Abstract

Lower-grade gliomas (LrGGs) are rare tumors that mainly concern young adults, with an overall survival ranging from 5 to 20 years and without any curative treatment to date. LrGGs are frequently associated with psychological disorders and neurocognitive impairments, including memory and dysexecutive syndrome, that can negatively affect professional, familial and social functioning, ultimately reducing the patients' health-related quality of life (HRQoL). Maintaining an acceptable HRQoL is a key objective because survival outcomes tend to be better in patients with fewer psychopathological comorbidities and better HRQoL. Neuropsychological rehabilitation and cognitive behavioral therapy (CBT) have shown promising results in patients with neurological conditions, mental health disorders, and cancer. However, they are not routinely used in patients with LrGG, and onco-neuro-psychologists (i.e., neuro-psychologists trained in oncology) with expertise in neurocognition and CBT are lacking. The aim of this study protocol is to evaluate the efficacy of the remote FREEDOME program, which integrates CBT and a digital neurocognitive tool, in patients with LrGG who experience cognitive complaints post-therapeutic phase. This ongoing, prospective, open-label, multicenter, randomized trial (1:2) should include 187 patients with LrGG considered “stable” (12 months after surgery, 6 months after chemotherapy or radiotherapy) and who are not planned to receive any cancer treatment in the first 4 months after enrollment. The primary objective is to assess the FREEDOME program effects on perceived cognitive impairment at month 4 post-inclusion. Secondary objectives include patient adherence to the intervention, and effects on the subjective and objective neurocognitive functioning, HRQoL (including sleep, fatigue and return-to-work) and psychopathological symptoms over time. The study will also explore the intervention effects on the patient memory and irritability, as perceived by family caregivers. This study may represent an important step in the implementation of evidence-based neuropsychological interventions tailored to the specific needs of patients with LrGG. Clinical trial registration ClinicalTrials.gov: NCT06468176; ID-RCB: 2023-A02376-39.

Abstract

Abstract BACKGROUND Many patients with primary brain tumors suffer from cognitive deficits, which negatively impact their quality of life. However, cognitive rehabilitation programs for these patients are scarce. We developed an iPad-based cognitive rehabilitation program for brain tumor patients, which was based on our effective face-to-face cognitive rehabilitation program. After successful completion of a feasibility study, a randomized controlled trial has been started. OBJECTIVE To evaluate the immediate and long-term effects of the iPad-based program on cognitive performance and patient-reported outcome measures (PROMs) in patients with primary brain tumors in an early stage of the disease. METHODS Prior to surgery, patients with presumed low-grade glioma and meningioma are included. Before surgery and 3 mo after surgery, neuropsychological assessments are conducted. After the second neuropsychological assessment, patients are assigned to the intervention group or waiting-list control group. The intervention consists of psychoeducation, compensation training, and retraining. Patients are advised to spend 3 h per week on the program for 10 wk. Immediately after completion of the program and a half-year thereafter, postintervention assessments take place. Patients in the control group are offered the opportunity to follow the program after all study assessments. EXPECTED OUTCOMES We expect that early cognitive rehabilitation has beneficial effects on cognitive performance and PROMs in brain tumor patients. DISCUSSION The iPad-based program allows brain tumor patients to follow a cognitive rehabilitation program from their homes. Forthcoming results may contribute to further improvement of supportive care for brain tumor patients.

