Adult Brain Tumor Patients Research Articles

Functional Connectivity in Adult Brain Tumor Patients: A Systematic Review.

Brain tumor (BT) patients often experience reduced cognitive abilities and disrupted adaptive functioning before and after treatment. An innovative approach to understanding the underlying brain networks associated with these outcomes has been to study the brain's functional connectivity (FC), the spatially distributed and temporally correlated activity throughout the brain, and how it can be affected by a tumor. The present review synthesized the extant BT FC literature that utilizes functional magnetic resonance imaging to study FC strength of commonly observed networks during rest and task. A systematic review of English articles using PubMed was conducted. Search terms included brain tumor OR glioma AND functional connectivity, independent component analysis, ICA, psychophysiological interaction, OR PPI. Studies in which participants were diagnosed with BTs as adults that evaluated specific networks of interest using independent component analysis or seed-based component analysis were included. Twenty-five studies met inclusion criteria. BT patients often presented with decreases in FC strength within well-established networks and increases in atypical FC patterns. Network differences were tumor adjacent and distal, and left hemisphere tumors generally had a greater impact on FC. FC alterations often correlated with behavioral or cognitive outcomes when assessed. Overall, BTs appear to lead to various alterations in FC across different functional networks, and the most common change is a decrease in expected FC strength. More longitudinal studies are needed to determine the time course of network alterations across treatment and recovery, the role of medical treatments in BT survivors' FC, and the potential of FC patterns as biomarkers of cognitive outcomes.

Development and validation of NTCP models for acute side-effects resulting from proton beam therapy of brain tumours

BackgroundThe limited availability of proton beam therapy (PBT) requires individual treatment selection strategies, such as based on normal tissue complication probability (NTCP). We developed and externally validated NTCP models for common acute side-effects following PBT in brain tumour patients in effort to provide guidance on optimising patient quality of life. MethodsAn exploration cohort including 113 adult brain tumour patients who underwent PBT was investigated for the following endpoints: alopecia, scalp erythema, headache, fatigue and nausea. Dose–volume parameters of associated normal tissues were used for logistic regression modelling. Statistically significant parameters showing high area under the receiver operating characteristic curve (AUC) values in internal cross-validation were externally validated on two cohorts of 71 and 96 patients, respectively. ResultsStatistically significant correlations of dose–volume parameters of the skin for erythema and alopecia were found. In internal cross-validation, the following prognostic parameters were selected: V35Gy (absolute volume receiving 35 Gy) for erythema grade ≥1, D2% (dose to 2% of the volume) for alopecia grade ≥1 and D5% for alopecia grade ≥2. Validation was successful for both cohorts with AUC >0.75. A bivariable model for fatigue grade ≥1 could not be validated externally. No correlations of dose–volume parameters of the brain were seen for headache or nausea. ConclusionWe developed and successfully validated NTCP models for scalp erythema and alopecia in primary brain tumour patients treated with PBT.

Abstract 900: Dianhydrogalactitol (VAL-083) has the potential to overcome major challenges in the treatment of DIPG

