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Tran S, Lapidus A, Neal A, Peters KB, Gately L, Ameratunga M. A systematic review of the impact of brain tumours on risk of motor vehicle crashes. J Neurooncol 2024; 166:395-405. [PMID: 38321326 PMCID: PMC10876497 DOI: 10.1007/s11060-024-04586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Brain tumours are associated with neurocognitive impairments that are important for safe driving. Driving is vital to maintaining patient autonomy, despite this there is limited research on driving capacity amongst patients with brain tumours. The purpose of this review is to examine MVC risk in patients with brain tumours to inform development of clearer driving guidelines. METHODS A systematic review was performed using Medline and EMBASE. Observational studies were included. The outcome of interest was MVC or measured risk of MVC in patients with benign or malignant brain tumours. Descriptive analysis and synthesis without meta-analysis were used to summarise findings. A narrative review of driving guidelines from Australia, United Kingdom and Canada was completed. RESULTS Three studies were included in this review. One cohort study, one cross-sectional study and one case-control study were included (19,135 participants) across United States and Finland. One study evaluated the incidence of MVC in brain tumour patients, revealing no difference in MVC rates. Two studies measured MVC risk using driving simulation and cognitive testing. Patients found at higher risk of MVC had greater degrees of memory and visual attention impairments. However, predictive patient and tumour characteristics of MVC risk were heterogeneous across studies. Overall, driving guidelines had clear recommendations on selected conditions like seizures but were vague surrounding neurocognitive deficits. CONCLUSION Limited data exists regarding driving behaviour and MVC incidence in brain tumour patients. Existing guidelines inadequately address neurocognitive complexities in this group. Future studies evaluating real-world data is required to inform development of more applicable driving guidelines. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2023 CRD42023434608.
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Affiliation(s)
- Sophie Tran
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Adam Lapidus
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - Andrew Neal
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | | | - Lucy Gately
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute for Medical Research, The University of Melbourne, Melbourne, VIC, Australia
| | - Malaka Ameratunga
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia.
- Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Huuskonen M, Koistinen T, Sihvola N, Parkkari I, Palovaara S, Kytö V, Sipilä J, Jyrkkiö S, Heervä E. Controlled register‐based study of road traffic accidents in 12,651 Finnish cancer patients during 2013–2019. Cancer Med 2022; 12:7406-7413. [PMID: 36397273 PMCID: PMC10067070 DOI: 10.1002/cam4.5444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/14/2022] [Accepted: 11/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little controlled evidence exists on road traffic accident (RTA) risk among patients diagnosed with cancer, while clinicians are often requested to comment their ability to drive. The aim of this study was to evaluate RTA risk in a population-based cohort of cancer patients living in Southwest Finland. PATIENTS All adult patients diagnosed with cancer in 2013-2019 were included. Acute appendectomy/cholecystectomy and actinic keratosis patients without cancer were selected from the same region as the control cohort. Participants were cross-referenced to a national driving licence database, yielding 12,651 cancer and 6334 control patients with a valid licence. Due to marked differences in their clinical presentation, the cancer cohort was divided into nine cancers of interest (breast, prostate, colorectal, lung, melanoma, head & neck, primary brain tumours, gynaecological and haematological malignancies). The nationwide law-regulated motor liability insurance registry was searched for all RTAs leading to injury with claims paid to not- or at-fault participants. At-fault drivers were verified based on sex and birth year. RESULTS During a median follow-up of 34 months, 167 persons were at-fault drivers in RTAs leading to injury. Among the nine cancers of interest, RTA risk did not differ from the control cohort. Among cancer patients, multivariable regression suggested male sex and opioid use, but not advanced cancer stage or given systemic therapy, as the most influential risk factors for RTA. CONCLUSIONS Cancer diagnosis itself was not associated with increased RTA risk, but other associated symptoms, medications, comorbidities or specific cancer subgroups may.
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Affiliation(s)
- Marja‐Liisa Huuskonen
- Department of Traffic Medicine Turku University Hospital and University of Turku Turku Finland
| | | | | | - Inkeri Parkkari
- Finnish Transport and Communications Agency Traficom Helsinki Finland
| | - Sanna Palovaara
- Department of Oncology Turku University Hospital and University of Turku Turku Finland
| | - Ville Kytö
- Heart Centre Turku University Hospital and University of Turku Turku Finland
| | - Jussi Sipilä
- Department of Neurology Siun Sote, North Karelia Central Hospital Joensuu Finland
- Clinical Neurosciences Turku University Hospital and University of Turku Turku Finland
| | - Sirkku Jyrkkiö
- Department of Oncology Turku University Hospital and University of Turku Turku Finland
| | - Eetu Heervä
- Department of Oncology Turku University Hospital and University of Turku Turku Finland
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Estevis E, Noll KR, Bradshaw ME, Wefel JS. Driver safety in patients with primary brain tumors. Neurooncol Pract 2019; 6:490-498. [DOI: 10.1093/nop/npz014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors.
