A-128 Treatment Preferences for Cancer-Related Cognitive Impairment in Patients with Primary Brain Tumor

Objective: Patients with primary brain tumors (PwPBT) experience negative cognitive sequalae (cancer-related cognitive impairment; CRCI) as a result of tumor burden, surgical intervention, radiotherapy, and chemotherapy. Research investigating CRCI treatments for PwPBT remains nascent. Most of the previous investigations have applied interventions developed for and tested in other medical populations to PwPBT, leaving gaps in our understanding of what might best serve the specific needs of PwPBT. Thus, the present study examined sources of cancer-related distress and preferences for interventions to address CRCI in PwPBT.

Methods: As part of institutional quality improvement, PwPBT rated specific symptoms of cancer-related distress (from “not at all” to “very much” bothered) as well as preferences for specific interventions to address or cope with CRCI (from “not at all” to “very” interested). Patients also self-reported demographics and medical characteristics. Descriptive statistics characterized sources of distress and treatment preferences.

Results: PwPBT (N = 41, age 45.1 + 13.2, 52.5% male, 87.5% White) completed the questionnaire. Fatigue (54%) and cognitive changes (53%) were rated as the most distressing symptoms following brain tumor diagnosis. Cognitive rehabilitation (42%) and mindful movement (42%) were the most preferred interventions for management of CRCI; followed by psychotherapy (37%), mindfulness meditation (30%), and medication (20%).

Discussion: As expected, cognitive changes were a highly-rated source of distress for PwPBT, second only to fatigue. Both formal cognitive rehabilitation and mindful movement, or gentle exercise like yoga, were the most preferred interventions for management of CRCI. Importantly, these interventions may dually address fatigue symptoms for PwPBT. These data can inform future intervention development within neuro-oncology.

Re-examining popular screening measures in neuro-oncology: MMSE and RBANS

BACKGROUND

The Mini-Mental Status Examination (MMSE) is routinely used in neuro-oncology clinics to rule out cognitive impairment. However, the MMSE is known to have poor sensitivity to mild cognitive impairment, raising concern regarding its continued use. More comprehensive cognitive screeners are available, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and may be better able to assess for cognitive dysfunction.

METHODS

This retrospective cross-sectional study compared the relative rates of impairment using the MMSE-2 and RBANS in a sample of neuro-oncology patients (N = 81). A preliminary analysis of the sensitivity and specificity of the MMSE-2 to the level of cognitive impairment identified on the RBANS was conducted; in addition, we examined whether an adjustment of the MMSE-2 cut-off score improved consensus with a positive screening on the RBANS.

RESULTS

The MMSE-2 failed to identify over half of the patients with cognitive dysfunction that were identified on the RBANS. Further analysis showed limited sensitivity of the MMSE-2 to the level of impairment detected on the RBANS, and an adjustment of the cut-off score did not improve the sensitivity or specificity of the MMSE-2.

CONCLUSIONS

These results provide caution for neuro-oncology clinics using the MMSE. If providers continue to rely on the MMSE to screen for cognitive impairment alone, they may fail to identify individuals with mild cognitive impairments.

Introducing FCR 6 – Brain: Measuring Fear of Cancer Recurrence in Brain Tumor Patients and Their Caregivers

Background

Fear of cancer recurrence (FCR) is a psychological consequence of cancer diagnosis that impacts quality of life in neuro-oncology. However, the instruments used to assess FCR have not been tested for validity in patients with brain tumors. The present study explored the psychometric properties of a brief FCR scale in patients with primary brain tumor (PBT) and their caregivers.

Methods

Adult patients with PBT (n = 165) and their caregivers (n = 117) completed the FCR–7-item scale (FCR7) and measures of psychological functioning. Exploratory factor analyses (EFA) were conducted for both patient and caregiver FCR7. Convergent validity, prevalence, the difference between FCR in patients and caregivers, and relationships with relevant medical and demographic variables were explored.

Results

EFAs revealed a single factor with one item demonstrating poor loading for both patients and caregivers. Removal of the item measuring hypervigilance symptoms (checking for physical signs of tumor) greatly improved the single factor metrics. The amended scale (FCR6-Brain) demonstrated good convergent validity. Caregiver FCR was significantly higher than patient. Clinical guidance to identify clinically significant FCR was introduced. Age, gender, and time since diagnosis were related to FCR, with higher FCR in younger women more recently diagnosed.

