Abstract A029: Use and predictors of perceived cognitive function using the Neuro-QoL perceived cognitive function scale in patients with primary brain tumors
Authors: Johnson Morgan L. , Vera Elizabeth , Reinhart Kimberly , Miller Hope , Choi Anna , Kunst Tricia , Reyes Jennifer , Mendoza Tito , Armstrong Terri S. 
Published: March 2024

Abstract
Background: Cognitive dysfunction is a commonly reported symptom in the primary brain tumor (PBT) population but is associated with substantial heterogeneity in both the course and severity. Brief, reliable, and sensitive measures of patient-perceived impact of cognitive symptoms are needed for clinical care and research. This study aims to describe the prevalence and predictors of cognitive dysfunction in PBT patients enrolled in a natural history study (NCT02851706: PI T. Armstrong). Methods: Clinical and demographic characteristics and patient-reported outcomes (PRO), including symptom burden (MD Anderson Symptom Inventory-Brain Tumor (MDASI-BT) using symptom burden, interference, and cognitive symptom factor scores); perceived cognition (Neuro-QoL Cognitive Function); and anxiety/depression (Patient-Reported Outcomes Measurement Information System Anxiety and Depression Short Forms) were collected and characterized using descriptive statistics. Neuro-QoL Cognitive Function T-scores &lt; 40 indicate moderate-severe (MS) cognitive dysfunction. Univariate tests on cognitive dysfunction included chi-square tests and independent samples t-tests with p-value &lt; 0.10. Variables significantly associated with MS outcome were then included in a subsequent multivariate logistic regression with backward selection. Clinical variables and PROs were evaluated separately, then combined for a final multivariate model with p-value &lt; 0.05. Results: The cohort included 327 patients [median age: 47 years (range: 18-85), primarily white (78%) males (55%) with high-grade tumors (73%), most commonly with glioblastoma (36%), with 26% reporting cognitive dysfunction as a presenting symptom]. Sixty-five percent had a Karnofsky Performance Status (KPS) ≥ 90, 73% had received radiation, and 44% had experienced one or more tumor recurrences. MS cognitive dysfunction was reported in 29% of patients. At the univariate level, age, employment status, cognitive symptoms at presentation, current corticosteroid use, anti-convulsant use, KPS, and number of surgeries were significant clinical predictors of MS cognitive dysfunction; as were, separately, worsening symptom burden, interference, cognitive symptom factor, anxiety, and depression. Evaluated together, a final multivariate model found increasing scores on symptom interference and cognitive symptom factor increased the likelihood of MS cognitive dysfunction (interference OR=1.25, 95% CI [1.09, 1.44], p&lt;0.001; cognitive symptom factor OR=1.81, 95% CI [1.50, 2.19], p&lt;0.001) with 84% classification rate. Conclusion: Understanding the impact and prevalence of cognitive functioning is essential for PBT patient care and identifying supportive care interventions. Findings indicate self-report of cognitive symptoms and interference of symptoms with daily living contribute to moderate-to-severe cognitive dysfunction. Future research in cognitive function will compare self-report with objective assessment, explore its predictors in select populations (i.e., IDH-mutant tumors), and examine its association with biomarkers.
Citation Format: Morgan L. Johnson, Elizabeth Vera, Kimberly Reinhart, Hope Miller, Anna Choi, Tricia Kunst, Jennifer Reyes, Tito Mendoza, Terri S. Armstrong. Use and predictors of perceived cognitive function using the Neuro-QoL perceived cognitive function scale in patients with primary brain tumors [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr A029.