Abstract

Lower-grade gliomas (LrGGs) are rare tumors that mainly concern young adults, with an overall survival ranging from 5 to 20 years and without any curative treatment to date. LrGGs are frequently associated with psychological disorders and neurocognitive impairments, including memory and dysexecutive syndrome, that can negatively affect professional, familial and social functioning, ultimately reducing the patients' health-related quality of life (HRQoL). Maintaining an acceptable HRQoL is a key objective because survival outcomes tend to be better in patients with fewer psychopathological comorbidities and better HRQoL. Neuropsychological rehabilitation and cognitive behavioral therapy (CBT) have shown promising results in patients with neurological conditions, mental health disorders, and cancer. However, they are not routinely used in patients with LrGG, and onco-neuro-psychologists (i.e., neuro-psychologists trained in oncology) with expertise in neurocognition and CBT are lacking. The aim of this study protocol is to evaluate the efficacy of the remote FREEDOME program, which integrates CBT and a digital neurocognitive tool, in patients with LrGG who experience cognitive complaints post-therapeutic phase. This ongoing, prospective, open-label, multicenter, randomized trial (1:2) should include 187 patients with LrGG considered “stable” (12 months after surgery, 6 months after chemotherapy or radiotherapy) and who are not planned to receive any cancer treatment in the first 4 months after enrollment. The primary objective is to assess the FREEDOME program effects on perceived cognitive impairment at month 4 post-inclusion. Secondary objectives include patient adherence to the intervention, and effects on the subjective and objective neurocognitive functioning, HRQoL (including sleep, fatigue and return-to-work) and psychopathological symptoms over time. The study will also explore the intervention effects on the patient memory and irritability, as perceived by family caregivers. This study may represent an important step in the implementation of evidence-based neuropsychological interventions tailored to the specific needs of patients with LrGG. Clinical trial registration ClinicalTrials.gov: NCT06468176; ID-RCB: 2023-A02376-39.

Abstract

Abstract BACKGROUND Many patients with primary brain tumors suffer from cognitive deficits, which negatively impact their quality of life. However, cognitive rehabilitation programs for these patients are scarce. We developed an iPad-based cognitive rehabilitation program for brain tumor patients, which was based on our effective face-to-face cognitive rehabilitation program. After successful completion of a feasibility study, a randomized controlled trial has been started. OBJECTIVE To evaluate the immediate and long-term effects of the iPad-based program on cognitive performance and patient-reported outcome measures (PROMs) in patients with primary brain tumors in an early stage of the disease. METHODS Prior to surgery, patients with presumed low-grade glioma and meningioma are included. Before surgery and 3 mo after surgery, neuropsychological assessments are conducted. After the second neuropsychological assessment, patients are assigned to the intervention group or waiting-list control group. The intervention consists of psychoeducation, compensation training, and retraining. Patients are advised to spend 3 h per week on the program for 10 wk. Immediately after completion of the program and a half-year thereafter, postintervention assessments take place. Patients in the control group are offered the opportunity to follow the program after all study assessments. EXPECTED OUTCOMES We expect that early cognitive rehabilitation has beneficial effects on cognitive performance and PROMs in brain tumor patients. DISCUSSION The iPad-based program allows brain tumor patients to follow a cognitive rehabilitation program from their homes. Forthcoming results may contribute to further improvement of supportive care for brain tumor patients.

Abstract

OBJECTIVES This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors. METHODS Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. RESULTS The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive. CONCLUSIONS Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types. IMPLICATIONS FOR NURSING PRACTICE Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.

Abstract

OBJECTIVES This systematic review (PROSPERO CRD42021275421) synthesized evidence on the efficacy of cognitive rehabilitation on cognitive and functional outcomes in adult cancer survivors. METHODS Articles were identified though PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science from inception through June 30, 2023. Studies included participants ≥18 years old, diagnosed with cancer. Primary outcomes were validated measures of subjective and objective cognition. Articles were dual reviewed for eligibility and data extraction. Risk of bias was assessed with the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. RESULTS The search yielded 3,811 articles; 65 full-text articles were reviewed; 53 articles (15 cognitive training, 14 strategy-based, 21 combinations, three inpatient rehabilitation), representing 52 unique studies, were included. Positive effects were observed in at least one objective cognitive measure in 93% of strategy training, 81% of cognitive training, 79% of combination rehabilitation interventions. Positive effects were observed in subjective cognition in 100% of strategy training, 55% of cognitive training, and 92% of combination interventions. Among studies with comparator groups, processing speed improved in 60% of cognitive training studies, while strategy training did not improve processing speed; otherwise, cognitive domain effects were similar between intervention types. Impact on functional outcomes was inconclusive. CONCLUSIONS Cognitive rehabilitation appear beneficial for cancer-related cognitive impairment (CRCI). Differential effects on specific cognitive domains (eg, processing speed) and subjective cognition may exist between intervention types. IMPLICATIONS FOR NURSING PRACTICE Nurses should increase patient and provider awareness of the benefits of cognitive rehabilitation for CRCI.