Abstract Despite decades of clinical trials, children with diffuse intrinsic pontine gliomas (DIPG) continue to have a very poor prognosis and dismal survival. DIPG is inoperable and standard treatment is radiation alone. Major obstacles to the successful treatment of DIPG include 1) an intact blood brain barrier impeding drug penetration, 2) inherent tumor cell resistance mechanisms to conventional chemotherapeutics, and 3) a lack of drug-induced potentiation of radiotherapy. VAL-083 is a structurally unique bi-functional DNA targeting agent that has the potential to overcome these barriers. VAL-083 readily crosses the blood-brain barrier and accumulates in brain tumor tissue where it rapidly forms interstrand DNA crosslinks at guanine-N7, leading to persistent DNA double strand breaks, cell cycle arrest, and cancer cell death. VAL-083 has cytotoxic activity in several pediatric brain tumors as assessed in NCI-sponsored clinical trials, both as a single agent and in combination with other chemotherapeutics. We recently completed a Phase I/II clinical trial in refractory GBM and established a well-tolerated dosing regimen of VAL-083 in adult brain tumor patients. We have previously demonstrated that VAL-083 cytotoxicity is independent of both the primary, DNA repair protein O6-methylguanine DNA methyltransferase (MGMT), and the secondary, DNA mismatch repair (MMR) system, mechanisms of resistance to temozolomide (TMZ) in vitro. TMZ is commonly used in combination with radiation for the treatment of adult brain tumors but has failed to improve the effect of radiation in DIPG. Importantly, VAL-083 potentiates the effect of radiation and overcomes TMZ resistance in TMZ-resistant adult glioblastoma cancer stem cells (CSCs) and non-CSCs at concentrations that are physiologically achievable in the CNS. Additionally, VAL-083 demonstrated synergistic efficacy in prostate and lung cancer cells with topoisomerase (Topo) inhibitors camptothecin and etoposide, commonly used in the treatment of pediatric brain tumors. In conclusion, VAL-083 is able to 1) cross the blood brain barrier, 2) overcome resistance mechanisms to chemotherapeutics commonly used in the treatment of adult gliomas, and 3) potentiate the effects of radiation in adult glioma cells at physiologically achievable concentrations. Thus, VAL-083 may have the potential to overcome major challenges in DIPG treatment as a single agent, in combination with radiotherapy, or as part of a combination regimen with Topo inhibitors. In the present study, we investigated the effects of VAL-083 in combination with radiation, irinotecan (Topo 1 inhibitor), or Wee1 inhibitor AZD1775 in a panel of DIPG cell lines with varying genetic profiles. The results will provide guidance for the design of animal models studying VAL-083 treatment of DIPG, either as part of a chemo-radiation regimen or in combination with Topo or Wee1 inhibitors. Citation Format: Anne Steino, Beibei Zhai, Jeffrey A. Bacha, Dennis M. Brown, Mads Daugaard, Sabine Mueller. Dianhydrogalactitol (VAL-083) has the potential to overcome major challenges in the treatment of DIPG [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 900.

Screening for distress in patients with primary brain tumor using distress thermometer: a systematic review and meta-analysis

BackgroundPatients with primary brain tumors are reported to have an elevated level of distress prevalence, due to the functional sequelae and the unfavorable prognosis, but the estimated prevalence of this disorder varies among studies. The Distress Thermometer (DT) is widely used distress screening tools to identify patients suffering from elevated psychosocial distress. The objective of this meta-analysis is to get a summarized estimate of distress prevalence in adult primary brain tumor patients screened by the DT instrument to identify distress in brain tumor patients.MethodWe searched studies published in PubMed, PsycINFO, and Cochrane library through August 2017 and checked related reviews and meta-analyses for eligible studies. Studies were eligible if they were published in the peer-reviewed literature and evaluated distress level by Distress Thermometer. The prevalence of distress symptoms in patients with the intracranial tumor was estimated by study-level characteristics using stratified meta-analysis. The prevalence of distress level or symptoms during the follow-up examination at different time points was detected by secondary analysis of the longitudinal studies included.ResultsTwelve studies including a total of 2145 brain tumor patients were included in this analysis. Eight used a cross-sectional design and four were longitudinal. The pooled prevalence of distress was 38.2% (95% confidence interval (CI) 28.7%–47.7%) for the overall sample. The pooled prevalence of distress DT ≥4 was 41.1% (642/1686, 95% CI 28.6%–53.5%) and the pooled prevalence of distress by DT ≥6 was 29.7% (137/459, 95% CI 19.5%–39.9%). The distress symptom did not decrease in follow-up studies (Relative Increase Ratio:1.02, 95% CI, (0.78, 1.35)). A huge heterogeneity in different studies was detected, and different screening scales were not compared.ConclusionThe high prevalence of distress becomes an enormous challenge for primary brain tumor patients. Routine screening and evaluation of distress in brain tumor patients may assist medical workers to develop proper interventions, which may lead to better quality of life and oncology management.

