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ObjectiveThis study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population.MethodsTwo cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression.ResultsThe DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety.Significance of resultsThe DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.

Background A diagnosis of cancer may increase mortality salience and provoke death-related distress. Primary brain tumor (PBT) patients may be at particular risk for such distress given the certainty of tumor progression, lack of curative treatments, and poor survival rates. This study is the first to examine the prevalence of death-related distress and its correlates in PBT patients. Methods Adult PBT patients (N = 105) enrolled in this cross-sectional study and completed the Death Distress Scale (subscales: Death Depression, Death Anxiety, Death Obsession), Generalized Anxiety Disorder–7, and Patient Health Questionnaire–9. Prevalence and predictors of death-related distress, and the relationships of demographic variables to clusters of distress, were explored. Results The majority of PBT patients endorsed clinically significant death-related distress in at least one domain. Death anxiety was endorsed by 81%, death depression by 12.5%, and death obsession by 10.5%. Generalized anxiety was the only factor associated with global death-related distress. Cluster analysis yielded 4 profiles: global distress, emotional distress, resilience, and existential distress. Participants in the resilience cluster were significantly further out from diagnosis than those in the existential distress cluster. There were no differences in cluster membership based on age, sex, or tumor grade. Conclusions PBT patients appear to have a high prevalence of death-related distress, particularly death anxiety. Further, 4 distinct profiles of distress were identified, supporting the need for tailored approaches to addressing death-related distress. A shift in clusters of distress based on time since diagnosis also suggest the need for future longitudinal assessment.

BACKGROUND: CogMed Working Memory Training (CWMT) is a computer-based program shown to improve working memory (WM) among those with cognitive impairments. No study to date has investigated its feasibility, acceptability, and satisfaction in adult patients with glioma, despite the well-documented incidence of WM impairment in this population. METHODS: Twenty patients with glioma and objective and/or perceived WM deficits enrolled in the study: 52% high-grade, 60% female, Mage = 47 (range = 21–72 years). Adverse events were monitored to determine safety. Feasibility and acceptability were assessed based on established metrics. Satisfaction was explored by exit-interviews. Neurocognitive tests and psychological symptoms were analyzed at baseline and post-CWMT to estimate effect sizes. RESULTS: Of 20 enrolled patients, 16 completed the intervention (80% retention rate). Reasons for withdrawal included time burden (n = 2); tumor-related fatigue (n = 1) or loss to follow-up (n = 1). No adverse events were determined to be study-related. Adherence was 69% with reasons for nonadherence similar to those for study withdrawal. The perceived degree of benefit was only moderate. Baseline to post-CWMT assessments showed medium to large effects on neurocognitive tasks. Psychological symptoms remained stable throughout the study period. CONCLUSIONS: CWMT was found to be safe and acceptable in adult patients with glioma. Enrollment, retention rates, and treatment adherence were all adequate and comparable to studies recruiting similar populations. Only moderate perceived benefit was reported despite demonstrated improvements in objectively-assessed WM. This may indicate that the time commitment and intervention intensity (5 weeks of 50-min training sessions on 5 days/week) outweighed the perceived benefits of the program. (Trial Registration Number: NCT03323450 registered on 10/27/2017).

Autoimmune polyendocrine syndrome type 1 (APS-1) is a rare but severe monogenetic autoimmune endocrine disease caused by failure of the Autoimmune Regulator (AIRE). AIRE regulates the negative selection of T cells in the thymus, and the main pathogenic mechanisms are believed to be T cell-mediated, but little is known about the role of B cells. Here, we give an overview of the role of B cells in thymic and peripheral tolerance in APS-1 patients and different AIRE-deficient mouse models. We also look closely into which autoantibodies have been described for this disorder, and their implications. Based on what is known about B cell therapy in other autoimmune disorders, we outline the potential of B cell therapies in APS-1 and highlight the unresolved research questions to be answered.

Background The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients’ home (DTH) had minimal prior study. Methods We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020. Results A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience, and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP. Conclusions These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (eg, reliability, validity) for neuro-oncology patients is warranted.

