Neurocognitive testing along with a road test or simulated driving test are the best approach to gauging whether palliative care patients can drive safely, according to a new review.

"Palliative care patients should be counselled about driving because there is a proportion that may perform poorly on these measures of driving ability, and they may be at increased risk of road-traffic incidents," Dr. Mark Howard of St. Francis Hospice in Romford, UK, told Reuters Health.

Neurocognitive test

"At present, there is insufficient evidence to recommend a particular neurocognitive test (or battery of tests) to screen a patient group that would be cared for by specialist palliative care services," Howard and Dr. Christina Ramsenthaler of Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation in Brixton, U.K., write.

"However, in this review, impairment in divided attention has shown association with road test or simulated driving scores in MS, heart failure and Huntington's disease patients," they add in their paper, online December 6 in BMJ Supportive & Palliative Care.

Palliative-care patients have "progressive incurable illnesses, comorbidities and medications to manage their symptoms," raising concerns about whether they should continue to drive, the authors note.

They reviewed 14 articles, including six in patients with multiple sclerosis, four in Huntington's disease patients, and the rest in patients with heart failure, chronic obstructive pulmonary disease (COPD), interstitial lung disease or cancer.

Thirteen of the studies found significant differences in road-test and simulated driving scores between palliative-care patients and controls. Nine found a correlation between driving safety and tests of divided attention. From 19%-47% of patients with MS or Huntington's disease failed a road test or simulated driving test.

"We currently have very little evidence about the driving ability of cancer patients. This gap in the research literature was therefore disappointing," Howard said. "Where I work, about 85% of our patients have a diagnosis of metastatic cancer, and the research findings do not fully represent that proportion."

He added: "There is clarity on how to approach a situation where a patient's cancer that has spread to their brain, but it is not clear about patients with widespread cancer not involving their brain, such as in their bones, liver and lungs. We do not have any data on how many patients in this situation continue to drive."

When patients do wish to keep driving, Howard said, "extra care must be taken to ensure that the treatments (such as pain medications or sedatives) are not compromising this ability. There is guidance from the licensing authority that we adhere to, but this does not always cover the patient we see in front of us."