Ketogenic therapy:the experience of adult brain tumour patients supported by Matthews Friends

Ketogenic therapy:the experience of adult brain tumour patients supported by Matthews Friends

Hispanic and African American adult brain tumor patients treated at Harbor-UCLA Medical Center compared to Los Angeles County and Torrance, California

The objective of this study is to shed light on racial disparities among Hispanic and African American adult brain tumor patients treated at Harbor-UCLA Medical Center compared to the general populations of Los Angeles County (LAC) and Torrance, California (CA). A retrospective review of patients admitted to the neurosurgery service at Harbor-UCLA Medical Center during years 2006 through 2010 was performed. Government census data was queried and pertinent national statistics were retrieved. Brain tumor patients at Harbor-UCLA were compared to the general populations of LAC and Torrance. A total of 271 patients were included in the study. The mean age was 46.9 years. Hispanics comprised the majority of neurosurgical patients (n = 151, 55.7%), followed by African Americans (n = 35, 12.9%). A greater percentage of Hispanic patients were treated at Harbor-UCLA relative to the general Hispanic populations of LAC and Torrance (p < .001). A greater percentage of African American patients were treated at Harbor-UCLA relative to the general African American populations of LAC and Torrance (p = .035 and p < .001, respectively). Our data revealed significant racial disparities amid the Harbor-UCLA Hispanic and African American patient populations compared to the general Angeleno populations of LAC and Torrance.

Aberrant paramagnetic signals outside the tumor volume on routine surveillance MRI of brain tumor patients.

Late complications of cerebral radiation therapy (RT) involve vascular injury with acquired cavernous malformation, telangiectasias and damage to vascular walls which are well recognized in children. Its incidence in adults is unknown. Blood products and iron deposition that accompany vascular injury create paramagnetic effects on MRI. This study retrospectively investigated the frequency of paramagnetic lesions on routine surveillance MRI of adult brain tumor patients. MRI studies of 115 brain tumor patients were reviewed. Only studies containing sequences of either susceptibility weighted images or gradient echo or blood oxygenation level dependent imaging were included. Lesions inside the tumor volume were not considered. 68 studies fulfilled the above criteria and included 48 patients with previous RT (35 followed for >2years and 13 for 1year) and 20 patients who were not treated with RT. The median age at time of irradiation was 47years. Aberrant paramagnetic lesions were found in 23/35 (65%) patients followed for >2years after RT and in only 1/13 (8%) patients followed for 1-year after radiation (p = 0.03). The 1-year follow-up group did not differ from the control group [2/20 (9%)]. Most lesions were within the radiation field and none of the patients had related symptomatology. The number and incidence of these lesions increased with time and amounted to 75% over 3years post RT. MRI paramagnetic signal aberrations are common findings in adult brain tumor patients that evolve over time after RT. The clinical significance of these lesions needs further investigation.

Rehabilitation pathways in adult brain tumor patients in the first 12months of disease. A retrospective analysis of services utilization in 719 patients.

Although previous studies have demonstrated the efficacy of rehabilitation programs for brain tumor (BT) patients and the positive impact on quality of life of functional gain, there are few studies focusing on specific rehabilitation management of brain tumor patients. With the aim to evaluate the pattern of rehabilitation care and health services utilization in patients with brain tumor, we retrospectively analyzed administrative data on a large cohort of brain tumor patients diagnosed during the period 2008-2009 in the Lazio Region. Pattern of rehabilitation care was analyzed during a follow-up of 12months after diagnosis. Data for this study were gathered and linked from two sources: (1) hospital discharge records stored into the Lazio Regional Health System database and (2) rehabilitation pathways database including inpatient and outpatient interventions files. We identified 789 patients with an ICD-9-CM code of 191.** in the Regional Health System databases in the study period. Among 719 patients included in this study, 92 (12.8%) were treated with inpatient rehabilitation program, 22 (3.1%) received an outpatient personalized program with intensive rehabilitation plan, and 85 (11.8%) received outpatients rehabilitation interventions. Our retrospective analysis on the rehabilitation service utilization in a large cohort of BT patients shows that a limited number of patients received rehabilitation interventions during the first year after diagnosis. Nevertheless, the rehabilitation needs in BT patients are largely unmet and the lack of defined physical and cognitive rehabilitation strategies may negatively affect the functional independence and the short- and long-term quality of life.

