For patients diagnosed with brain tumors and the physicians caring for them, survival is, understandably, the primary goal. But when an estimated 90 percent of brain tumor patients must cope with one or more significant functional, cognitive or psychological impairments as a result of their tumors, is just surviving good enough?
Doctors in the U-M Brain Tumor Program don’t think so. In a first-of-its-kind clinical model called the Functional Wellness Initiative, they are bringing together both the latest therapies to improve survival and the comprehensive portfolio of rehabilitation services patients need to help them maximize the quality of their lives.
The initiative targets adult patients with both malignant and benign brain tumors affecting language, motor, psychological and neurocognitive outcomes. It grew largely out of the experience of U-M neurosurgeon Shawn Hervey-Jumper, M.D. While training at another top institution, he began to see the need for an approach focusing not only on survival, but on helping brain tumor patients live fuller lives. His concept was to address functional and cognitive deficits as soon as possible while treating the tumor medically and surgically, and to streamline cross-discipline collaboration for more comprehensive treatment planning.
“Many patients face a complex mix of challenges as the result of their tumors,” says Hervey-Jumper. “In the past, separate evaluations were needed from each discipline before arriving at a treatment strategy. That meant burdening patients with multiple appointments, and making it more challenging for providers to coordinate their efforts. Here at Michigan, we’re now able to bring the experts together for the patient right from the start.”
The Functional Wellness team is anchored by Dr. Hervey-Jumper, whose clinical and research focus is on brain mapping and functional reorganization, neuro-oncologist Aaron Mammoser, M.D., who specializes in novel therapeutics to improve survival, Sean Smith, M.D., a physical medicine and rehabilitation physician specializing in improving the quality of life of cancer patients, Nicolette Gabel, Ph.D., a clinical neuro-psychologists who specializes in neurocognitive remediation, and Karen Kluin, M.S., a speech pathologist who specializes in perioperative language testing and rehabilitation. Thomas Ferguson, N.P. is the program’s clinical coordinator. Other faculty of the University of Michigan Brain Tumor Program Larry Junck, M.D., Oren Sagher, M.D., Jason Heth, M.D., and Daniel Orringer, M.D. are vital members of the Functional Wellness team.
Collaboration and coordination from day one
During their first appointment, patients will interact with a team of clinicians collaborating to provide all-inclusive, individualized care plans. The initial visit includes a baseline assessment of neurocognitive and motor functions, social structure and language capabilities and a review of imaging and prior oncological history. In consultation with a neurosurgeon and or neuro-oncologist, patients can discuss treatment options including surgery, chemotherapy, radiation therapy, anti-angiogenic options and clinical trials offered through the U-M Brain Tumor Program. On the same day, experts in a range of rehabilitative therapies will work with them to devise strategies to maximize and improve existing motor, language and cognitive function. Every aspect of the care plan is based on the unique needs, values and preferences of the patient and the family.
“This approach will allow us to provide a more individualized care experience,” says Mammoser. “Patients will be able to discuss their needs and concerns with all of their care providers at one time. By reducing the number of visits needed, we’re saving patients and families time and travel while enhancing their care experience.”
“We hope it will also lead to stronger collaborations with our patients’ referring physicians,” adds Hervey-Jumper. “They are integral members of the team that will help these patients face the ongoing challenges of maintaining a full, productive life.”
An enhanced platform for translational research
The Functional Wellness Initiative also expands opportunities for U-M brain tumor researchers from all the participating disciplines to translate their findings into the clinical setting. Several projects are currently underway, including:
- An examination of the neurocognitive and behavioral consequences of brain tumor treatment, and the impact of multidisciplinary remediation on survival, quality of life and healthcare costs.
- An examination of the effect of an early intervention exercise regimen on physical function, symptom burden and health-related quality of life among patients with low and high grade glioma.
- A study of the neurobiology of cognitive function in adult glioma patients.
To refer a patient to the Functional Wellness Initiative, contact Administrative Coordinator Kaitlin McMurray at 734-647-5434 or [email protected]. To speak with a physician in the U-M Brain Tumor Program, contact us through M-LINE, our 24/7 physician-to-physician portal, at 800-962-3555.