Exploring Compensation to Maintain Cognitive Function in Adults Newly Diagnosed With Brain Cancer
Condition: Primary Brain Tumor; Brain Metastases, Adult
MeSH terms: Brain Neoplasms
Study type: Observational

Summary: 
      Recent research indicates that variability in cognitive function for brain tumor survivors
      may be explained by differences in cognitive reserve (CR) and use of compensatory
      strategies.However, it is unknown when cognitive function declines or survivors tap into
      compensation. This longitudinal mixed methods study proposes to explore differences in
      cognitive function and change over time in newly diagnosed adults with brain cancer prior to,
      immediately after (within 2 weeks), and 2-3 months after radiation therapy treatment has been
      completed.

      Specific aims are to:

      Aim1: Examine the relationship between objective and subjective cognitive function in
      subjects newly diagnosed with brain cancer prior to and after XRT.

      Aim 2: Explore the interrelationship between cognitive function and compensation (neural and
      behavioral) by high/low CR prior to and after XRT.

      Aim 3: Describe the trajectory of objective and subjective cognitive function over time by
      CR, cancer type, and associated treatment-related factors.
    

Detailed description: 
      Cognitive impairments experienced by cancer survivors, from time of diagnosis through the
      health trajectory, are distressing, persistent, and negatively impact everyday function and
      quality of life. While reports of cancer- and treatment-related cognitive concerns vary
      substantially and may be underestimated in some diagnoses, the estimated incidence ranges
      from 30% in breast cancer up to 90% in brain cancers. Those with brain cancers, including
      both primary brain tumors and secondary brain metastases, often receive news of their
      diagnosis during prime productive years of their lives. Due to the cognitive effects from
      cancer or its treatment, most brain cancer survivors report difficulties returning to work or
      maintain family demands. Survivors often report co-occurring symptoms or a symptom cluster
      that include fatigue, sleep and mood disturbances, adding to multimorbidity conditions from
      the psychoneuroimmunologic effects of cancer. As medical advances have fostered significant
      gains in cancer survivorship and cancer is now recognized as a chronic illness, there is an
      urgency to address commonly faced symptoms and chronic conditions throughout the cancer
      trajectory beginning at time of diagnosis.

      Cancer treatment is designed to induce cell death but when treating brain cancers, treatment
      may negatively impact neurogenesis and neural repair. Previous study indicates that some
      survivors of brain tumors use behavioral compensation, the investigators aim to understand
      how neural compensation may be impacted. Cognitive functions associated with biomarkers
      (NComp) are brain-derived neurotrophic factor (BDNF), catechol-O-methyl transferase (COMT).
      As survival rises, the investigators need to identify factors that moderate cognitive
      function in order to develop interventions aimed at minimizing functional decline.

      This study is significant as it: 1) describes cognitive variability decline over time, and
      use of N/BComp; 2) uniquely explores cognition and N/BComp over time; 3) explores moderators
      of cognitive function across brain cancer survivors, 4) may lead to developing targeted
      cognitive interventions.

      Cognitive function impacts everyday functional abilities and quality of life, however, change
      in cognition can elude detection. Discrepancies observed between subjective and objective
      cognitive, co-occurring symptoms, and its relationship with cognitive reserve are new
      research areas of interest in oncology. Exploring neural or behavioral compensation within
      the context of cognitive reserve is novel. No known oncology studies have reported the
      relationship of neural and behavioral compensation with change in cognitive function over
      time. Examining the trajectory of these variables can aid in identifying potential cognitive
      interventions for targeted use to prevent decline or maintain function over time.

      This study is innovative because it is the first to explore the interface of
      neural/behavioral compensation and the cognitive trajectory, within a framework of cognitive
      reserve, in adults newly diagnosed with brain cancers.
    

Intervention name(s): Neuropsychological Testing
Intervention type(s): Other
Intervention description(s): Measure cognition function and cognitive reserve in patients before, during and after radiation therapy using cumulative scores of Hollingshead Index, North American Adult Reading Test, HVLT-R, TMT A&B and COWA over time.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study participants will be recruited from the appropriate clinics within a large academic
        health care setting.
      
Biospecimen description: 
      Blood samples will be collected for biomarker testing: ELISA ( optional gentyping), BDNF and
      COMT