Conclusions

The FCR6-Brain is the first validated instrument to assess FCR in this population and should be used to identify individuals at risk for FCR and guide development of future psychotherapeutic interventions. This study highlights the distinct characteristics of FCR in neuro-oncology. Symptoms of hypervigilance in PBT patients need further investigation.

QOLP-30. FEAR OF CANCER RECURRENCE IN PRIMARY BRAIN TUMOR PATIENTS: DO DISEASE-RELATED CHARACTERISTICS MATTER?

BACKGROUND/PURPOSE

Fear of cancer recurrence (FCR) is associated with disease-related variables including cancer stage and time since diagnosis in non-CNS cancer patients. However, no studies have investigated these relationships in primary brain tumor patients (PBT), with most research on FCR excluding this population purposefully. Given that a diagnosis of PBT is diverse in terms of prognosis, treatment, and disease trajectory, FCR in neuro-oncology may be different from other cancer populations and warrants investigation.

METHODS

PBT patients receiving care at an NCI-designated cancer center completed the FCR-7, a validated questionnaire assessing FCR. Disease-related variables, including tumor grade, tumor hemisphere, and time since diagnosis were obtained via medical records and investigated as correlates of FCR using t-test, non-parametric Kruskal-Wallis test, and Pearson correlation, respectively.

RESULTS

Eighty PBT patients (58% female; M age=50.83, range=20-86) agreed to participate. Average patient FCR7 was 17.15 (SD=8.93). The 60th percentile of patient FCR7 was 17.00 and the 90th percentile was 31.90. There was no difference in FCR between low and high tumor grades (p = 0.50). There was no difference in FCR between left, right, and bilateral tumor hemispheres (p = 0.67). Similarly, time since diagnosis was unrelated to FCR (p = 0.54).

CONCLUSION

Inconsistent with findings in non-CNS cancer, FCR was not related to disease-related variables in PBT patients. Given the certainty of tumor recurrence in this population, FCR may be a more robust experience in PBT patients, such that disease characteristics do not buffer this cancer-specific distress. These results emphasize the need for inclusion of PBT in psycho-oncology research, particularly investigations of psychotherapy targeting FCR across disease-related variables such as tumor grade, tumor hemisphere, and time since diagnosis. The lack of generalizability of non-CNS cancer findings and the further exclusion of this population will prevent efforts to provide patient-centered end-of-life care within neuro-oncology.

QOLP-22. POSTTRAUMATIC GROWTH IN NEURO-ONCOLOGY

BACKGROUND

Posttraumatic Growth (PTG) refers to the positive psychological change following a trauma and may include a heightened appreciation for life, greater value in meaningful relationships, and/ or spiritual development. A brain cancer diagnosis may be experienced as a traumatic event given the high risk of tumor progression, lack of curative treatments, and ultimately unexpected disheartening prognosis; however, there is limited research on PTG in neuro-oncology. The aim of this study was to determine the profile of PTG in patients diagnosed with primary brain tumors (PBTs).

METHODS

Patients with PBTs (N = 53, Mage = 48.17, 52.8% male) completed the Post Traumatic Growth Inventory (PTGI) during routine neuro-oncology clinic visits. Descriptive statistics and frequencies for the five factors of the PTGI and PTGI total were calculated.

RESULTS

PTG was evident across all domains with the most growth reported in appreciation for life and the least growth in new possibilities. Most patients endorsed low levels of growth across the five factors; 29-49% of patients endorse moderate-to-high severity in at least one PTG domain. Lastly, the average total score (M = 46.10) of this sample met the established cutoff for moderate-to-high PTG (> 46).

CONCLUSIONS

The results suggest that patients with PBTs may perceive positive psychological growth following the traumatic event of a brain tumor diagnosis. Specifically, patients may experience a greater appreciation for life but relatively less growth in new possibilities, perhaps due to the poor prognosis of many PBTs. In non-CNS cancer populations, patients with higher PTG reported better quality of life and lower distress. Further research to expand our knowledge of PTG and the associated factors, including the demographic, medical, and psychological correlates, will better equip providers to promote positive change in PBT patients.

QOLP-18. A CALL TO ACTION: DEATH ANXIETY IN NEURO-ONCOLOGY

BACKGROUND

Patients with primary brain tumors (PBT) are at increased risk for psychological distress given the certainty of tumor progression, lack of curative treatments, and poor prognoses. A specific type of distress, death anxiety, was recently identified as an area of concern among neuro-oncology patients. However, researchers have yet to fully examine the prevalence or risk-factors of death anxiety in this population, and, importantly, what evidence-based treatments may be available to alleviate symptoms.

