Neuro-oncology inclusion in psychotherapeutic intervention trials: learning which cognitive adaptations could support patient engagement?

Abstract BACKGROUND Many patients with brain tumors experience double vulnerability—significant emotional distress coupled with cognitive decline—however, these cognitive changes often prohibit their inclusion in psychotherapeutic interventions that might otherwise improve their wellbeing. The primary goal of this analysis was to understand how best to accommodate the neurocognitive needs of patients with brain tumors so that they may effectively participate in future psychotherapeutic interventions. Our secondary goal was to assess potential differences in desired cognitive adaptations between patients with primary compared to metastatic brain tumors. METHODS In two recently completed Phase 2 proof-of-concept trials, patients with both primary and metastatic brain tumors (N = 27) participated in a 3-month psychotherapeutic intervention, Managing Cancer and Living Meaningfully (CALM). During exit interviews, participants reported whether evidence-informed accommodations would support their cognitive limitations and enhance engagement in future trials. Additionally, trial interventionists identified which accommodations were used in each session. RESULTS Participants recommended several accommodations: appointment reminders (100%), topic refreshers (94%), prior session summaries (88%), visual handouts (82%), time for consolidation (71%), transcription notepads (65%), and questionnaire completion assistance (24%). Interventionists documented using appointment reminders (66%), topic refreshers (53%), prior session summaries (60%), and time for consolidation (60%) in more than half of sessions. Visual handouts (2%), notepads (0%), and questionnaire assistance (17%) were rarely or never used. CONCLUSIONS: RESULTS were similar across the two brain tumor populations surveyed: primary and metastatic brain tumors. Accommodations that were recommended by patients and used by interventionists included: (1) appointment reminders to support session attendance, (2) topic refreshers and prior session summaries to support memory, and (3) additional time to assist with slower processing and support comprehension. Implementing supportive cognitive strategies is vital when promoting neuro-oncology inclusion in psychotherapeutic interventions and meeting the needs of this underserved population.