Patients with primary and metastatic brain tumours achieved functional gains after rehabilitation. High functional improvement is a significant predictor of longer survival in brain metastases and GBM. This study has implications for rehabilitation in the post-acute management of patients who have disabilities due to brain tumours.

Background: As more evidence emerges to support the incorporation of exercise for cancer survivors to positively affect physical, emotional, and social health, it is imperative that health-care providers use current knowledge to develop evidence-based exercise programs for these patients. Our purpose is to describe the development, implementation, and effectiveness of the CanWell program, an evidence-based, community and partnership-based, exercise, and education program for all people with cancer.Methods: Exercise and cancer research was reviewed, summarized, and utilized to develop CanWell. A 12-week, supervised, community-based, exercise, and education program established in collaboration between an acute care hospital, academic center, and a not-for-profit YMCA facility. CanWell participants completed physical and health-related quality of life measures prior to initiating the program and repeated them at 6 and 12 weeks.Results: Following the exercise program, participants reported significant improvements in healthrelated quality of life, recorded distance ambulated during a 6-min walk test, and total minutes on a treadmill recorded using the standardized exponential exercise protocol treadmill test. Furthermore, no increases in disease burden were identified using the Edmonton Symptom Assessment System. In addition, no exercise related injuries were reported by CanWell participants.Conclusions: As the body of evidence supporting the incorporation of exercise as a standard of care for cancer survivors, it is imperative that care providers use current knowledge to provide opportunities for their patients to exercise in effective exercise programs. CanWell is an example on how collaboration between hospital, university, and community institutions can be used to move research into practice and meet the needs of cancer survivors.

Study design: Retrospective, descriptive study. Objective: To determine if patients with metastatic spinal cord compression (MSCC) make significant functional gains through rehabilitation. To study survival and predictors of survival in MSCC. To explore predictive factors for high or low functional gains in MSCC. Setting: Inpatient neuro-oncology rehabilitation ward, Henderson General Hospital, Hamilton, Canada. Methods: Clinical records were examined for 63 inpatients with MSCC. Demographics, treatment of MSCC, length of rehabilitation, admission, and discharge Functional Independence Measure (FIM) scores, Tokuhashi score and survival data were collected. Statistical analyses included nonparametric comparisons, Kaplan-Meier analyses, Cox regression, and exploratory logistic regression. Results: FIM score improved from 83 to 102 (Po0.0001). Estimated median survival from time of rehabilitation was 10.0 months. Kaplan-Meier analysis showed longer survival in patients with high Tokuhashi scores (9-15) compared to low scores (0-8) (Po0.005); and high FIM change (413) compared to low FIM change (p13) (Po0.02). Cox regression revealed that high FIM gain and high Tokuhashi score were prognostic factors. Logistic regression showed Tokuhashi score (odds ratio (OR) ¼ 1.30, 95% confidence interval (CI) ¼ 1.04-1.62) and length of rehabilitation (OR ¼ 1.04, 95% confidence interval (CI) ¼ 1.01-1.07) were associated with high FIM gain. Conclusions: Rehabilitation improves functional outcomes in MSCC. Patients who had a high Tokuhashi score and achieved high functional gains after rehabilitation had longer survival. Tokuhashi score and length of rehabilitation were associated with high FIM gain. The Tokuhashi score can help identify patients with good prognosis and potential for improvement during rehabilitation.

Cancer survivors participating in supervised exercise programs learn to exercise safely with oversight from care providers who monitor and facilitate their progress. This study investigated the long-term exercise participation levels and identified exercise barriers for graduates from a specialized cancer exercise and education program. Subjects were graduates from a 12-week supervised exercise program (www.canwellprogram.ca) who participated in a, prospective, long-term evaluation. Measures included: six-minute walk test (6-MWT), STEEP treadmill test, Functional Assessment Cancer Therapy-General (FACT-G), Edmonton Symptom Assessment System (ESAS), Godin Leisure-Time Exercise Questionnaire, and exercise barriers survey. Analysis was performed using the paired t -test. Fifty-seven (55% of eligible cohort) CanWell participants (mean age= 60; 74% females) were included in this study. Post program changes included statistically significant reductions in total min on the treadmill and a trend towards improvements in 6-MWT distance. No significant changes were recorded in total FACT-G or ESAS score, however functional well-being approached statistical significant improvements. The most commonly reported exercise barriers included fatigue, cost, and return to work. While most participants (86%) believed they were able to exercise, only 63% reported being able to progress their exercise. These finding demonstrated that although CanWell graduates have substantial support from exercise specialists and most have early success with exercise, environment-related factors diminish long-term independent adherence to exercise. Providing cancer survivors with the skills needed to monitor and progress their exercise routines, or access to “tune-ups” may increase exercise adherence and maximize benefits.