Collaboration in the presence of cerebral edema: The complications of steroids.

Background:Brain tumor patients often present with neurological changes in the presence of cerebral edema. High-dose dexamethasone is often required for symptom management in brain tumor patients. There are limitations in the foundational research that support the recommendations for appropriate prescribing of dexamethasone. Understanding these limitations can help prescribers and care teams collaborate to better manage this unique patient population as well as identify areas for further research.Methods:Evidence-based clinical practice guidelines for the management of adult brain tumor patients were reviewed from several certifying organizations. A complex database search and literature review was completed regarding relevant evidence used within these guidelines and for any supporting literature. The search was limited to MEDLINE, Cumulative Index to Nursing and Allied Health, Cochrane Library, and the National Guideline Clearinghouse using keywords. Each selected evidence-based guideline underwent appraisal using the Johns Hopkins Evidence-based Practice Model.Results:All clinical practice guidelines identified recommendations for appropriate dosing and tapering of dexamethasone. The management of steroid-induced side effects was addressed in two of the reviewed guidelines. Only one guideline identified specific nursing interventions for monitoring steroid-related side effects. No guideline addressed interval timing of provider or nursing-based interventions as well as the role of collaboration between provider and nurse in monitoring for steroid toxicities.Conclusions:More high-quality, well-controlled studies are needed around dexamethasone dosing for the management of cerebral edema. Clinical practice guidelines need to encompass both the prescriber and nursing-based interventions. Collaboration between disciplines is a necessity when monitoring and managing steroid-induced toxicities in brain tumor patients. Future evidence-based guidelines need recommendations for appropriate interval screening tests and quantifiable tools needed to aid in monitoring steroid-induced complications.

NIMG-76HIGH INCIDENCE OF ABERRANT PARAMAGNETIC SIGNALS ON MRI OF ADULT PATIENTS SURVIVING TWO OR MORE YEARS AFTER BRAIN IRRADIATION THAT SIGNIFIES RADIATION-INDUCED LATE EFFECTS

BACKGROUND: Late complications of cerebral radiation therapy involve vascular injury that may lead to development of cavernous malformation (CM), telangiectasias and damage to vascular walls. Radiation-induced CM is a recognized late complication in children but its incidence in adult patients is unknown. Typically, blood products, iron deposition and calcifications which accompany vascular injury/malformation create paramagnetic/diamagnetic effects on MRI. OBJECTIVE: To retrospectively investigate frequency of MRI paramagnetic lesions in adult patients surviving >2 years after cranial irradiation. METHODS: We reviewed MRI studies of 60 patients followed for > 2 years after radiotherapy. Studies that did not have either susceptibility weighted images or gradient echo sequence or blood oxygenation level dependant imaging sequences were excluded from the study. Lesions inside the tumor volume were not considered. RESULTS: 34 studies fulfilled the inclusion criteria. The underlying pathology requiring radiotherapy included glial tumors (20), lymphoma (4), and others. The median age at time of radiotherapy was 44 years (range 20 -71). Aberrant paramagnetic/diamagnetic lesions were found in 22 (65%) patients. The size of the lesions ranged between 1-9 mm. The number of lesions varied: 10 patients had 1-5 lesions, 5 had 6-10 and 7 had >10 lesions. In one case the finding was associated with venous anomaly. Most lesions were within the radiation field and none of the patients had related symptomatology. The median interval between radiation and the study MRI was 6 years (range 2-29). No statistical difference was found in patients' age or in the interval from radiation between those who developed signal abnormality and those who did not. CONCLUSIONS: MRI paramagnetic/diamagnetic signal aberrations, consistent with CM and/or calcifications, are common findings which signify late effects of radiotherapy in adult brain tumor patients surviving >2 years after treatment. These lesions are benign and do not require intervention.

