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      CMET-47. CLINICAL EVALUATION OF FITNESS TO DRIVE IN PATIENTS WITH BRAIN METASTASES

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          Abstract

          INTRODUCTION

          Brain tumors can result in focal neurological and cognitive deficits which may impair the ability to drive. There are no evidence-based recommendations on driving restrictions for patients with brain metastases. Recommendations vary per practice, with extrapolation based on local driving and epilepsy laws. Occupational Therapy driving assessment (OTDA) may provide insight into limitations for this population.

          OBJECTIVE

          To determine whether clinical neurologic examination is sufficient to predict suitability to drive in patients with brain metastases.

          METHODS

          We assessed the concordance between Neurology assessment of suitability to drive (pass/fail) and OTDA in individuals with brain metastases. 40 subjects were prospectively enrolled. Neurooncology evaluation was performed as standard of care, including an interview and neurological examination. Subjects subsequently underwent OTDA during which a battery of objective measures of visual, cognitive and motor skills related to driving was administered.

          RESULTS

          Preliminary results from the first 29 patients included are reported. Mean age was 68 years. Lung was the primary location of the tumor in 62% cases. More patients in the group that failed OTDA had bilateral brain metastasis (77.3% vs 42.9%,p=0.0478). The sensitivity of the Neurology assessment to predict driving fitness compared to OTDA was 22.7% and the specificity 71.4%. The 22 patients who failed OTDA were more likely to fail on Vision Coach (81.8%), MOCA (68.2%) and Trail Making (50%) tests.

          DISCUSSION

          There was poor correlation between the assessment of suitability to drive by Neurology and the outcome of the OTDA in patients with brain metastases. Subtle deficits that may impair the ability to drive safely may not be evident on neurologic examination. The Vision Coach, MOCA and Trail Making tests were the most sensitive tests to predict driver safety. The results raise questions about the choice of assessments in making recommendations about fitness to drive in people with brain metastases.

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          Author and article information

          Journal
          Neuro Oncol
          Neuro-oncology
          neuonc
          Neuro-Oncology
          Oxford University Press (US )
          1522-8517
          1523-5866
          November 2018
          05 November 2018
          : 20
          : Suppl 6 , Abstracts from the 23rd Annual Scientific Meeting and Education Day of the Society for Neuro-Oncology November 15 – 18, 2018 New Orleans, Louisiana
          : vi63
          Affiliations
          [1 ]Mayo Clinic Arizona, Scottsdale, AZ, USA
          [2 ]Mayo Clinic Arizona, Phoenix, AZ, USA
          [3 ]Department of Neurology, Mayo Clinic, AZ, Phoenix, AZ, USA
          [4 ]Mayo Clinic, Department of Neurology and Neurosurgery, Mathematical Neuro-Oncology Lab, Precision Neurotherapeutics Innovation Program, Phoenix, AZ, USA
          Article
          PMC6217027 PMC6217027 6217027 noy148.256
          10.1093/neuonc/noy148.256
          6217027
          22b958e9-83fd-4341-b262-65f0828442f7
          © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

          This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

          History
          Page count
          Pages: 1
          Categories
          Abstracts
          CNS Metastasis

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