INNV-06. Build it and they will come: Cognitive rehabilitation in primary brain tumor

Abstract BACKGROUND Cognitive impairment is common in primary brain tumors (PBT), with evidence for cognitive rehabilitation (CR), although with few studies of self-sustaining clinical programs. We conducted a retrospective analysis of a CR program to understand treatment engagement and goal attainment by cognitive and clinical characteristics in those referred with subjective complaints. METHODS We retrospectively reviewed records of adults with stable PBT and cognitive complaints referred to neuropsychological evaluation and +/- CR with cognitive and emotional assessments completed upon referral. Impairment type was defined as: absolute ≥ -1.5 SD on ≥ 2 tests, or relative ≥ -1.5 from premorbid intellect on ≥ 2 tests. SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goal (partial or full) attainment was tracked with CR engagement defined as completing ≥ 2 sessions. Chi-square was used to evaluate associations with a two-sided <0.05 p-value threshold. RESULTS We identified 177 patients with PBT referred between May 2018 to May 2022. The mean age was 50 (SD=13.5); 76% had ≥16 years of education; median time since diagnosis was 35.2 months (IQR=85.4); 14% glioblastoma; 56% IDH-mutant; 34% grade 2; 74% prior radiotherapy; and 62% not working. Among those referred, 21% demonstrated relative and 73% absolute impairment (73% with impaired processing speed, 71% executive functioning, and 63% verbal learning). Of those referred and recommended, 124 (87%) engaged in CR (median 8 visits, IQR=9); 57% fully and 25% partially met their goals. CR engagement and goal achievement were not significantly associated with cognitive and emotional findings upon referral or other clinical factors (all p≥0.05). CONCLUSION We confirm that subjective complaints in PBT often have objective impairments and underscore the value of premorbid estimates, especially in highly educated patients. Our data demonstrates high rates of CR engagement when offered. Additional study is warranted to understand treatment response, durability, and the mechanism of action.