Applying a Biopsychosocial Perspective to Investigate Factors Related to Emotional Adjustment and Quality of Life for Individuals With Brain Tumour

The relationship between social determinants of health and neurocognitive and mood-related symptoms in the primary brain tumor population: A systematic review

Social determinants of health (SDOH) impact cancer-related health outcomes, including survival, but their impact on symptoms is less understood among the primary brain tumor (PBT) population. We conducted a systematic review to examine the relationships between SDOH and neurocognitive and mood-related symptoms among the PBT population. PubMed, EMBASE, and CINAHL were searched using PROGRESS criteria (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital) on March 8th, 2022. Two individuals screened and assessed study quality using the NHLBI Assessment Tool for Observational Cohort and Cross-sectional Studies. Of 3006 abstracts identified, 150 full-text articles were assessed, and 48 were included for a total sample of 28 454 study participants. Twenty-two studies examined 1 SDOH; none examined all 8. Four studies measured place of residence, 2 race/ethnicity, 13 occupation, 42 gender, 1 religion, 18 education, 4 socioeconomic status, and 15 social capital. Fifteen studies assessed neurocognitive and 37 mood-related symptoms. While higher education was associated with less neurocognitive symptoms, and among individuals with meningioma sustained unemployment after surgery was associated with depressive symptoms, results were otherwise disparate among SDOH and symptoms. Most studies were descriptive or exploratory, lacking comprehensive inclusion of SDOH. Standardizing SDOH collection, reducing bias, and recruiting diverse samples are recommended in future interventions.

Daily functioning in glioma survivors: associations with cognitive function, psychological factors and quality of life

Aim: Understanding and supporting quality of life (QoL) and daily functioning in glioma patients is a clinical imperative. In this study, we examined the relationship between cognition, psychological factors, measures of health-related QoL and functioning in glioma survivors. Materials & methods: We examined neuropsychological, self-reported cognition, mood and QoL correlates of work and non-work-related daily functioning in 23 glioma survivors, and carried out linear models of the best predictors. Results & conclusion: A total of 13/23 participants were working at the time of enrollment. The best model for worse work-related functioning (R2 = .83) included worse self-reported cognitive function, depression, loneliness and brain tumor symptoms. The best model for worse non-work-related functioning (R2 = .61) included worse self-reported cognitive functioning, anxiety, sleep disturbance and physical functioning. Neuropsychological variables were not among the most highly correlated with function. Worse cognitive, particularly self-reported and psychosocial outcomes may compromise optimal functioning in glioma survivors.

Mental time travel in patients "cured" from primary central nervous system lymphoma

Introduction: Significant advances in neuro-oncological treatment led to considering neurocognitive functioning and everyday functional needs in patients with long-term survival. Since a potentially lethal disease interrupts normal life and represents a threat to physical and psychological integrity, patients have to cope with the new challenges. Long-term survival and even "cure" is possible in primary central nervous system lymphoma (PCNSL), however, suffering from a life-threatening disease may affect patients´ cognitive processing of past and future (i.e., the generation of personal past memories and generation of personal future events). Therefore, the present study aimed to assess how PCNSL long-term survivors remember their past and anticipate their future.Methods: Recall of past and anticipation of future events (i.e., mental time travel), both positive and negative, was assessed in 39 PCNSL patients with ongoing complete remission to therapy for at least 1 year in an adapted verbal fluency paradigm. A group of 39 healthy controls matched for age, gender and education was assessed with the same paradigm evaluating retrospective and prospective cognitions.Results: Concerning the generation of personal future events PCNSL patients anticipated significantly fewer negative events for the distant future as compared to healthy controls. At trend level, patients also reported fewer negative events regarding their recent past.Conclusions: The results provide support for an altered generation of personal future events (i.e., future-directed assumptions) in PCNSL patients with ongoing complete remission. Being "cured" after experiencing a threat to life might induce cognitive reappraisal processes and lead people to reexamine their priorities and principles in life, resulting in a less negative evaluation of (future) life (i.e., "optimism bias") after facing death. Clinicians should be aware of these possible cognitive and affective processes and of chronic psychological disturbances in cancer survivors. Possible adaptive strategies ought to be promoted in supportive (neuro)psychological therapy.