Abstract

Abstract Background Awake craniotomy is essential for glioma resection in functionally integrated brain regions, allowing real-time monitoring to reduce cognitive and emotional deficits. Although widely used, its long-term neuropsychological effects remain debated. This systematic review aims to investigate cognitive and emotional outcomes after awake brain surgery and the factors that influence recovery, including extent of resection, follow-up timing, and neural plasticity. Methods This systematic review analyzes 34 studies on pre- and postoperative functional outcomes in glioma patients undergoing awake surgery. Following PRISMA guidelines, studies were selected with adult glioma patients (WHO grade I-IV) who had neuropsychological assessments before and after surgery. Data on preoperative cognitive profiles, recovery trajectories, and follow-up durations were examined, focusing on methodological consistency and assessment tools. Results The findings demonstrated substantial variability in functional outcomes, with many patients recovering within 3 to 6 months post-surgery, while others experienced persistent deficits. Functional recovery was influenced not only by the extent of tumor resection but also by network-level reorganization. Methodological inconsistencies in neuropsychological assessments highlighted the need for standardized, personalized evaluation protocols, emphasizing the importance of comprehensive functional assessments. Conclusions This review emphasizes the shift from a localized cortical approach to a dynamic, network-based view of cognitive and emotional recovery. It calls for standardized, personalized neuropsychological assessments to optimize rehabilitation, along with extended follow-ups, and multidisciplinary care for long-term quality of life. Future research should refine assessment methods and strategies to better understand neuroplasticity and improve clinical outcomes in neuro-oncology.

Abstract

Abstract Background Awake craniotomy is essential for glioma resection in functionally integrated brain regions, allowing real-time monitoring to reduce cognitive and emotional deficits. Although widely used, its long-term neuropsychological effects remain debated. This systematic review aims to investigate cognitive and emotional outcomes after awake brain surgery and the factors that influence recovery, including extent of resection, follow-up timing, and neural plasticity. Methods This systematic review analyzes 34 studies on pre- and postoperative functional outcomes in glioma patients undergoing awake surgery. Following PRISMA guidelines, studies were selected with adult glioma patients (WHO grade I-IV) who had neuropsychological assessments before and after surgery. Data on preoperative cognitive profiles, recovery trajectories, and follow-up durations were examined, focusing on methodological consistency and assessment tools. Results The findings demonstrated substantial variability in functional outcomes, with many patients recovering within 3 to 6 months post-surgery, while others experienced persistent deficits. Functional recovery was influenced not only by the extent of tumor resection but also by network-level reorganization. Methodological inconsistencies in neuropsychological assessments highlighted the need for standardized, personalized evaluation protocols, emphasizing the importance of comprehensive functional assessments. Conclusions This review emphasizes the shift from a localized cortical approach to a dynamic, network-based view of cognitive and emotional recovery. It calls for standardized, personalized neuropsychological assessments to optimize rehabilitation, along with extended follow-ups, and multidisciplinary care for long-term quality of life. Future research should refine assessment methods and strategies to better understand neuroplasticity and improve clinical outcomes in neuro-oncology.

Abstract

Abstract The astroblastomas are brain tumors with low prevalence and high degree of malignancy, which originate in the glial tissue, more specifically in the astrocytes. Although they are more frequent in young adults, there are some juvenile cases flagged and their recovery is generally uncertain. The goal of this study is to report the therapeutic effects of neuropsychological rehabilitation in a young 15-year-old child after the diagnosis and surgical removal of an astroblastoma. The child manifested some difficulties in specific areas (attention- concentration, memory, motivation) and depressive symptoms. The patient underwent a neuropsychological stimulation protocol, which consisted of 1-hour sessions of the monitored practice of stimulating tasks adapted to their needs accompanied by activities to perform at home. There was an improvement in the overall results as well as a decrease in depressive symptoms. The results suggest that neuropsychological intervention has a positive impact on the rehabilitation process of young people. Keywords: Gliomas, Astroblastoma, Neuropsychological Intervention.

