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The thesis has been prepared in a paper-based format and includes three papers: Paper 1, a systematic review; Paper 2, an empirical study; and Paper 3, a critical appraisal and reflection on the work. Paper 1 has been prepared for submission to Neuro-Oncology. The paper presents a systematic review of 21 studies concerning the relationships of demographic, clinical and mental health factors on health-related quality of life (HRQoL) and psychological functioning in adults with primary malignant brain tumours. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. Methodological qualities of studies included were appraised using a checklist based on the Newcastle-Ottawa Scale (Wells et al, n.d.).Findings were synthesised narratively adhering to published guidelines (Popay et al, 2006). The review identified evidence for factors relating to HRQoL and psychological functioning, offered several considerations for clinical practice, and outlined recommendations for improving the methodological rigour of future research. Paper 2 has been prepared for submission to Psycho-Oncology and presents the findings of a qualitative study of patients’ psychological adjustment to glioblastoma, the most aggressive and most common form of brain tumour in adults. Semi-structured interviews were conducted with 10 participants 3.3-5.1 months post-diagnosis. Data were analysed using a constructivist grounded theory methodology (Charmaz, 2014). Analysis yielded three theoretical categories describing processes of maintaining continuity with the past, reframing the present and changing to accommodate an uncertain future. The implications of these findings on current supportive interventions are discussed. Paper 3 is not intended for publication. It offers a critical appraisal of the individual papers and the research process overall, considering their strengths and limitations. The paper also discusses issues of reflexivity encountered during the empirical study, and considers the implications of this research for the author’s professional development as a clinical psychologist.

Thesis Abstract An Investigation of Cognitive Deficits Related to Surgery for Glioblastoma using a Computerised Assessment Tool - Rohitashwa Sinha Glioblastoma, the most aggressive type of primary brain cancer, causes abysmal survival rates and high risks of cognitive deficit to its sufferers. These deficits are due to both its being diffusely infiltrative and its radical treatments such as brain surgery and radiotherapy. Currently the course of cognitive deficits from before to after surgery has not been reliably researched. Studies report high rates of drop-out due to burdensome 'pen-and-paper' based assessments conducted by neuropsychologists, a lack of these resources entirely or the data collection being focused on the period around radiotherapy or less aggressive tumours instead. As a result, patients still undergo resection surgery for glioblastoma without a reliable evidence base for making their treatment decisions, without any assessment for their cognitive deficit burden and without any targeted interventions to protect their cognitive function. In this doctoral research, I have set up a prospective study to assess cognitive function before and after resection surgery, but before radiotherapy and with particular focus on participants with glioblastoma who have been underserved by current infrastructure and research focus. The methodology involves using a computerised testing battery called 'OCS-Bridge', which has broadened the access to such cognitive assessments. Participant retention has been higher than in the literature. This may be due in part to the efficiency of the format as well as the study design for data collection, where assessment timepoints were advised by patients and carers rather than clinicians. Using a variety of analysis techniques, this thesis progresses through a systematic review confirming the lack of reliable consensus in this area and a format comparison study to support the use of OCS-Bridge by comparison to conventional testing. Next, machine learning and Kaplan-Meier analyses are used to show cognitive deficits as predictors of clinical outcomes including overall survival. The longitudinal analyses of the high peri-operative odds of cognitive deficits until radiotherapy follows. Finally, a tract based spatial statistics study using diffusion tensor MRI brain scans demonstrates that a common anatomical mechanism exists, affecting the same right hemisphere white matter tracts underlying social cognition deficits in participants with glioblastoma as is seen in traumatic brain injury and neurodegenerative disease contexts. 3 By contributing new knowledge, research methodology, immediately translational implications for clinical practice and by linking the mechanisms of cognitive deficits between glioblastoma and other neurological diseases, the results herein have already secured further research funding. This future work will build on the understanding of cognitive deficits presented here and to trial a targeted rehabilitation intervention to help people with glioblastoma and their families.