Os05.5.a novel study of cognitive rehabilitation improving work performance in primary brain tumor

Abstract BACKGROUND Primary brain cancer survivors are living longer yet have emotional distress and cognitive impairments that negatively impact their quality of life (QOL), including returning to work. We present a novel tele-cognitive rehabilitation study in primary brain cancer survivors to improve work performance. MATERIAL AND METHODS Retrospective review of clinically and radiologically stable adult primary brain cancer patients off treatment and referred for cognitive rehabilitation. Neuropsychological, psychological, vocational, and QOL assessments completed. Wilcoxon rank sum and Fisher’s exact or Chi-square tests were used for between and within-group comparisons. Work status improvement defined as returning to employment and/or minimal cognitive symptoms at work. RESULTS 79 patients with known baseline work status were analyzed. 80% opted in tele-cognitive rehabilitation services. Working (n=38), not working (n=41) had similar age, time since diagnosis, and history of radiotherapy. Not working had higher grade tumors (p=.01), worse cognitive function (executive function, attention, verbal learning all p<0.05) yet more engagement support groups (p<0.04). Subsequently, 38 patients (42% of whom were not working) received vocational tele-cognitive rehabilitation (median 11 sessions). 82% had improved work status compared to 34% non-treatment. Occupational improvements are not correlated to baseline work status and age. Glioblastoma was least improved, while Oligodendroglioma was most likely to improve (p=.05). Higher doses of radiotherapy were inversely related to work improvements (p<0.05). Higher verbal memory (p=0.05), processing speed (p=0.06), and executive functioning (p=0.02), IDH mutant tumors (p=0.06), and motivation for treatment (p=0.04) were associated with improved work status. Those with depressive symptoms who engaged in psychotherapeutic services had significantly improved work status (p=0.01). CONCLUSION When offered, patients want cognitive rehabilitation. Further, occupational functioning improves with tele-cognitive rehabilitation. Higher cognitive functioning, IDH mutation, radiotherapy dose, and motivation for treatment are important to consider. Despite not working and having worse cognition, patients improved similarly to their working counterparts. Depression benefitted from psychotherapeutic support. Tele-cognitive rehabilitation embedded within a multidisciplinary care model shows promise to improve work abilities in primary brain tumor patients.