Cognitively Engaging Activities Often Discontinued After Treatment of Primary Brain Tumors
Advancements in brain tumor treatment have increased survival rates, but cognitive issue persist after treatment.
|The following article features coverage from the 2017 Oncology Nursing Society's Annual Conference in Denver, Colorado. Click here to read more of Oncology Nurse Advisor's conference coverage.|
Survivors of primary brain tumors (PBTs) tend to freely discontinue cognitively engaging activities to compensate for diminishing cognitive function after treatment completion, according to a poster presentation at the 2017 Oncology Nursing Society Annual Meeting.
Advances in the treatment of primary brain tumors have improved survival rates, increasing surveillance of late effects in patients. Cognitive complaints, for example, persist among adult survivors of PBT after treatment is completed.
Although neuropsychological evaluations and subjective complaints have been the focus of some research, little is known about compensatory strategies/behaviors (CS/B) survivors of PBT use to perform cognitive tasks of daily living. Therefore, a team of researchers in North Carolina sought to describe CS/B used by survivors of PBT during cognitive evaluations compared with a group of matched healthy controls, and to explore the relationship of cognitive reserve in the context of CS/B use.
“By identifying compensatory behaviors that adult survivors of PBT use during cognitive evaluations, as well as their engagement in daily cognitive activities, we can begin to determine which strategies may aid or hamper cognitive processes and everyday function,” explained Deborah Allen, PhD, RN, CNS, FNP-BC, AOCNP, at Duke Cancer Institute in Durham, North Carolina.
For the study, the researchers enrolled participants who scored higher than 24 on MMSE, completed oncology treatment at least 1 year prior, and their tumor status was stable. Using a cross-sectional descriptive-exploratory design, participants completed a structured 100-minute session that included subjective assessments of cognitive function, symptom presence, and quality of life, and a neuropsychological battery.
In addition, a subset of 7 PBT survivors completed a video-recorded 30-minute interview in which they discussed their perceptions of their everyday function and how it changed since their diagnosis. Participants in this subset were an average of 50 years old (standard deviation [SD] 9.7), 57% were women, and they had completed 12 years education. The PBT in this group was high-grade gliomas, and participants were 2 to 15 years post diagnosis.
A group of 7 healthy adults, matched for age, gender, and education, were recruited. The healthy participants were video-recorded completing the same study session for behavioral comparison, and were interviewed for their perceptions of their everyday function.
Objective and subjective cognitive impairment/complaints were reported more frequently in the PBT group, specifically deficits in the memory and attention domains. The PBT group also rated their cognitive impairment/complaints as more severe than did the healthy group.
Cognitive strategies/behaviors used by the PBT group included purposeful counting, repeating instructions, and storytelling throughout the session. They also required more time to complete tasks.
The PBT group reported performing an average of 5 cognitively engaging activities a week, whereas the healthy group reported 11 activities per week. Furthermore, the PBT group reported discontinuing 4 to 12 cognitively engaging activities since their diagnoses.
Participants in the PBT group who had lower cognitive reserve had greater cognitive impairment, reported more symptoms, and had discontinued more cognitively engaging activities.
“By identifying CS/B that adult survivors of PBT use during cognitive evaluations, as well as their engagement in daily cognitive activities, we can begin to determine which strategies may aid or hamper cognitive processes and everyday function,” the researchers said. These determinations may also lead to identifying those at greater cognitive risk so early interventions can be initiated in these patients.
Read more of Oncology Nurse Advisor's coverage of the 2017 Oncology Nursing Society's Annual Conference by visiting the conference page.
1. Allen D, Neelon V, Smith S. Exploring compensatory behaviors used to maintain cognitive function in adult survivors of primary brain tumor. Poster presentation at: Oncology Nursing Society 42nd Annual Congress; May 4-7, 2017; Denver, CO.