Physiotherapists’ perspectives on physiotherapy during and/or after (chemo)radiotherapy for glioma: a qualitative study

A glioma is a type of tumor that grows within the brain. Unlike many other cancers that might be treated with a single surgery or a course of medication, gliomas often require a complex sequence of care. Patients frequently undergo surgery to remove as much of the tumor as possible, followed by a combination of chemotherapy and radiation therapy to target remaining cells. This treatment process is grueling. It can leave patients with physical weaknesses, such as trouble walking or balancing, as well as cognitive challenges like memory loss or difficulty concentrating. The side effects of the medication and the tumor itself can also cause extreme fatigue. For many, the goal of treatment is not just to survive, but to maintain the ability to live independently, to walk to the bathroom, or to play with a grandchild. Physical therapists are the specialists who help people regain these abilities, yet for patients with gliomas, there has been no clear roadmap to guide them.

Until now, physical therapists working with these patients have had to navigate a difficult path without specific instructions. Standard exercise programs designed for other cancer patients often do not account for the unique neurological damage caused by brain tumors, while programs for stroke patients do not address the specific fatigue and side effects of cancer treatment. To bridge this gap, a team of researchers in the Netherlands set out to listen to the experts on the front lines. They interviewed ten physical therapists who specialize in either cancer care or brain disorders. These therapists had each treated at least four patients with gliomas. The goal was simple: to understand what these therapists see, what they struggle with, and what they believe patients truly need during and after their treatment.

The interviews revealed that every patient presents a different puzzle. The symptoms depend heavily on where the tumor is located in the brain. A tumor in one area might cause balance issues, while another might affect speech or personality. High-grade tumors, which grow quickly and spread into surrounding tissue, often cause severe problems, whereas lower-grade tumors might cause milder, more specific issues. Beyond the tumor itself, the treatment adds another layer of complexity. Radiation and chemotherapy can make patients feel incredibly tired, and medications used to control seizures or reduce brain swelling can alter a patient's energy levels or even their sense of their own physical limits. Some patients might feel hyperactive and overestimate their strength, while others might feel too weak to move. This variability means that a single, standard exercise plan cannot work for everyone.

The therapists also highlighted the heavy emotional and psychological weight these patients carry. A diagnosis of a brain tumor often strips away a person's ability to work or care for their family, leading to a loss of identity and deep grief. This emotional burden can make physical therapy difficult. A patient who is overwhelmed by sadness or in denial about their condition may struggle to engage in exercises, even if they physically could. The therapists noted that they must be skilled not just in moving bodies, but in supporting minds. They need to know how to talk to someone who is grieving, how to explain why a partner's personality might have changed, and how to keep a patient motivated when the road ahead seems uncertain.

Despite these challenges, the therapists found that patients have very clear and practical goals. Most want to return home and live as independently as possible. They need to be able to get out of bed, walk up stairs, and manage daily tasks without help. To achieve this, the therapy must be tailored to the individual's current capacity. During the intense phase of radiation and chemotherapy, the focus often shifts from building new strength to simply maintaining what the patient has. The therapists emphasized that staying active during this time is crucial, even if the intensity is low. It helps patients cope better with the treatment and prevents their muscles from wasting away too quickly. However, the schedule of hospital visits and the sheer exhaustion of the treatment often make it hard for patients to attend regular therapy sessions.

The study suggests that the most effective care comes from a therapist who understands both the brain and the cancer. A specialist in cancer might know how to manage fatigue but lack the skills to handle a patient with paralysis or balance issues. Conversely, a specialist in brain disorders might not fully grasp the specific side effects of chemotherapy. The therapists interviewed argued that the ideal practitioner needs a blend of both skill sets. They also stressed the importance of safety. Because some patients are at risk of having seizures, therapy sessions must be conducted in a safe environment, sometimes with a nurse nearby or with the patient in a wheelchair to prevent falls. Communication is also key; instructions must be short, clear, and repeated, as memory problems can make it hard for patients to remember what to do.

The researchers found that when therapy is done correctly, it makes a tangible difference. Patients can regain confidence in their ability to move. They might not walk far, but walking twenty meters with a walker can be a significant victory that restores a sense of independence. Therapy helps prevent complications like bedsores and pneumonia in the later stages of the disease. It also helps patients and their families understand the changes happening in the brain, turning fear into understanding. The study concludes that there is no one-size-fits-all solution. Instead, successful physical therapy for glioma patients requires a personalized approach that weaves together neurological expertise and oncological knowledge, adapting constantly to the patient's changing needs and the harsh realities of their treatment.