Background Neurocognitive assessments have become integral to comprehensive neuro-oncology care. Existing screening tools may be insensitive to cognitive changes caused by medical treatments. Research supports the clinical value and psychometric properties of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in various medical populations; however, there is minimal evidence for its use in neuro-oncology. The purpose of the current study was to further explore the cognitive profile of patients with primary brain tumor (PBT) using the RBANS and to assess rates of below-expectation performance compared to normative data and estimated intellectual functioning. Methods Data were collected on 82 PBT patients (54% male; age range, 19-81 years). All patients were administered the RBANS-Update and the Advanced Clinical Solutions–Test of Premorbid Functioning (TOPF) according to standardized instructions. Cognitive strengths and weaknesses were identified for PBT patients. Descriptive analyses, t tests, and chi-squared tests were utilized to identify and compare cognitive profiles. Results Overall, cognitive performance was low average for PBT patients. When compared to standardization data, PBT patients performed significantly worse across all 5 RBANS indexes, with Attention and Memory showing the largest discrepancies. Estimated intelligence analyses reflected greater deficits in cognitive functioning than when compared to a normal distribution. Conclusions Preliminary research demonstrates the RBANS is an efficient screening tool to assess cognitive deficits in PBT patients. Data also support the importance of comparison to self, rather than normative distribution in ensuring proper identification and classification of patients.

Primary brain tumor (PBT) patients may experience existential distress; however, few studies have examined this issue. The objectives of this study were to (1) systematically review PBT representation in psycho-oncology literature regarding fear/anxiety related to progression, recurrence, and death and (2) preliminarily assess the prevalence of fear of dying in a sample of PBT patients. Systematic searching of three databases yielded 1555 articles for review. Of these, 327 studies met inclusion criteria (patient sample N = 132,951). Only eight studies (0.18% of the participants) included patients with a PBT diagnosis, potentially due to exclusion criteria such as cognitive impairment or specific treatment parameters which may prohibit PBT patient participation. Review of the results from the eight included studies revealed mixed methods and limited demographic analyses; existential distress was correlated with heightened depression and anxiety, and overall worsened quality of life. From the original data collection, approximately one-third of PBT patients endorsed fear of dying, which was positively related to depression severity. Taken together, results suggest that PBT patients are considerably underrepresented in existential psycho-oncology literature, despite preliminary findings suggesting prevalence of these concerns. Future research on existential distress in neuro-oncology is warranted.

Objective Fear of cancer recurrence (FCR) is related to psychological distress and poor quality of life in cancer patients and their caregivers. However, no studies have investigated FCR in neuro-oncology. Given the varied prognosis, treatment, and disease trajectory of brain cancer, FCR may affect patients and their caregivers differently. Methods Eighty adult primary brain tumor (PBT) patients and 52 caregivers completed questionnaires assessing FCR and psychological distress (depressive symptoms, generalized anxiety, and death anxiety). Differences in patient and caregiver FCR by demographic and medical characteristics were examined. Using multilevel modeling, the Actor-Partner Interdependence Model (APIM) was used to investigate the interrelationship between patient and caregiver FCR with demographics and psychological distress measures. Results Caregivers reported significantly higher FCR than patients. There were no effects of demographic or medical characteristics on patient FCR. Time since diagnosis was negatively related to caregiver FCR. All measures of psychological distress exerted a significant actor effect on FCR among both patients and caregivers. Two partner effects were found: caregiver depressive symptoms and death anxiety negatively predicted patients' FCR. Conclusions This is the first investigation of FCR in PBT patients and their caregivers. Most demographic and medical characteristics were not related to patient or caregiver FCR. Caregiver FCR may be higher at the time of diagnosis and decrease over time. APIMs revealed actor effects on patient and caregiver FCR for all measures of psychological distress. Results demonstrated the dyadic effects of a brain tumor diagnosis, emphasizing the need to include caregivers in psychotherapy for neuro-oncology patients.