METHODS

Adult PBT patients (N=81) completed validated questionnaires on symptoms of death anxiety, generalized anxiety, and depression. Item-level frequencies were run to determine prevalence rates. Analyses were then conducted (t-tests, ANOVAs, Pearson correlations, regressions) to determine whether certain demographic, disease-related variables, and/or symptoms of psychological distress put patients at higher risk for death anxiety. Literature on evidence-based treatment options was also reviewed.

RESULTS

Over half (50-64%) of our sample endorsed items related to fear of death, distressing thoughts about death, and fear of the future, with 35% scoring above the cut-off for death anxiety. Predictors of death anxiety included generalized anxiety symptoms, bilateral or right hemisphere tumor, and female gender (r2=0.367; F(3,77)=16.488, p< .05). Younger age, lower grade tumors, and heightened depressive symptoms were associated with higher death anxiety (p< .05). While interventions to reduce distress in advanced cancer populations are available, most have purposely excluded neurological cancers, thus limiting their generalizability in neuro-oncology.

CONCLUSION

The proportion of PBT patients who endorsed death anxiety aligns with other advanced cancer populations. However, item-level analysis suggests heightened concern in neuro-oncology and a need for targeted intervention. Moreover, specific demographic, disease-related, and psychological distress variables put certain PBT patients at increased risk. These findings highlight the need for routine screenings and monitoring, as well as inclusion of neuro-oncology patients in evidenced-based treatment trials for reducing distress, specifically death anxiety.

COVD-19. COGNITION, CANCER, AND COVID: DELIVERING DIRECT-TO-HOME TELE-NEUROPSYCHOLOGY SERVICES TO NEURO-ONCOLOGY PATIENTS

BACKGROUND

The COVID-19 pandemic altered the delivery of healthcare services globally with a rapid adoption of telemedicine to meet patient’s needs. Telemedicine is critical for neuro-oncology patients who may be at an increased risk of infection, yet require continuity of care. An important aspect of neuro-oncology care includes neuropsychological assessment, which can be challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored under proctored conditions and proven feasible and reliable. Conducting TNP visits directly to the patients’ home (DTH-TNP) had minimal study prior to the pandemic, but was implemented to reduce COVID-19 exposure.

METHODS

We used surveys to examine patient acceptance and clinician feasibility of DTH-TNP at two regionally diverse medical institutions routinely providing neuropsychological assessments services to neuro-oncology patients from April to August 2020, Massachusetts General Hospital (MGH) and Virginia Commonwealth University (VCU).

RESULTS

45 patients voluntarily responded (MGH=30, VCU=15) and 98 percent (MGH=100%, VCU=93%) of respondents were satisfied with the DTH-TNP experience. Nine percent (MGH=7%, VCU=13%) reported challenges (e.g., technological issues) during the appointment. Eighty-nine percent (MGH=90%, VCU=87%) would recommend the virtual visit to others. Patients perceived reduced risk of infection (MGH=77%, VCU=87%) and time traveling to clinic (MGH=87%, VCU=80%) as favorable aspects of DTH-TNP. 43 clinician surveys collected at MGH indicated that clinicians were able to achieve the goal of their appointment in 91% of clinical encounters. Common issues reported by clinicians included trouble connecting (7%) to the telemedicine platform and environmental disruptions (12%).

DISCUSSION

This preliminary data suggests neuro-oncology patients and clinicians find DTH-TNP to be an acceptable and feasible practice, while also recognizing its limitations. This study is limited in that voluntary patient surveys are subject to bias. These results suggest that further study of DTH-TNP (e.g., reliability, validity, and limitations) for neuro-oncology patients is warranted. Future directions are discussed.