Screening for Psychological Distress in Adult Primary Brain Tumor Patients and Caregivers: Considerations for Cancer Care Coordination.

This study aimed to assess psychological distress (PD) as scored by the Distress Thermometer (DT) in adult primary brain tumor patients and caregivers (CGs) in a clinic setting and ascertain if any high-risk subgroups for PD exist. From May 2012 to August 2013, n = 96 patients and n = 32 CG underwent DT screening at diagnosis, and a differing cohort of n = 12 patients and n = 14 CGs at first recurrence. Groups were described by diagnosis (high grade, low grade, and benign) and English versus non English speaking. Those with DT score ≥4 met caseness criteria for referral to psycho-oncology services. One-way ANOVA tests were conducted to test for between-group differences where appropriate. At diagnosis and first recurrence, 37.5 and 75.0% (respectively) of patients had DT scores above the cutoff for distress. At diagnosis, 78.1% of CGs met caseness criteria for distress. All CGs at recurrence met distress criterion. Patients with high-grade glioma had significantly higher scores than those with a benign tumor. For patients at diagnosis, non English speaking participants did not report significantly higher DT scores than English speaking participants. Psychological distress is particularly elevated in CGs and in patients with high-grade glioma at diagnosis. Effective PD screening, triage, and referral by skilled care coordinators are vital to enable timely needs assessment, psychological support, and effective intervention.

MR Imaging Evaluation of Intracerebral Hemorrhages and T2 Hyperintense White Matter Lesions Appearing after Radiation Therapy in Adult Patients with Primary Brain Tumors.

The purpose of our study was to determine the frequency and severity of intracerebral hemorrhages and T2 hyperintense white matter lesions (WMLs) following radiation therapy for brain tumors in adult patients. Of 648 adult brain tumor patients who received radiation therapy at our institute, magnetic resonance (MR) image data consisting of a gradient echo (GRE) and FLAIR T2-weighted image were available three and five years after radiation therapy in 81 patients. Intracerebral hemorrhage was defined as a hypointense dot lesion appearing on GRE images after radiation therapy. The number and size of the lesions were evaluated. The T2 hyperintense WMLs observed on the FLAIR sequences were graded according to the extent of the lesion. Intracerebral hemorrhage was detected in 21 (25.9%) and 35 (43.2) patients in the three- and five-year follow-up images, respectively. The number of intracerebral hemorrhages per patient tended to increase as the follow-up period increased, whereas the size of the intracerebral hemorrhages exhibited little variation over the course of follow-up. T2 hyperintense WMLs were observed in 27 (33.3%) and 32 (39.5) patients in the three and five year follow-up images, respectively. The age at the time of radiation therapy was significantly higher (p < 0.001) in the patients with T2 hyperintense WMLs than in those without lesions. Intracerebral hemorrhages are not uncommon in adult brain tumor patients undergoing radiation therapy. The incidence and number of intracerebral hemorrhages increased over the course of follow-up. T2 hyperintense WMLs were observed in more than one-third of the study population.

Hope and mood changes throughout the primary brain tumor illness trajectory.