BACKGROUND Posttraumatic Growth (PTG) refers to the positive psychological change following a trauma and may include a heightened appreciation for life, greater value in meaningful relationships, and/ or spiritual development. A brain cancer diagnosis may be experienced as a traumatic event given the high risk of tumor progression, lack of curative treatments, and ultimately unexpected disheartening prognosis; however, there is limited research on PTG in neuro-oncology. The aim of this study was to determine the profile of PTG in patients diagnosed with primary brain tumors (PBTs). METHODS Patients with PBTs (N = 53, Mage = 48.17, 52.8% male) completed the Post Traumatic Growth Inventory (PTGI) during routine neuro-oncology clinic visits. Descriptive statistics and frequencies for the five factors of the PTGI and PTGI total were calculated. RESULTS PTG was evident across all domains with the most growth reported in appreciation for life and the least growth in new possibilities. Most patients endorsed low levels of growth across the five factors; 29-49% of patients endorse moderate-to-high severity in at least one PTG domain. Lastly, the average total score (M = 46.10) of this sample met the established cutoff for moderate-to-high PTG (> 46). CONCLUSIONS The results suggest that patients with PBTs may perceive positive psychological growth following the traumatic event of a brain tumor diagnosis. Specifically, patients may experience a greater appreciation for life but relatively less growth in new possibilities, perhaps due to the poor prognosis of many PBTs. In non-CNS cancer populations, patients with higher PTG reported better quality of life and lower distress. Further research to expand our knowledge of PTG and the associated factors, including the demographic, medical, and psychological correlates, will better equip providers to promote positive change in PBT patients.

ZusammenfassungPrimäre Kopfschmerzerkrankungen wie Spannungskopfschmerzen und Migräne beginnen in der Kindheit und werden mit der Einschulung und Pubertät häufiger. Bei Spannungskopf-schmerzen spielt die zentrale Schmerzsensibilisierung und Aktivierung zentraler nozizeptiver Neurone eine wichtige Rolle. Die Migräne ist eine primäre Erkrankung des Gehirns mit Auffälligkeiten schmerzmodulierender Systeme und der kortikalen Reizverarbeitung. Bei beiden Kopfschmerzformen spielen bio-psycho-soziale Faktoren eine entscheidende Rolle. Sekundäre Kopfschmerzen durch eine entzündliche oder strukturelle hirnorganische Ursache sind selten. Die Diagnose erfolgt anhand der Anamnese und der körperlichen Untersuchung sowie apparativer Untersuchungen bei Auffälligkeiten. Bei Spannungskopfschmerzen steht die multimodale Schmerztherapie im Vordergrund, bei Migräne die medikamentöse Therapie der Attacken und bei sekundären Kopfschmerzen die Behandlung der Grunderkrankung. Behandlungsziele sind die Minderung der Schmerzwahrnehmung, Förderung von Kontroll- und Selbstwirksamkeitserfahrungen, die Steigerung der körperlichen Leistungsfähigkeit sowie die Wiederaufnahme normaler Alltagsstrukturen und sozialer Kontakte als Voraussetzung für eine zunehmende Schmerzminderung.

Mindfulness in health care professionals (HCPs) is often discussed as a tool for improving patient care outcomes, yet there has not been a critical evaluation of the evidence, despite a growing body of research on mindfulness-based interventions (MBIs). Numerous mechanisms exist by which mindfulness in HCPs may have an effect on patient care, and the field lacks an integrated model to guide future investigations into how MBIs may exert effects. The primary goals of this integrative review are to evaluate the evidence for the impact of MBIs in HCPs on patient care outcomes and to propose a causal model to guide future research. Databases were systematically searched for eligible studies investigating either an MBI or a measure of dispositional mindfulness in HCPs on patient care outcomes. Studies were critically evaluated using a previously developed tool. Twenty-six studies were identified (N = 1,277), which provide strong support for effects of mindfulness on HCP-reported patient care. Moderate support was found for patient safety, patient treatment outcomes, and patient-centered care. There was overall weak evidence to support a relationship between HCP-mindfulness on patient satisfaction. Mindfulness in HCPs may be related to several aspects of patient care.