Methods
Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver’s Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome.
Results
Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome.
Conclusions
A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
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Affiliation(s)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Harris M, Gebski V. Re: Medical Oncology Group of Australia position statement and membership survey on voluntary assisted dying. Intern Med J 2018; 48:1414-1415. [PMID: 30387308 DOI: 10.1111/imj.14099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/15/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Marion Harris
- Department of Medical Oncology, Monash Health, Melbourne, Victoria, Australia
| | - Val Gebski
- Biostatistics and Research Methodology, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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To drive or not to drive, that is still the question: current challenges in driving recommendations for patients with brain tumours. J Neurooncol 2018; 137:379-385. [DOI: 10.1007/s11060-017-2727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/24/2017] [Indexed: 10/18/2022]
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Driving habits and behaviors of patients with brain tumors: a self-report, cognitive and driving simulation study. Sci Rep 2018; 8:4635. [PMID: 29545606 PMCID: PMC5854700 DOI: 10.1038/s41598-018-22937-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/05/2018] [Indexed: 01/13/2023] Open
Abstract
The purpose of the study is to determine driving habits and behaviors of patients with brain tumors in order to better inform discussions around driving safety in this population. Eight-four patients with brain tumors participated in a survey on their driving behaviors since their diagnosis. Thirteen of these patients and thirteen sex- and age-matched healthy controls participated in cognitive testing and several driving simulation scenarios in order to objectively assess driving performance. Survey responses demonstrated that patients with brain tumors engage in a variety of driving scenarios with little subjectve difficulty. On the driving simulation tasks, patients and healthy controls performed similarly except that patients had more speed exceedances (U = 41, p < 0.05) and a greater variability in speed (U = 57, p < 0.05). Performance on the selective attention component of the UFOV was significantly associated with greater total errors in the Bus Following task for patients with brain tumors compared to healthy controls (rs = 0.722, p < 0.05, CI [0.080, 0.957]). Better comprehensive driving assessments are needed to identify patients with driving behaviors that put themselves and others at risk on the road.
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Ranchet M, Akinwuntan AE, Tant M, Salch A, Neal E, Devos H. Fitness-to-drive agreements after stroke: medical versus practical recommendations. Eur J Neurol 2016; 23:1408-14. [DOI: 10.1111/ene.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 01/25/2023]
Affiliation(s)
- M. Ranchet
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - A. E. Akinwuntan
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
- Dean's Office; School of Health Professions; The University of Kansas Medical Center; Kansas City KS USA
| | - M. Tant
- CARA; Belgian Road Safety Institute; Brussels Belgium
| | - A. Salch
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - E. Neal
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - H. Devos
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
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Louie AV, Chan E, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Warner A, D'Souza DP. Assessing fitness to drive in brain tumour patients: a grey matter of law, ethics, and medicine. ACTA ACUST UNITED AC 2013; 20:90-6. [PMID: 23559871 DOI: 10.3747/co.20.1260] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive deficits from brain tumours may impair the ability to safely operate a motor vehicle. Although certain jurisdictions in Canada legally require that physicians report patients who are unfit to drive, criteria for determining fitness are not clearly defined for brain tumours. METHODS Patients receiving brain radiotherapy at our institution from January to June 2009 were identified using the Oncology Patient Information System. In addition to descriptive statistics, details of driving assessment were reviewed retrospectively. The Fisher exact test was used to determine factors predictive of reporting a patient to the Ontario Ministry of Transportation (mto) as unfit to drive. A logistic regression model was constructed to further determine factors predictive of reporting. RESULTS Of the 158 patients available for analysis, 48 (30%) were reported to the mto, and 64 (41%) were advised to stop driving. With respect to the 53 patients with seizures, a report was submitted to the mto for 30 (57%), and a documented discussion about the implications of driving was held with 35 (66%). On univariate analysis, younger age, a central nervous system primary, higher brain radiotherapy dose, unifocal disease, and the presence of seizures were predictive of physician reporting (p < 0.05). On logistic regression modelling, the presence of seizures (odds ratio: 3.9) and a higher radiotherapy dose (odds ratio: 1.3) remained predictive of reporting. INTERPRETATION Physicians frequently do not discuss the implications of driving with brain tumour patients or are not properly documenting such advice (or both). Clear and concise reporting guidelines need to be drafted given the legal, medical, and ethical concerns surrounding this public health issue.
