P15.04.B TELE-COGNITIVE REHABILITATION FOR ADULT LOWER GRADE GLIOMA: A PROSPECTIVE FEASIBILITY STUDY

Abstract BACKGROUND Cognitive impairments are common in patients with lower-grade gliomas (LrGG, grades 1-3), yet evidence-based interventions are limited. Tele-health cognitive rehabilitation offers a potential solution. We conducted a pilot study investigating the adherence, satisfaction, and preliminary efficacy of tele-cognitive rehabilitation in adults with LrGG. MATERIAL AND METHODS Eligible participants were adults with stable LrGG (≥ 6 months post-treatment) reporting subjective and objective cognitive impairments (>1 SD below average in ≥2 domains). Patients received three months of individual cognitive rehabilitation Goal Management Training (GMT) via telehealth which is a behavioral treatment designed to address cognitive impairments. Cognitive assessments and patient-reported outcomes (PROs) were collected at baseline (T1), post-intervention (T2), and 9 months post-baseline (T3). Adequate adherence required ≥80% of participants completing ≥80% of sessions. Adequate satisfaction was defined as a score ≥6/7 on a post-T2 survey. Preliminary efficacy was assessed using repeated measures t-tests, effect sizes, and reliable change indices (RCI) for within-group changes (T1-T2, T1-T3). RESULTS Thirty-two patients (median age 48 years; median 61 months post-diagnosis; 46% astrocytoma and 46% oligodendroglioma; 82% IDH mutant; 39% grade 2 and 61% grade 3; 64% prior radiotherapy) were prospectively enrolled between May 2019 and September 2023. GMT adherence was high at 88%. Significant improvements were observed in the WAIS-IV Working Memory Index from T1 (mean z=-0.12, SD 1.13) to T2 (mean z=0.06, SD 1.09; p=0.03, eta²=0.18), with 25% demonstrating reliable improvement. PROs also improved: Fatigue Symptom Inventory Interference Index decreased significantly from T1 (mean=3.37, SD 2.48) to T3 (mean=2.55, SD 2.42; p=0.04, eta²=0.18). Clinically evident fatigue (FSI >3) decreased from 50% at T1 to 25% at T3. The Brief Symptom Inventory (BSI)-Somatic subscale improved significantly both from T1 (mean=0.06, SD 0.84) to T2 (mean=-0.38, SD 0.60; p=0.001, eta²=0.33) and T1-T3 (mean=-0.34, SD 0.76; p=0.01, eta²=0.28). Overall satisfaction with GMT was excellent (mean=6.87/7, SD 0.35). CONCLUSION Tele-cognitive rehabilitation using individual GMT is feasible for adults with stable LrGG, demonstrating good adherence and high patient satisfaction. Preliminary results show promising improvements in working memory, fatigue interference, and somatic distress, with some effects sustained 6 months post-intervention. Further research is warranted to confirm efficacy and explore mechanisms of action.