BACKGROUND Patients with high-grade glioma report substantial psychological distress, yet are frequently excluded from psycho-oncology research. Managing Cancer and Living Meaningfully (CALM) is an expressive-supportive psychotherapy designed to address the inevitable challenges that patients with advanced cancer face. CALM was shown in a large randomized controlled trial to reduce depression and death-related distress, but brain cancer was an exclusion criterion. METHODS In this ongoing ORBIT Model Phase Ib Refine trial, 10 adults with high-grade glioma and heightened distress (PHQ/DADDS) participated in CALM. Feasibility and acceptability were assessed based on established metrics, satisfaction was explored by surveys and exit-interviews, and preliminary efficacy of reducing distress was analyzed by pre to post-CALM paired t-tests; effect sizes estimated using Cohen’s d. RESULTS Of 11 patients referred and screened, 10 enrolled in the study (91% enrollment rate; 70% GBM; 70% female; M age =55yrs). Reasons for withdrawal was disinterest in intervention topics (n=2). Eight patients completed baseline assessments and at least one CALM session. To date, seven have completed treatment. Retention is 63%, with one participant still in active treatment. No adverse events were determined to be study-related. Perceived benefit was high (4.8/5), and all participants reported they would recommend program to others. Pre- to post-CALM analyses show medium-to-large effects on reducing depression (d=1.2), anxiety (d=.74), and death-related distress (d=.54). Small effects were seen for quality-of-life improvement (d=.26). Fear of cancer recurrence worsened (d=.75). CONCLUSIONS Preliminary data suggests that CALM is both feasible and acceptable in adult patients with high-grade glioma. Enrollment and retention rates were adequate. Patients reported high benefit and recommendation to others. Depression, generalized anxiety, and death-related distress all improved with medium-to-large effects, suggesting CALM may be a promising intervention for high-grade glioma patients as they navigate the challenges of brain cancer. Adjunctive treatment may be necessary to address fear of cancer recurrence.

Key Points Question Does a psychosocial aftercare program (PAC) after in-hospital intensive interdisciplinary pain treatment (IIPT) for pediatric patients with chronic pain improve functional outcomes? Findings In this randomized clinical trial including 419 patients aged 8 to 17 years randomized and 222 patients analyzed at 6 months, PAC significantly improved all pain-related as well as emotional outcome parameters compared with treatment as usual. Meaning These findings suggest PAC should be considered in IIPT for pediatric chronic pain and its effectiveness tested in other pediatric psychosomatic conditions., This randomized clinical trial evaluates the effectiveness of a psychosocial aftercare program for pediatric patients with severe chronic pain vs usual care after discharge from intensive interdisciplinary pain treatment., Importance Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. Objective To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. Design, Setting, and Participants This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. Interventions Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. Main Outcomes and Measures The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. Results A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = −8.84; P

Sarah E Braun,1 Stephen M Auerbach,1 Bruce Rybarczyk,1 Bennett Lee,2 Stephanie Call2 1Department of Psychology, School of Humanities and Sciences, VirginiaCommonwealth University, Richmond, VA, USA; 2Department of Internal Medicine, Division of General Medicine, Virginia Commonwealth University, Richmond, VA, USA Purpose: Burnout has been documented at high levels in medical residents with negative effects on performance. Some dispositional qualities, like mindfulness, may protect against burnout. The purpose of the present study was to assess burnout prevalence among internal medicine residents at a single institution, examine the relationship between mindfulness and burnout, and provide preliminary findings on the relation between burnout and performance evaluations in internal medicine residents.Methods: Residents (n = 38) completed validated measures of burnout at three time points separated by 2 months and a validated measure of dispositional mindfulness at baseline. Program director end-of-year performance evaluations were also obtained on 22 milestones used to evaluate internal medicine resident performance; notably, these milestones have not yet been validated for research purposes; therefore, the investigation here is exploratory.Results: Overall, 71.1% (n = 27) of the residents met criteria for burnout during the study. Lower scores on the “acting with awareness” facet of dispositional mindfulness significantly predicted meeting burnout criteria χ2(5) = 11.88, p = 0.04. Lastly, meeting burnout criteria significantly predicted performance on three of the performance milestones, with positive effects on milestones from the “system-based practices” and “professionalism” domains and negative effects on a milestone from the “patient care” domain.Conclusion: Burnout rates were high in this sample of internal medicine residents and rates were consistent with other reports of burnout during medical residency. Dispositional mindfulness was supported as a protective factor against burnout. Importantly, results from the exploratory investigation of the relationship between burnout and resident evaluations suggested that burnout may improve performance on some domains of resident evaluations while compromising performance on other domains. Implications and directions for future research are discussed. Keywords: burnout, mindfulness, internal medicine residents, performance evaluations