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Affiliation(s)
- A V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, ON. ; Schulich School of Medicine and Dentistry, Western University, London, ON
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Field KM, Guyatt N, Fleet M, Rosenthal MA, Drummond K. Communicating with brain tumor patients about driving: are we falling short of the mark? Asia Pac J Clin Oncol 2013; 10:92-3. [PMID: 23551566 DOI: 10.1111/ajco.12071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kathryn M Field
- Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Chan E, Louie AV, Hanna M, Bauman GS, Fisher BJ, Palma DA, Rodrigues GB, Sathya A, D'Souza DP. Multidisciplinary assessment of fitness to drive in brain tumour patients in southwestern Ontario: a grey matter. ACTA ACUST UNITED AC 2013; 20:e4-e12. [PMID: 23443064 DOI: 10.3747/co.20.1198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neurocognitive impairments from brain tumours may interfere with the ability to drive safely. In 9 of 13 Canadian provinces and territories, physicians have a legal obligation to report patients who may be medically unfit to drive. To complicate matters, brain tumour patients are managed by a multidisciplinary team; the physician most responsible to make the report of unfitness is often not apparent. The objective of the present study was to determine the attitudes and reporting practices of physicians caring for these patients. METHODS A 17-question survey distributed to physicians managing brain tumour patients elicited Respondent demographicsKnowledge about legislative requirementsExperience of reportingBarriers and attitudes to reporting Fisher exact tests were performed to assess differences in responses between family physicians (fps) and specialists. RESULTS Of 467 physicians sent surveys, 194 responded (42%), among whom 81 (42%) were specialists and 113 (58%) were fps. Compared with the specialists, the fps were significantly less comfortable with reporting, less likely to consider reporting, less likely to have patients inquire about driving, and less likely to discuss driving implications. A lack of tools, concern for the patient-physician relationship, and a desire to preserve patient quality of life were the most commonly cited barriers in determining medical fitness of patients to drive. CONCLUSIONS Legal requirements to report medically unfit drivers put physicians in the difficult position of balancing patient autonomy and public safety. More comprehensive and definitive guidelines would be helpful in assisting physicians with this public health issue.
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Affiliation(s)
- E Chan
- Schulich School of Medicine and Dentistry, Western University, London, ON
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Louie AV, D'Souza DP, Palma DA, Bauman GS, Lock M, Fisher B, Patil N, Rodrigues GB. Fitness to drive in patients with brain tumours: the influence of mandatory reporting legislation on radiation oncologists in Canada. ACTA ACUST UNITED AC 2012; 19:e117-22. [PMID: 22670100 DOI: 10.3747/co.19.916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Certain jurisdictions in Canada legally require that physicians report unfit drivers. Physician attitudes and patterns of practice have yet to be evaluated in Canada for patients with brain tumours. METHODS We conducted a survey of 97 radiation oncologists, eliciting demographics, knowledge of reporting laws, and attitudes on reporting guidelines for unfit drivers. Eight scenarios with varying disability levels were presented to determine the likelihood of a patient being reported as unfit to drive. Statistical comparisons were made using the Fisher exact test. RESULTS Of physicians approached, 99% responded, and 97 physicians participated. Most respondents (87%) felt that laws in their province governing the reporting of medically unfit drivers were unclear. Of the responding physicians, 23 (24%) were unable to correctly identify whether their province had mandatory reporting legislation. Physicians from provinces without mandatory reporting legislation were significantly less likely to consider reporting patients to provincial authorities (p = 0.001), and for all clinical scenarios, the likelihood of reporting significantly depended on the physician's provincial legal obligations. CONCLUSIONS The presence of provincial legislation is of primary importance in determining whether physicians will report brain tumour patients to drivers' licensing authorities. In Canada, clear guidelines have to be developed to help in the assessment of whether brain tumour patients should drive.
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Affiliation(s)
- A V Louie
- Department of Radiation Oncology, London Regional Cancer Program, London, ON
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