The ambiguity of defining hope impacts the level of readiness faced by health care professionals treating patients with glioma, a disease with unpredictable outcomes. This study describes the report of hope and the relationship between hope and mood in adult brain tumor patients at various points in the illness trajectory. This was a cross-sectional study with data collection including use of the Herth Hope Index (HHI), the Profile of Mood States-Short Form (POMS-SF), and clinical information. Descriptive statistics were used to report sample characteristics. Spearman's rho and Mann-Whitney tests were used to compare and differentiate scores. Eighty-two patients ranging in age from 22 to 78 years (median, 44.5 y) participated in the study. Patients were primarily male (57.3%), married (76.8%), and had a high-grade glioma (35.4%). Nearly half had recurrence, and more than 20% were on active treatment. The overall HHI total score for the sample was 41.32 (range: 13-48). Patients with recurrence had a lower HHI interconnectedness (median = 14.00) score and higher total mood disturbance (median = 14.00) compared with patients without recurrence (median = 15.00 and median = 0.00, respectively; P < .05). All negative mood states on the POMS-SF were negatively correlated with HHI subscales. Overall, patients reporting more hope also reported less overall mood disturbance As expected, patients with tumor recurrence reported lower hope and higher mood disturbance than those who were newly diagnosed or without recurrence. Targeting interventions specifically tailored to an individual's needs for improvement in quality of life throughout the disease course may include measures to address hope in order to facilitate positive coping strategies.

Psychotherapy Interventions for Managing Anxiety and Depressive Symptoms in Adult Brain Tumor Patients: A Scoping Review.

BackgroundAdult brain tumor (BT) patients and longer-term survivors are susceptible to experiencing emotional problems, including anxiety and/or depression disorders, which may further compromise their quality-of-life (QOL) and general well-being. The objective of this paper is to review psychological approaches for managing anxiety and depressive symptoms in adult BT patients. A review of psychological interventions comprising mixed samples of oncology patients, and which included BT patients is also evaluated. The review concludes with an overview of a recently developed transdiagnostic psychotherapy program, which was specifically designed to treat anxiety and/or depressive symptoms in adult BT patients.MethodsElectronic databases (PsycINFO, Medline, Embase, and Cochrane) were searched to identify published studies investigating psychological interventions for managing anxiety and depressive symptoms in adult BT patients. Only four randomized controlled trials (RCTs) were identified.ResultsOnly one of the RCTs tested a psychosocial intervention, which was specifically developed for primary BT patients, and which was found to improve QOL including existential well-being as well as reducing depressive symptoms. A second study tested a combined cognitive rehabilitation and problem-solving intervention, although was not found to significantly improve mood or QOL. The remaining two studies tested multidisciplinary psychosocial interventions in heterogeneous samples of cancer patients (included BT patients) with advanced stage disease. Maintenance of QOL was found in both studies, although no secondary gains were found for improvements in mood.ConclusionThere is a notable paucity of psychological interventions for adult BT patients across the illness trajectory. Further research is required to strengthen the evidence base for psychological interventions in managing anxiety and depressive symptoms, and enhancing the QOL of distressed adults diagnosed with a BT.

OT-08 * DISTINCT BRAIN LINEAGE AND STROMAL GENE EXPRESSION PATTERNS IN WNT, SHH, GROUP 3 AND GROUP 4 MOLECULAR SUBGROUPS OF PEDIATRIC MEDULLOBLASTOMA

Medulloblastomas are the most common malignant brain tumors in children, comprising distinct molecular subgroups that differ in neuroanatomical predilection, clinical characteristics and overall survival. Here we compare genetic brain lineage and stromal immune profiling in N = 558 pediatric medulloblastomas against N = 426 adult glioblastomas. The medulloblastoma cohort included N = 114 SHH (20%), N = 34 WNT (6%), N = 156 Group 3 (28%), and N = 254 Group 4 (46%). Genetic brain lineage analyses revealed WNT and SHH medulloblastoma to be distinctly astrocytic and astroglial; more similar to adult mesenchymal/classical glioblastoma than other pediatric medulloblastoma. In contrast, Group 4 was distinctly neuronal and oligodendrocytic; more similar to adult proneural/neural glioblastoma than other pediatric medulloblastoma. Interestingly, Group 3 demonstrated no brain lineage enrichment-unlike any other pediatric or adult brain tumor subtype-suggesting a non-CNS etiology for this subgroup known for distinctive large-cell anaplastic histology, aggressive behavior, and uniquely high incidence of metastatic disease. Analysis of stromal immune signatures revealed significant macrophage-specific enrichment in WNT and SHH, but not Group 3 and 4 tumors. These myeloid signatures were characteristic of M2-polarized macrophages, unlike adult glioblastomas, which enriched in both M1 and M2 signatures. While myeloid responses in adult glioblastoma were predictive of poor overall survival, the opposite was true in pediatric medulloblastoma-with improved survival in children with robust immune responses. These data demonstrate that medulloblastoma subtypes display distinct brain lineages and share greater similarities to adult glioblastomas than other pediatric medulloblastomas, further supporting distinct cellular origins for each subtype. Furthermore, innate immune responses were distinctive between subtypes and, in contrast to adult tumors, predictive of good outcomes, suggesting prognostic significance of immune responses differs in children versus adults. Taken together, these findings highlight the distinctiveness of medulloblastoma subtypes with important clinical implications for the design of future targeted molecular therapy and immunotherapy trials in pediatric and adult brain tumor patients.

