QOL-34. Rest, refresh, and recall: Interim feasibility of telehealth neurocognitive assessment and Cognitive Behavioral Therapy for Insomnia (CBT-I) in individuals with primary brain tumor

Abstract BACKGROUND Insomnia and cognitive impairment are prevalent and burdensome in individuals with primary brain tumors (PBT). Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia with potential cognitive benefits. However, CBT-I has not been rigorously tested in neuro-oncology, and its effect on cognition in this population remains unknown. We present the effect of cognitive capacity on interim feasibility metrics from a randomized pilot trial of CBT-I in individuals with PBT, including rates of eligibility, enrollment, and objective neurocognitive assessment completion. We also explore reasons for attrition and subjective cognitive change. METHODS Adults with PBT and insomnia were randomized to six-session telehealth group CBT-I (n=29) or Treatment as Usual (TAU; n=31). Subjective and objective cognitive functioning are assessed at baseline, post-intervention, and 3-month follow-up. Feasibility thresholds included eligibility (>70%), enrollment (>70%), and objective neurocognitive assessment completion (>70% post, >60% follow-up). We examined reasons for attrition and explored pre-to-post subjective cognitive change (FACT-Brain-Cognitive Index) using descriptive statistics. RESULTS All screened patients (N=84) met cognitive eligibility criteria (TICS>20; 100% eligibility), with 96.4% meeting all inclusion criteria (n=81). Seventy enrolled (86.4% enrollment; (Mage=51.4±13.64; 52.7% female; 87.7% White) and 60 were randomized. No study withdrawals have been due to cognitive incapacity. To date, the feasibility of objective neurocognitive assessment is 25/39 (64.1%) [68.4% CBT-I; 60% TAU] at post, and 17/29 (58.6%) [66.7% CBT-I; 50% TAU] at follow-up. Most CBT-I (n=9/11) and TAU (n=7/12) participants similarly endorsed stable-to-improved FACT-Br-CI from pre-to-post-intervention. CONCLUSIONS Preliminary findings suggest cognitive capacity does not hinder recruitment, enrollment, or retention of individuals with PBT. However, interim neurocognitive assessment completion rates fell below predefined feasibility thresholds; while these rates may continue to improve, future trials of CBT-I may seek to optimize longitudinal data collection. Exploratory findings of stable-to-improved subjective cognition across groups warrant further investigation in future efficacy trials.