The interplay between emotion regulation, emotional well-being, and cognitive functioning in brain tumor patients and their caregivers: An exploratory study

OBJECTIVE

Brain tumor patients may suffer from a range of health-impairing problems reducing their quality of life. To identify potential targets for interventions, we examined the influence of different emotion regulation strategies on affective and cognitive functioning as indices of quality of life in patients and their caregivers in the early phase of treatment.

METHODS

To this end, we conducted an exploratory longitudinal study on a small cohort, measuring emotion regulation, emotional well-being, and cognitive functioning on the day before each patient's tumor resection (28 patients and 11 caregivers) and several months after neurosurgery (22 patients and 10 caregivers).

RESULTS

Results showed that emotion regulation strategies are relatively stable from preoperative to postoperative assessment. Nevertheless, several associations between emotion regulation strategies and quality of life indices were evident after tumor resection. In particular, our results were largely in line with previous research findings in healthy and other patient populations, corroborating the adaptive character of cognitive reappraisal, whereas suppression and expression of emotions were related to reduced cognitive and affective functioning, respectively.

CONCLUSIONS

Based on these results, we suggest that further intervention or qualitative studies explore whether therapeutic interventions directed toward mastery of cognitive reappraisal techniques and appropriate expression of emotions could lead to improved long-term adjustment among brain tumor patients and their caregivers.

Subjective cognitive functioning and associations with psychological distress in adult brain tumour survivors

PURPOSE

The impact of brain tumour on subjective cognitive function (SCF) has received little attention despite the implications of these perceptions for quality of life. SCF consists of two related yet distinct components, perceived cognitive impairment (PCI) and perceived cognitive abilities (PCA). This study compared the SCF of adult brain tumour survivors and healthy controls and examined demographic, illness-related, and psychological factors associated with SCF.

METHOD

Sixty-five adult survivors with primary brain tumour (age, 22-75 years), and 65 age- and sex-matched controls were recruited. Participants with brain tumour completed the Brief Test of Adult Cognition by Telephone, Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), ratings of physical symptoms, Depression Scale of the Depression Anxiety Stress Scales-21 (DASS-Depression), and Generalized Anxiety Disorder-7 (GAD-7) scale. Controls completed the FACT-Cog, DASS-Depression, and GAD-7.

RESULTS

Adult brain tumour survivors reported significantly greater PCI and lower PCA than controls, after accounting for anxiety. Higher PCI was significantly related to fatigue, pain, treatment-related side-effects, anxiety, and depression. Lower PCA was significantly associated with fatigue, pain, poorer objective cognitive function, lower education, anxiety, and depression. Anxiety uniquely accounted for 9-14% of variance in SCF.

CONCLUSIONS

Adult brain tumour survivors were found to experience poorer SCF than healthy controls after accounting for anxiety. SCF was related to multiple factors after brain tumour; however, an independent association with anxiety was identified.

IMPLICATIONS FOR CANCER SURVIVORS

These findings highlight the potential value of psychological interventions targeting anxiety and cognitive effects to improve quality of survivorship after brain tumour.

Coping with the Unthinkable: Psychosocial Advances in the Management of Primary Brain Tumour

Brain cancer is a complex and distressing illness with a typically poor prospect for survival. Worldwide, approximately 256,000 people (1800 in Australia) are diagnosed each year (Ferlay, Soerjomataram & Ervik, 2013). Cancer of the brain poses a double threat – to one's survival and sense of self. Most people with primary brain tumour develop serious neuro-cognitive symptoms (e.g., seizures, memory loss) and experience poor mental health and quality of life, which places enormous burden on family care givers. Not surprisingly, high rates of psychological distress have been reported by people with brain tumour and their family care givers. Psychological distress can persist beyond primary treatment, and often increases in the long-term phase of illness due to the perceived threat and experience of recurrence and functional decline. Over the last decade, there have been many advances in the psychosocial management of people with brain tumour. This paper provides an overview of the functional, psychological and social consequences of brain tumour, summarises some leading developments in psychological assessment and management, and outlines future directions in intervention research.