Systematic review of interventions to improve the provision of information for adults with primary brain tumors and their caregivers.

Background: Adults with primary brain tumors and their caregivers have significant information needs. This review assessed the effect of interventions to improve information provision for adult primary brain tumor patients and/or their caregivers.Methods: We included randomized or non-randomized trials testing educational interventions that had outcomes of information provision, knowledge, understanding, recall, or satisfaction with the intervention, for adults diagnosed with primary brain tumors and/or their family or caregivers. PubMed, MEDLINE, EMBASE, and Cochrane Reviews databases were searched for studies published between 1980 and June 2014.Results: Two randomized controlled, 1 non-randomized controlled, and 10 single group pre–post trials enrolled more than 411 participants. Five group, four practice/process change, and four individual interventions assessed satisfaction (12 studies), knowledge (4 studies), and information provision (2 studies). Nine studies reported high rates of satisfaction. Three studies showed statistically significant improvements over time in knowledge and two showed greater information was provided to intervention than control group participants, although statistical testing was not performed.Discussion: The trials assessed intermediate outcomes such as satisfaction, and only 4/13 reported on knowledge improvements. Few trials had a randomized controlled design and risk of bias was either evident or could not be assessed in most domains.

NC-01 * ATTENTIONAL AND LANGUAGE FUNCTIONING IN ADULT PATIENTS WITH GLIOMA: A VOXEL-BASED LESION-SYMPTOM MAPPING STUDY

OBJECTIVE: We statistically examined the relationship between lesion presence and neurocognitive performance on tasks of attention and language on a voxel-by-voxel basis in adult brain tumor patients using voxel-based lesion-symptom mapping (VLSM). VLSM is an innovative technique that has primarily been used in studies of stroke patients. METHODS: 98 right-handed adult patients with glioma were administered a neuropsychological battery comprised of 10 tasks: Digit Span Forward & Backward from the Wechsler Adult Intelligence Scale, Verbal Fluency (FAS, Animals), Woodcock-Johnson III Word Attack, and subtests of the Boston Diagnostic Aphasia Examination: Boston Naming Test, Complex Ideational Material, Commands, Responsive Naming, and Reading Sentences & Paragraphs. T2-weighted images were registered to a T1-weighted MNI atlas and the tumor region was contoured using a semi-automated thresholding technique. For a voxel, a general linear model was run to determine the relationship between cognitive performance and lesion presence, with medical and demographic characteristics specified as covariates. This analysis was repeated for each voxel with each subtest. Suprathreshold cluster-based analysis was used to correct for multiple comparisons. RESULTS: VLSM analysis identified several clusters of voxels with a significant relationship (p < .05) between lesion presence and neurocognitive performance on tasks of attention and language, and these significant clusters were depicted on high resolution statistical maps (1 mm3). Three composite maps were then generated, identifying the key anatomic structures involved in the attention/working memory cognitive domain (primarily frontal regions including dorsolateral prefrontal cortex), the expressive language cognitive domain (primarily lateral temporal regions), and the receptive language cognitive domain (primarily lateral and mesial temporal regions along with auditory cortex). CONCLUSION: These findings identify some of the key anatomic structures involved in attentional and language functioning in adult patients with glioma using an innovative lesion analysis technique.

