Acceptability and feasibility of cognitive assessments with adults with primary brain cancer and brain metastasis: A systematic review

Abstract

Routine cognitive assessment for adults with brain cancers is seldom completed but vital for guiding daily living, maintaining quality of life, or supporting patients and families. This study aims to identify cognitive assessments which are pragmatic and acceptable for use in clinical settings. MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane were searched to identify studies published in English between 1990 and 2021. Publications were independently screened by two coders and included if they: (1) were peer-reviewed; (2) reported original data relating to adult primary brain tumour or brain metastases; (3) used objective or subjective assessments; (4) reported assessment acceptability or feasibility. The Psychometric And Pragmatic Evidence Rating Scale was used. Consent, assessment commencement and completion, and study completion were extracted along with author-reported acceptability and feasibility data. PROSPERO Registration: CRD42021234794. Across 27 studies, 21 cognitive assessments had been assessed for feasibility and acceptability; 15 were objective assessments. Acceptability data were limited and heterogeneous, particularly consent (not reported in 23 studies), assessment commencement (not reported in 19 studies), and assessment completion (not reported in 21 studies). Reasons for non-completion could be grouped into patient-factors, assessment-factors, clinician-factors, and system-factors. The three cognitive assessments with the most acceptability and feasibility data reported were the MMSE, MoCA, and NIHTB-CB. Further acceptability and feasibility data are needed including consent, commencement and completion rates. Cost, length, time, and assessor burden are needed for the MMSE, MoCA, and NIHTB-CB, along with potentially new computerised assessments suited for busy clinical settings.

Understanding experiences of cognitive decline and cognitive assessment from the perspectives of people with glioma and their caregivers: A qualitative interview study

“…Telephone interviews were conducted between 13th September 2021 and 8th March 2022 by a PhD Candidate (MC) with qualifications and skills in social science methods and experience in qualitative research with people with a cancer diagnosis and their caregivers. The interviewer (MC) is currently conducting PhD research exploring cognition with people with glioma and their caregivers and has had previous and ongoing contact with participants through another study piloting cognitive assessments ( Carlson et al, 2022 ). A semi-structured interview guide (See Supplementary File 2 ) was developed exploring: experiences, observations, and feelings about perceived or objectively measured changes in thinking and memory (or absence thereof); experiences of thinking and memory assessment, and; experiences of met and unmet supportive care needs related to changes in thinking and memory…”

“…Relatively little is known about how people with glioma and their caregivers experience cognitive changes, cognitive assessment, and associated support. A 2022 systematic review found limited data on the acceptability of cognitive assessment among people with glioma ( Carlson et al, 2022 ). A 2020 cross-sectional study by Wong et al involving older adults (50 years or older) from the general population, reported 92 % of participants had at least one worry about having their cognition assessed or returning concerning cognitive results ( Wong et al, 2020 ).…”