Abstract

: Background: Brain tumors profoundly affect physical, cognitive, and emotional health. While surgical resection, radiotherapy, and chemotherapy remain the primary treatments, they often result in complications like muscle weakness, coordination deficits, and fatigue. Comprehensive rehabilitation, including neuro - physiotherapy, cognitive training, and psychosocial support, has shown potential to enhance recovery and quality of life. Methods: A brief review of the literature was conducted using PubMed, Google Scholar, and ResearchGate, restricted to English - language clinical trials, randomized controlled trials, and case studies published within the last decade. Of the 28 articles retrieved, 14 were included, comprising 8 clinical trials and 6 case studies. Results: Clinical trials demonstrated that exercise therapy, mind - body practices, and cognitive rehabilitation significantly improve physical fitness, cognitive function, and quality of life. High - intensity exercise was feasible even during aggressive glioblastoma treatments, while targeted neuro - physiotherapy enhanced motor function in low - grade tumor patients. Case studies highlighted individualized regimens, including vestibular rehabilitation and strengthening exercises, yielding improvements in balance, gait, and daily functionality. Conclusions: Rehabilitation interventions tailored to tumor type and stage improve physical and emotional well - being, functional independence, and overall quality of life. Holistic, personalized approaches should be integrated into standard care, though further research is needed to establish standardized protocols.

Abstract

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer diagnosis. Cognitive late effects develop in 20%–40% of ALL survivors, but the course of declines is unclear. The aim of this paper is to characterize cognitive functioning, and its association with patient‐reported outcomes, early in treatment.

Abstract

Abstract The astroblastomas are brain tumors with low prevalence and high degree of malignancy, which originate in the glial tissue, more specifically in the astrocytes. Although they are more frequent in young adults, there are some juvenile cases flagged and their recovery is generally uncertain. The goal of this study is to report the therapeutic effects of neuropsychological rehabilitation in a young 15-year-old child after the diagnosis and surgical removal of an astroblastoma. The child manifested some difficulties in specific areas (attention- concentration, memory, motivation) and depressive symptoms. The patient underwent a neuropsychological stimulation protocol, which consisted of 1-hour sessions of the monitored practice of stimulating tasks adapted to their needs accompanied by activities to perform at home. There was an improvement in the overall results as well as a decrease in depressive symptoms. The results suggest that neuropsychological intervention has a positive impact on the rehabilitation process of young people. Keywords: Gliomas, Astroblastoma, Neuropsychological Intervention.

Abstract

: Background: Brain tumors profoundly affect physical, cognitive, and emotional health. While surgical resection, radiotherapy, and chemotherapy remain the primary treatments, they often result in complications like muscle weakness, coordination deficits, and fatigue. Comprehensive rehabilitation, including neuro - physiotherapy, cognitive training, and psychosocial support, has shown potential to enhance recovery and quality of life. Methods: A brief review of the literature was conducted using PubMed, Google Scholar, and ResearchGate, restricted to English - language clinical trials, randomized controlled trials, and case studies published within the last decade. Of the 28 articles retrieved, 14 were included, comprising 8 clinical trials and 6 case studies. Results: Clinical trials demonstrated that exercise therapy, mind - body practices, and cognitive rehabilitation significantly improve physical fitness, cognitive function, and quality of life. High - intensity exercise was feasible even during aggressive glioblastoma treatments, while targeted neuro - physiotherapy enhanced motor function in low - grade tumor patients. Case studies highlighted individualized regimens, including vestibular rehabilitation and strengthening exercises, yielding improvements in balance, gait, and daily functionality. Conclusions: Rehabilitation interventions tailored to tumor type and stage improve physical and emotional well - being, functional independence, and overall quality of life. Holistic, personalized approaches should be integrated into standard care, though further research is needed to establish standardized protocols.