QL-02 * HOPE AND MOOD CHANGES THROUGHOUT THE PRIMARY BRAIN TUMOR ILLNESS TRAJECTORY

The ambiguity of defining hope impacts the level of readiness faced by healthcare professionals in treating patients with glioma, a disease with an unpredictable outcome. While the initial focus of care is on the physiological effects of the disease, a sense of hope has been demonstrated to positively impact coping during illness in other cancer patients. This study describes the report of hope and the relationship between hope and mood in adult brain tumor patients at various points in the illness trajectory. This was a cross-sectional study with data collection including the use of the Herth Hope Index (HHI) within 3 subscales (temporality, readiness, interconnectedness), the Profile of Mood States-Short Form (POMS-SF) and clinical information. Descriptive statistics were used to report sample characteristics. Spearman's rho compared POMS-SF and HHI scores. 82 patients participated in the study ranging in age from 22 to 78 years (mean 44.78). Patients were primarily male (57.3%), married (76.8%) and employed (51.2%). The majority of patients had a high grade glioma (77%), with nearly half having a recurrence and over 20% on active treatment at the time of this study. The overall HHI total score for the sample was 41.32(range 13-48). Patients with recurrence had a low HHI interconnectedness (median = 14.00) score and higher total mood disturbance (median = 14.00) compared with patients without recurrence (HHI median = 15.00, Mood median = .00, p < .05). All negative mood states on the POMS-SF were negatively correlated with HHI subscales. Overall, patients reporting more hope also reported less overall mood disturbance (tension, anger, fatigue, depression, confusion). Patients with tumor recurrence reported lower hope and higher mood disturbance then those who were newly diagnosed or without recurrence. Targeting interventions specifically tailored to individual needs in improvement of quality of life throughout the disease course may include measures to address hope to facilitate positive coping strategies.

Establishing standard performance measures for adult brain tumor patients: a nationwide inpatient sample database study

The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services (CMS) hospital acquired conditions (HACs) are used to evaluate the safety and quality of health care. We determined the incidence rates of PSIs and HACs among brain tumor patients in the Nationwide Inpatient Sample database (NIS). We queried the NIS for all hospitalizations involving a brain tumor. We determined the incidence rates of various PSIs and HACs among these patients by searching the hospital records for codes in the International Classification of Diseases, 9th Revision indicating each PSI or HAC. Among the 501 908 hospitalizations involving a brain tumor in the NIS, there were 102 046 occurrences of an AHRQ PSI, with 16% of patients experiencing one or more AHRQ PSI. Among brain tumor patients treated without surgery, 17.2% experienced ≥ 1 PSI. Among brain tumor patients treated with surgery, 9.8% experienced ≥ 1 PSI. The most common PSIs were postoperative respiratory failure, deep vein thrombosis, and sepsis. The total number of HACs associated with brain tumor patients was 13 778, with 2.63% of patients experiencing ≥1 HAC. Among brain tumor patients treated without surgery, 3.0% experienced ≥ 1 HAC. Among brain tumor patients treated with surgery, 7.4% experienced ≥ 1 HAC. The most common HACs were falls and trauma and pressure ulcers. Increasing comorbidity score was associated with increased likelihood of almost all PSIs and HACs. These data may be used to determine individual institutional improvements or success by comparison.

Insomnia Among Brain Tumor Patients: A Population-Based Prospective Study of Tumor Patients in Northern Finland

Patients with neurological diseases often suffer from sleep disturbances. Insomnia among adult brain tumor patients has usually been studied as part of quality-of-life studies, or some case reports on insomnia in these patients have been described. The authors aimed to study insomnia in a prospective study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality. Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery, Oulu University Hospital. The overall functional state of the patients was assessed by the Karnofsky Performance Scale, depression was measured by Beck Depression Inventory, and insomnia by Nottingham Health Profile. Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery. Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population, but level of insomnia significantly decreased as soon as 3 months after tumor operation. Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation. The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background.