No abstract

Ensuring optimal quality of life and functioning is a clinical priority in treating glioma survivors. Cognitive function and mood symptoms are prevalent in this population after treatment and it’s reasonable to consider these as significant contributors to patients’ functioning at work and in daily life. However, it’s unclear the degree to which these symptoms contribute to such outcomes. To address this question, we examined the relationships between cognitive tests (i.e., a neuropsychological battery) and mood measures (i.e., the Beck Depression Inventory-II, and the Beck Anxiety Inventory) and work and daily functioning (i.e., Work Productivity and Activity Impairment Questionnaire). Partial correlation of cognitive tests and regression models also included age and IQ (i.e., Test of Premorbid Functioning). Of the 11 participants who were currently working, worse work productivity was significantly associated with worse processing speed (Stroop color naming r=-.74,p=.03, Stroop color word r=-.78,p=.02). Similarly, worse ability in daily activities was also associated with worse processing speed and executive function (Stroop color naming, r=-.52,p=.04; Stroop color word, r=-.55,p=.03; Trails B, r=-.53,p=.03). Greater depression symptoms were strongly correlated with both worse work productivity (r=.83,p=.002), and worse ability in daily activities (r=.55,p=.01). Depression symptoms were generally uncorrelated with cognitive scores. In linear regression models that included both depression symptoms and cognitive scores, only depression emerged as a significant predictor of work productivity and ability to conduct daily activities. In sum, glioma survivors face multiple threats to work and daily functioning by way of tumor and treatment related symptoms. Our analyses suggest that both cognitive function and mood symptoms are important to consider in optimizing functioning, but depression appears to vastly outweigh cognitive function in this regard. These preliminary findings highlight the importance of careful attention to these symptoms in survivorship and point to future research directions elaborating on these relationships.

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.

Given the high prevalence of neurobehavioral symptoms such as depression, fatigue, and cognitive dysfunction in patients with gliomas, it is critical to regularly screen for these symptoms at each oncology visit. The current study evaluated the validity of the UCLA Neuro-Oncology Program Psychosocial Patient Screening Form (PPSF) to measure depression, fatigue, and cognitive complaints in a sample of 22 patients enrolled in a study observing neurocognitive and psychosocial change in long-term survivors. Patients were asked to complete the PPSF at regular clinical visits, and this data was retrospectively reviewed. The PPSF consisted of the Patient Health Questionnaire-2 (PHQ-2) and options to endorse experiencing more fatigue, as well as significant memory, speech, attention, or thinking difficulties. At the most recent visit, patients also completed a validated psychosocial assessment that included the Beck Depression Inventory-II (BDI-II), Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), and Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Endorsement of recent depressive symptoms, increased fatigue, and elevated cognitive difficulties on the PPSF at the most recent visit were found to be significantly correlated with abnormal mean scores on the BDI-II (M= 22.5, SD= 11.24, t= -3.47, p= 0.003), MFSI-SF (M= 26.08, SD= 15.51, t= -2.34, p= 0.029), and perceived cognitive abilities subscale of the FACT-Cog (M= 5, SD= 2, t= 4.642, p= 0.00), respectively. Abnormal scores on the MFSI-SF and FACT-Cog were also significantly correlated with endorsement of fatigue and cognitive complaints at any previous visit. Although other measures of screening for depression, fatigue, and cognitive complaints exist, the PPSF is effective in providing immediate, clinically significant information to the clinician for comprehensive patient care. The PPSF should be utilized to capture and address psychosocial changes and facilitate a deeper understanding of the effects of treatment on glioma patients.

Advanced multimodality treatments that have led to longer survival rates for patients with low-grade gliomas (LGGs) have also resulted in significant changes in cognition and quality of life (QoL). These changes remain poorly understood, largely due to the lack of multifactorial and in-depth studies on cognitive impairment in patients with LGG. Resting-state functional MRI (rs-fMRI) has been widely used as a reliable imaging biomarker to evaluate the treatment outcome by characterizing the cerebral networking alteration associated with a patient’s neurological status. In this preliminary report of an active study, we investigated the cognitive function and cerebral networking connectivity via rs-fMRI in survivors who had completed treatment for LGG within the past 10 years. Survivors were administered a battery of standardized neuropsychological tests. Of the 20 participants enrolled to date (mean age 43 ± 11), 10 participants were categorized as cognitively impaired based on the International Cognition and Cancer Task Force (ICCTF) guidelines, with recommended adjustments considering the number of tests in the battery. Compared to cognitively unimpaired participants, functional connectivity in cognitively impaired patients was lower between memory, visuospatial processing, and primary sensorimotor regions. These preliminary observations suggest there is a potential link between overall cognitive impairment and functional connectivity of various networks as measured using resting-state fMRI.