The moderating effect of estimated pre-morbid IQ on the relationship between neuropsychological status and subjective well-being after brain tumour

OBJECTIVE

People with brain tumour experience complex and distressing symptoms. Neuropsychological impairment is proposed to have a negative impact on subjective well-being; however, research is yet to examine the influence of estimated premorbid IQ on this relationship. This preliminary study investigated the moderating effect of estimated premorbid IQ on the relationship between global neuropsychological status (GNF) and depression and quality of life.

METHODS

73 adults (51% male) aged 21-65 years with primary brain tumour (52% benign) were administered a test battery assessing estimated premorbid IQ, GNF, depression (Depression Anxiety Stress Scales) and quality of life (Functional Assessment of Cancer Therapy, FACT).

RESULTS

A series of two-way analysis of covariance (ANCOVA) controlling for education found a significant interaction between estimated premorbid IQ (low average to average vs high average) and GNF (low vs high) on levels of depression (p < .05) and FACT emotional well-being (p < .05). For these outcomes, individuals with high average estimated premorbid IQ and low GNF reported better well-being than those with low-average to average estimated premorbid IQ and low GNF. Higher GNF was related to greater functional well-being (p < .01) irrespective of estimated premorbid IQ.

CONCLUSION

The finding that higher premorbid cognitive ability buffers the effect of neuropsychological impairment on emotional well-being after brain tumour advances understanding of the role of cognitive reserve in adjustment to neurological disorders.

Care and support needs of patients and carers early post-discharge following treatment for non-malignant brain tumour: establishing a new reality

OBJECTIVE

Non-malignant brain tumours have the potential to considerably affect functional outcomes and quality of life, with an associated significant burden for carers. There is a lack of knowledge about the care and support needs of patients with a brain tumour and their carers, in the early period following discharge from initial hospitalisation. The purpose of this study was to understand the early post-discharge support services and care requirements of individuals with brain tumour and their family caregivers between short-term (2 weeks) post-discharge and medium-term (3 months) following hospital discharge.

METHODS

A qualitative approach was utilised with semi-structured interviews of nine patients with brain tumour and five of their family caregivers. Thematic content analysis was used to generate in-depth descriptions of the participant's life experiences post-discharge following neurosurgical intervention.

RESULTS

The overarching theme emerging from the data analysis related to patients and carers 'establishing a new reality' underpinned by three primary categories: (1) coping with available supports, (2) adjusting to routines and relationships and (3) emotional responses.

CONCLUSION

Participants had a tendency to rely on informal support networks but identified unmet information and support needs particularly for carers. These findings highlight the need for more efficient and effective discharge preparation, referral to services and supports, provision of timely information and support for family caregivers of those with brain tumour.

The effects of radiotherapy on psychosocial and cognitive functioning in adults with a primary brain tumor: a prospective evaluation

A paucity of studies have evaluated the biopsychosocial factors contributing to quality of life (QoL) in adults with a primary brain tumor (BT). Our objective was to investigate (i) the effects of radiotherapy on the psychosocial (ie, posttraumatic stress symptoms [PTSS]) and cognitive functioning of adults with a primary BT, assessed preradiotherapy [T1] and postradiotherapy [T2], and (ii) predictors of PTSS and QoL postradiotherapy. Seventy adults with a BT were assessed at T1, and 67 patients were reassessed 3.5 months postradiotherapy. At each assessment, participants completed measures of PTSS, mood, QoL, and quality of social support and neurocognitive tests focusing on memory and executive functioning. Minimal differences in functioning were found between patients according to BT type (benign [n = 45] vs malignant [n = 25]) and tumor laterality (left vs right hemisphere), with 2 exceptions. Individuals with a left hemisphere benign BT experienced greater distress at T1, which declined at T2, whereas individuals with a left hemisphere malignant BT reported poorer social support at T2. The full sample performed poorly on tests of executive functioning, and 17% reported clinically elevated PTSS at T1, which reduced to 13% at T2. Younger age (<65 y), reduced QoL, and elevated anger symptoms at T1 predicted PTSS at T2, whilst having a benign BT, low PTSS, and depressive symptoms at T1 were predictive of improved QoL at T2. Findings highlight the importance of screening for psychosocial and cognitive disturbances in BT patients undergoing treatment to identify those at risk for acute and more prolonged problems.