Fitness-to-drive for glioblastoma patients: Guidance from the Swiss Neuro-Oncology Society (SwissNOS) and the Swiss Society for Legal Medicine (SGRM).
Résumé
OBJECTIVE:The management of brain tumour patientswho would like to resume driving is complex, and needsmultidisciplinary input and a consensus among treatingphysicians. The Swiss Neuro-Oncology Society (Swiss-NOS) and the Swiss Society for Legal Medicine (SGRM)aim to provide guidance on how to assess “fitness-to-dri-ve” of glioblastoma patients and to harmonise the relevantprocedures in Switzerland.METHODS:At several meetings, Swiss neuro-oncologistsdiscussed common practices on how to advise patientswith a stable, i.e., non-progressive, glioblastoma, whowish to resume driving after the initial standard tumourtreatment. All participants of the SwissNOS meetings wereinvited twice to return a questionnaire (modified Delphiprocess) on specific tools/procedures they commonly useto assess “fitness-to-drive” of their patients. Answers wereanalysed to formulate a tentative consensus for a struc-tured and reasonable approach.RESULTS:Consensus on minimum requirements for a“fitness-to-drive”programme for glioblastoma patientscould be reached among Swiss neuro-oncologists. Therecommendations were based on existing guidelines andexpert opinions regarding patients with seizures, visualdisturbances, cognitive impairment or focal deficits forsafe driving. At this point in time, the Swiss neuro-oncol-ogists agreed on the following requirements for glioblas-toma patients after the initial standard therapy and withouta seizure for at least 12 months: (1) stable cranial mag-netic resonance imaging (MRI) according to ResponseAssessment in Neuro-Oncology (RANO) criteria, to berepeated every 3 months; (2) thorough medical history, in-cluding current or new medication, a comprehensive neu-rological examination at baseline (T0) and every 3 monthsthereafter, optionally an electrocencephalogram (EEG) atbaseline; (3) ophthalmological examination including visu-al acuity and intact visual fields; and (4) optional neuropsy-chological assessment with a focus on safe driving. Testresults have to be compatible with safe driving at any time-point. Patients should be informed about test results andoptionally sign a document.CONCLUSIONS:We propose regular thorough clinicalneurological examination and brain MRI, optional EEG,neuropsychological and visual assessments to confirm “fit-ness-to-drive” for glioblastoma patients after initial tumour-directed therapy. The proposed “fitness-to-drive” assess-ments for glioblastoma patients serves as the basis for a prospective Swiss Pilot Project GLIODRIVE (BASEC Pro-jectID 2020-00365) to test feasibility, adherence and safe-ty in a structured manner for patients who wish to resumedriving. Research will focus on confirming the usefulnessof the proposed tools in predicting “fitness-to-drive” andmatch results with events obtained from the road trafficregistry (Strassenverkehrsamt).
Domaines
Sciences du Vivant [q-bio]Origine | Fichiers éditeurs autorisés sur une archive ouverte |
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