Cognitive impairment three months after surgery is an independent predictor of survival time in glioblastoma patients

Abstract

Purpose Cognitive functioning is increasingly investigated for its prognostic value in glioblastoma (GBM) patients, but the association of cognitive status during early adjuvant treatment with survival time is unclear. The aim of this study was to determine whether cognitive performance three months after surgical resection predicted survival time, while using a clinically intuitive time ratio (TR) statistic. Methods Newly diagnosed patients with GBM undergoing resection between November 2010 and February 2018 completed computerized cognitive assessment 3 months after surgery with the CNS Vital Signs battery (8 measures). The association of cognitive performance (continuous Z scores and dichotomous impairment status; impaired vs. unimpaired) with survival time was assessed with multivariate Accelerated Failure Time (AFT) models that also included clinical prognostic factors and covariates related to cognitive performances. Results 114 patients were included in the analyses (median survival time 16.4 months). Of the clinical factors, postoperative Karnofsky Performance Status (TR 1.51), surgical (TR 2.20) and non-surgical (TR 1.94) salvage treatment, and pre-surgical tumor volume (cm 3 , TR 1.003) were significant independent predictors of survival time. Independently of the base model factors and covariates, impairment on Stroop test I and Stroop test III estimated 23% and 26% reduction of survival time (TR 0.77, TR 0.74) respectively, as compared to unimpaired performance. Conclusion These findings suggest that impaired performances on tests of executive control and processing speed in the early phase of adjuvant treatment can reflect a worse prognostic outlook rather than an early treatment effect, and their assessment might allow for early refinement of current prognostic stratification.

A Prospective Study of Longitudinal Risks of Cognitive Deficit for People Undergoing Glioblastoma Surgery Using a Tablet Computer Cognition Testing Battery: Towards Personalized Understanding of Risks to Cognitive Function

“…For the first time, we showed the ‘natural history’ of the deficits in glioblastoma changing from before surgery to early after surgery and then to before adjuvant chemotherapy and radiotherapy at 4–6 weeks after surgery. Three recent studies focusing on glioblastoma had their earliest post-surgical assessment time at 3 months [ 18 , 19 , 54 ], so the current study explains the picture in-between. They found that the majority of those that were retained for reassessment at 3 months were ‘stable’ when compared to their performance before surgery.…”

“…Aside from the study results, the methods employed of using computerized cognition testing batteries are very generalizable to other neuro-oncology and general oncology contexts. Such tools have automated comparison to healthy normative control data for rapid analysis of individual performance into normal and deficit categories, as has been demonstrated in other studies [ 8 , 18 , 19 , 54 ]. Our patient and public involvement advice prior to the start of this study advised using these tools on presurgical assessment visits for A1 datasets, prior to discharge home after surgery, or before clinic visit for histology results for A2 datasets and alongside radiotherapy planning visits for A3 datasets.…”

Supportive care of patients diagnosed with high grade glioma and their carers in Australia

“…Only some patients were referred to mental health services, with some only available through external providers, presenting an access barrier. Australian clinical practice guidelines and OCPs indicate early consistent psychosocial care of brain cancer patients and their carers is critical [ 10 , 18 , 24 , 25 ]. Most cognitive rehabilitation intervention programs reported improvements in patients' cognitive test-performance [ 26 ] and could be considered for inclusion in psychosocial care of HGG patients.…”

A systematic review of the use of subcortical intraoperative electrical stimulation mapping for monitoring of executive deficits and neglect: what is the evidence so far?

“…The rationale for intraoperative mapping of these latter functions is that cognitive and visuospatial impairments occur relative frequently among patients with glial tumours, both before and after surgery [ 69 ]. Several studies demonstrated that executive function impairments three months after surgery in glioma patients are frequent [ 14 , 61 ]. More specifically, a recent study showed that long-lasting executive function impairments in low-grade glioma patients are related to surgical disconnections of frontal and parietal white matter pathways [ 17 ].…”