and SLT representative at neurooncology MDT meetingsIdentification of patients for prehab from MDT based on referral informationNeurooncology nurse specialist contacts therapist to assess in neurosurgery clinic if requiredPost operative therapy available on the wards

3. Prehab statistics 5 patients referred for prehab in 6/12 (4 brain, 1 spine).4 patients seen in clinic, 1 patient received telephone triageSLT sees patients pre-operatively for awake craniotomy with language mapping as requested by the neuro surgical teamOutcomes All patients received baseline assessment, although 2 patients unable to complete full assessment due to fatigue following neurosurgery clinic.2 patients given orthotics1 patient given a walking aid.1 patient referred to visual impairment team and given advice/education.3 patients referred to local community therapy teams for further assessment at home/provision of equipment for ADLs.

4. Prehab AssessmentBaseline cognitive assessmentBaseline physical assessmentBaseline speech and language assessmentEducation re neurological deficits and strategies to manage these deficits (e.g. how to manage sensory impairment)Education for family members of how to manage cognitive and behavioural impairmentsSignposting to support agenciesReferrals to community services including rapid response, rehabilitation teams, equipment prescriptionReferrals to orthoticsDiscussions with GPs and members of hospital neuro-oncology MDT re medical management of patients (e.g. seizure control)Education regarding preparation for surgeryAnxiety management

5. Pro’s/ Con’s PrehabPro’s Allows for more timely support services to be put in placeEnables therapists to establish if there have been any changes post opCan help increase the speed of discharge following surgeryCan help reduce anxiety of patient and their familiesCon’sPre-op clinic can be lengthy and thus fatiguing for the patient, hence engagement in therapy assessment at this time may not be considered a priority for the patient and they may not wish for assessment at this timeRelies on therapy staff being available

6. Post operative assessmentWard basedHolistic assessment of:Function Physical performanceCognition / communication / moodPhysio, OT, SLT, neuropsychology (on request)Anticipate needs on hospital dischargeHighlight areas of vulnerability Highlight areas of potential for improvement (could be remedial or compensatory)Identify patient and family awareness of condition, prognosis etc.Inform MDT of assessment outcomes to enable treatment decision making

7. Challenges Lack of robust pathway to ensure all patients that require prehab are referred and assessed prior to their operation dateInsufficient referrals to accurately interpret benefitLogistical complications with timely appointment bookings, transport, room availability, therapist availabilityQuick turnaround between being identified at MDT and the operation dateEmotional impact of diagnosis and preparation for surgery-increased length of time of appointments and interventions required Lack of inpatient 7 day service impacts LOS;Patients may opt not to have surgery.

8. MDT Reflections/SuggestionsHow many patients do you feel would benefit from prehab coming through the clinics? Consultants/ANPs to contact therapist directly from clinic if assessment required?(Depending on numbers this may require more funding) More discussion in MDT meeting to help identify appropriate patients?