QOLP-06. EXISTENTIAL DISTRESS: UNADDRESSED CONCERNS FOR ADULT NEURO-ONCOLOGY PATIENTS

BACKGROUND

Primary brain tumor (PBT) patients may experience existential distress including fear of cancer recurrence and death anxiety; however, to date few have examined this issue. The objectives of this study were twofold: first, to systematically review PBT representation in the psycho-oncology literature on existential distress, and second, to preliminarily assess the prevalence and correlates of existential distress in a sample of PBT patients. PRIMARY OBJECTIVE METHODS/

RESULTS

Three databases (PsycINFO, PubMed, and CINAHL) were systematically searched to identify articles measuring fear of cancer recurrence, fear of dying, or death anxiety in oncology patients. Included studies were examined to determine the frequency of PBT patients and identify exclusion criteria relevant to neuro-oncology. For studies including PBT patients, a more thorough data extraction was undertaken. Systematic searching found 336 studies meeting inclusion criteria (N=133,027). Eight studies (0.16% of the participants) included PBT patients. Exclusion criteria such as cognitive impairment and specific treatment parameters may have prohibited PBT patient participation. Studies including PBT patients used mixed methods with limited demographic analyses; existential distress was correlated with heightened psychological distress and poor quality of life. SECONDARY OBJECTIVE METHODS/

RESULTS

A cross-sectional analysis of 81 PBT patients (20–86 years old) was conducted. Patients completed validated questionnaires of death anxiety, death distress, generalized anxiety, and depressive symptoms. Descriptive analyses, t-tests, chi-square, and Pearson correlations were conducted. Up to 79% of PBT patients endorsed death anxiety. These patients were significantly younger, more likely to be female, and have a low-grade brain tumor (p< 0.05). Significant correlations were found between death anxiety and distress and symptoms of anxiety and depression (p< 0.01).

CONCLUSIONS

PBT patients are underrepresented in existential psycho-oncology literature, despite preliminary findings suggesting prevalence of these concerns. Future investigations of existential distress in neuro-oncology is warranted to inform psychosocial screening and treatment for PBT patients.

Composite impulsivity-related domains in college students

Impulsivity is a complex, multidimensional construct with prior theoretically and empirically derived characterizations of impulsivity-related behaviors varying considerably among studies. We assessed college students (N = 440) longitudinally with five impulsivity-related self-reported assessments and two computerized behavioral measures. Using a combination of exploratory and confirmatory factor analysis (CFA), we derived then validated several composite impulsivity-related domains (CIRDs). These factors replicated, in large part, findings from a previous study conducted by our group in an independent sample that used a similar analytical approach. The four CIRDs derived in current study are: 'Impulsive action', 'Approach/Appetite Motivation', 'Impulsivity/Compulsivity' and 'Experience and thrill seeking/Fearlessness'. Subsequent psychometric analyses found these CIRDs were relatively stable over the two-year period. Moreover, multiple regression analysis found that CIRD profiles associated with clinical and behavioral characteristics including anxiety, depression, attention deficit hyperactivity disorder and substance use symptomology. Overall, our data suggest that empirically-derived CIRDs have potential for organizing previous impulsivity-related constructs into a more naturalistic framework where distinct constructs are often expressed together in the same individuals. This framework might facilitate future research of neuropsychiatric disorder risk and etiology.

Longitudinal influence of alcohol and marijuana use on academic performance in college students

BACKGROUND

Alcohol and marijuana are the two most abused substances in US colleges. However, research on the combined influence (cross sectional or longitudinal) of these substances on academic performance is currently scant.

METHODS

Data were derived from the longitudinal 2-year Brain and Alcohol Research in College Students (BARCS) study including 1142 freshman students who completed monthly marijuana use and alcohol consumption surveys. Subjects were classified into data-driven groups based on their alcohol and marijuana consumption. A linear mixed-model (LMM) was employed using this grouping factor to predict grade point average (GPA), adjusted for a variety of socio-demographic and clinical factors.

RESULTS

Three data-driven clusters emerged: 1) No/low users of both, 2) medium-high alcohol/no-low marijuana, and 3) medium-high users of both substances. Individual cluster derivations between consecutive semesters remained stable. No significant interaction between clusters and semester (time) was noted. Post-hoc analysis suggest that at the outset, compared to sober peers, students using moderate to high levels of alcohol and low marijuana demonstrate lower GPAs, but this difference becomes non-significant over time. In contrast, students consuming both substances at moderate-to-high levels score significantly lower at both the outset and across the 2-year investigation period. Our follow-up analysis also indicate that when students curtailed their substance use over time they had significantly higher academic GPA compared to those who remained stable in their substance use patterns over the two year period.

CONCLUSIONS

Overall, our study validates and extends the current literature by providing important implications of concurrent alcohol and marijuana use on academic achievement in college.