Nadine M Richard1, Lori J Bernstein1,2, Warren P Mason3,4, Normand Laperriere5,6, Catherine Maurice3,4, Barbara-Ann Millar5,6, David B Shultz5,6, Alejandro Berlin5,6, Kim Edelstein7,8,9. 1. Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. 2. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 3. Department of Haematology Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. 4. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 5. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. 6. Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 7. Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada. kim.edelstein@uhn.ca. 8. Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada. kim.edelstein@uhn.ca. 9. Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Avenue Room 18-716, Toronto, ON, M5G 2M9, Canada. kim.edelstein@uhn.ca.
Abstract
PURPOSE:Patients with brain tumors face unique quality of life challenges. Executive dysfunction is common and functionally limiting, with no established treatments as standard care. This pilot study evaluated the efficacy of Goal Management Training (GMT), a behavioral intervention combining mindfulness and strategy training, for improving executive and real-life functioning in this population. METHODS:Twenty-five primary brain tumor survivors were randomized to GMT, an active control (Brain Health Program, BHP), or a wait-list (WAIT) control group. The BHP was a supportive care intervention offering education and activities to promote general brain health, without cognitive strategy training. Participants in GMT and BHP completed eight individual sessions and homework between sessions; those in WAIT received usual care. Assessments at baseline, immediately post-training, and 4-month follow-up used a battery of objective and subjective measures, including functional goal attainment. RESULTS:Adherence (% sessions completed) was high for both GMT (98.9%) and BHP (84.4%). Executive functions improved with GMT but not BHP or WAIT (repeated measures analysis of variance, time-by-group interaction, post-training P = 0.077, follow-up P = 0.046). Both intervention groups reported fewer cognitive concerns at post-training (P = 0.049) and follow-up (P < 0.001). Functional goal attainment was greatest with GMT (post-training P = 0.027, follow-up P = 0.064). CONCLUSIONS:GMT improved executive and real-life functioning in brain tumor survivors, with gains maintained at 4-month follow-up. Clinical implementation of this adaptable program merits consideration for clinically stable patients with cognitive dysfunction. Further development and larger prospective cognitive rehabilitation trials appear warranted.
RCT Entities:
PURPOSE:Patients with brain tumors face unique quality of life challenges. Executive dysfunction is common and functionally limiting, with no established treatments as standard care. This pilot study evaluated the efficacy of Goal Management Training (GMT), a behavioral intervention combining mindfulness and strategy training, for improving executive and real-life functioning in this population. METHODS: Twenty-five primary brain tumor survivors were randomized to GMT, an active control (Brain Health Program, BHP), or a wait-list (WAIT) control group. The BHP was a supportive care intervention offering education and activities to promote general brain health, without cognitive strategy training. Participants in GMT and BHP completed eight individual sessions and homework between sessions; those in WAIT received usual care. Assessments at baseline, immediately post-training, and 4-month follow-up used a battery of objective and subjective measures, including functional goal attainment. RESULTS: Adherence (% sessions completed) was high for both GMT (98.9%) and BHP (84.4%). Executive functions improved with GMT but not BHP or WAIT (repeated measures analysis of variance, time-by-group interaction, post-training P = 0.077, follow-up P = 0.046). Both intervention groups reported fewer cognitive concerns at post-training (P = 0.049) and follow-up (P < 0.001). Functional goal attainment was greatest with GMT (post-training P = 0.027, follow-up P = 0.064). CONCLUSIONS:GMT improved executive and real-life functioning in brain tumor survivors, with gains maintained at 4-month follow-up. Clinical implementation of this adaptable program merits consideration for clinically stable patients with cognitive dysfunction. Further development and larger prospective cognitive rehabilitation trials appear warranted.
Entities:
Keywords:
Goal Management Training; Neuro-oncology; Neuropsychology; Quality of life; Supportive care
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