Driving safety in patients with primary brain tumours and brain metastases in Canada: a scoping review.

Abstract

Background: Driving engages cognitive, sensory, motor, and visual functions, all of which may become compromised in patients with brain tumours or brain metastases. Many of these diagnoses are incurable and clinically dynamic, which poses added risk to safety on the road. While driving restrictions are essential for public safety, they may reduce patient independence and quality of life, particularly in palliative contexts. In Canada, no tumour-specific national guidelines exist, highlighting the need for a multidisciplinary framework that balances patient well-being and public safety.

Methods: A scoping review was conducted using Medline, American Psychological Association (APA) PsycInfo, and Google Scholar to identify studies examining driving safety, licensing outcomes, fitness-to-drive assessments, or the impact of driving restrictions among patients with primary brain tumours or brain metastases. Canadian national and provincial driving policies were further reviewed and compared with international guidelines. Findings were synthesized to identify determinants of driving safety and gaps in current regulatory frameworks.

Results: One hundred and seventy-five studies were initially screened and 13 met the inclusion criteria. Simulation-based and standardized driving assessments demonstrated that deficits in attention, executive function, visuomotor coordination, and visual processing were associated with impaired driving performance, even among patients with preserved functional status. Canadian guidance remains largely seizure-focused and defers to physician discretion, with limited incorporation of structured cognitive or functional assessment pathways. Canadian surveys revealed low physician confidence, limited awareness of existing resources, and variability in reporting practice. In contrast, international frameworks such as the United Kingdom Driver & Vehicle Licensing Agency provide tumour- and treatment-specific timelines, while Austroads emphasizes function-based assessment similar to Canada.

Conclusions: Driving fitness assessment in patients with brain tumour is inconsistent in Canada, shaped by reliance on seizure history, heterogeneous provincial legislation, and lack of tumour-specific standards. Evidence supports a multidisciplinary, function-focused approach to driving fitness assessment that incorporates structured evaluation with ongoing reassessment. Development of national, brain-tumour specific guidelines is needed to ensure clear and safe decision-making for this patient population.