Background Health-care professional (HCP) students experience high levels of burnout, characterized by work- and school-related stress. Burnout is associated with a host of negative psychological and health outcomes. It may also contribute to cognitive dysfunction and decreased work productivity and may be related to trait mindfulness. This study cross-sectionally explored psychological distress and its correlates in a sample of interdisciplinary HCP students using cluster analysis. Method Fifty-seven interdisciplinary HCP students completed validated measures of burnout, depressive and anxiety symptoms, perceived stress, and rumination, which were entered into a cluster analysis. A neuropsychological test measured executive function; validated questionnaires assessed work productivity and trait mindfulness. Relationships between cluster membership and classroom productivity, executive function, and trait mindfulness were investigated. Results Burnout, depressive symptoms, and perceived stress were reported at high rates in this sample. The cluster analysis yielded 4 clusters, categorized as follows: Healthy, Ruminative Healthy, Moderate Distress, and High Distress. Cluster membership significantly differed based on trait mindfulness and classroom productivity. Trait mindfulness was related to classroom productivity. Although not significant, there were small to medium associations between executive function and both cluster membership and trait mindfulness. Discussion Cluster membership was highly related to trait mindfulness and classroom productivity, suggesting these are important correlates of psychological distress in HCP students. Taken together, these results underscore the need for interventions, especially ones that are mindfulness-based, to manage stress and work-relevant functioning in HCP students.

In most brain tumor populations, current treatment options are not curative. Instead, medical teams focus on prolonging survival while trying to maintain or improve a patient’s quality of life. This is especially true for patients with longer expected survival such as those with oligodendroglioma’s. Quality of life is a multidimensional construct covering life domains such as physical, psychological, and social, as well as symptoms induced by disease and its treatment. This chapter discusses quality of life components specific to patients living with oligodendroglioma. Patient case reports along with charts/illustrations are provided for insight into the daily challenges of those living with oligodendroglioma. Physical, cognitive-behavioral, and psychosocial interventions which have been applied in brain tumor patients are also addressed.

BACKGROUND The COVID-19 pandemic altered the delivery of healthcare services globally with a rapid adoption of telemedicine to meet patient’s needs. Telemedicine is critical for neuro-oncology patients who may be at an increased risk of infection, yet require continuity of care. An important aspect of neuro-oncology care includes neuropsychological assessment, which can be challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored under proctored conditions and proven feasible and reliable. Conducting TNP visits directly to the patients’ home (DTH-TNP) had minimal study prior to the pandemic, but was implemented to reduce COVID-19 exposure. METHODS We used surveys to examine patient acceptance and clinician feasibility of DTH-TNP at two regionally diverse medical institutions routinely providing neuropsychological assessments services to neuro-oncology patients from April to August 2020, Massachusetts General Hospital (MGH) and Virginia Commonwealth University (VCU). RESULTS 45 patients voluntarily responded (MGH=30, VCU=15) and 98 percent (MGH=100%, VCU=93%) of respondents were satisfied with the DTH-TNP experience. Nine percent (MGH=7%, VCU=13%) reported challenges (e.g., technological issues) during the appointment. Eighty-nine percent (MGH=90%, VCU=87%) would recommend the virtual visit to others. Patients perceived reduced risk of infection (MGH=77%, VCU=87%) and time traveling to clinic (MGH=87%, VCU=80%) as favorable aspects of DTH-TNP. 43 clinician surveys collected at MGH indicated that clinicians were able to achieve the goal of their appointment in 91% of clinical encounters. Common issues reported by clinicians included trouble connecting (7%) to the telemedicine platform and environmental disruptions (12%). DISCUSSION This preliminary data suggests neuro-oncology patients and clinicians find DTH-TNP to be an acceptable and feasible practice, while also recognizing its limitations. This study is limited in that voluntary patient surveys are subject to bias. These results suggest that further study of DTH-TNP (e.g., reliability, validity, and limitations) for neuro-oncology patients is warranted. Future directions are discussed.

BACKGROUND Patients with primary brain tumors (PBT) are at increased risk for psychological distress given the certainty of tumor progression, lack of curative treatments, and poor prognoses. A specific type of distress, death anxiety, was recently identified as an area of concern among neuro-oncology patients. However, researchers have yet to fully examine the prevalence or risk-factors of death anxiety in this population, and, importantly, what evidence-based treatments may be available to alleviate symptoms. METHODS Adult PBT patients (N=81) completed validated questionnaires on symptoms of death anxiety, generalized anxiety, and depression. Item-level frequencies were run to determine prevalence rates. Analyses were then conducted (t-tests, ANOVAs, Pearson correlations, regressions) to determine whether certain demographic, disease-related variables, and/or symptoms of psychological distress put patients at higher risk for death anxiety. Literature on evidence-based treatment options was also reviewed. RESULTS Over half (50-64%) of our sample endorsed items related to fear of death, distressing thoughts about death, and fear of the future, with 35% scoring above the cut-off for death anxiety. Predictors of death anxiety included generalized anxiety symptoms, bilateral or right hemisphere tumor, and female gender (r2=0.367; F(3,77)=16.488, p< .05). Younger age, lower grade tumors, and heightened depressive symptoms were associated with higher death anxiety (p< .05). While interventions to reduce distress in advanced cancer populations are available, most have purposely excluded neurological cancers, thus limiting their generalizability in neuro-oncology. CONCLUSION The proportion of PBT patients who endorsed death anxiety aligns with other advanced cancer populations. However, item-level analysis suggests heightened concern in neuro-oncology and a need for targeted intervention. Moreover, specific demographic, disease-related, and psychological distress variables put certain PBT patients at increased risk. These findings highlight the need for routine screenings and monitoring, as well as inclusion of neuro-oncology patients in evidenced-based treatment trials for reducing distress, specifically death anxiety.

Objectives To fill gaps in the literature on the effects of mindfulness for healthcare professionals (HCPs), the current pragmatic trial investigated feasibility, acceptability, and effectiveness of Mindfulness for Interdisciplinary Healthcare Professional (MIHP) students on stress and work-relevant outcomes in the absence of offering school-based incentives. Design A partially randomized waitlist-controlled design (intention-to-treat sample: 22 in the mindfulness group, 26 in the control group) was employed. Intervention MIHP is an eight-week intervention that incorporates meditation training, yoga, and discussion on the application of mindfulness principles to stressors commonly faced by HCPs and students. Main outcome measures Domains of feasibility and acceptability; Maslach Burnout Inventory and other validated measures of psychological functioning; cognitive task performance on the Trail Making Test A & B; and the Work Productivity and Activity Impairment plus Classroom Impairment Questionnaire. Results Results supported the feasibility and acceptability of MIHP but found randomization to be unacceptable. Small to large effects were found for MIHP, relative to the control group, on outcomes of burnout, perceived stress, mindfulness, and activity impairment. No effect of MIHP was found on cognitive performance or work productivity outcomes. Conclusions Preferential group allocation improved retention relative to randomization in the absence of school-based incentives. Results suggest that MIHP is feasible and acceptable and may have benefit for improving mindfulness and reducing burnout, stress, and activity impairment. Cognitive performance, work absenteeism, and work impairment did not change following MIHP. Results support future investigations into the effects of participant compensation on MIHP’s dissemination and effectiveness.

Objective Major depression with peripartum onset (MDP) has been associated with multiple adverse offspring health outcomes. The biological mechanisms underlying this relationship remain unclear, but DNA methylation (DNAm) represents a plausible mechanism for mediating MDP exposures and changes in offspring development, behavior, and health. Advances in DNAm research necessitate reevaluating the MDP-DNAm literature to determine how well past studies conform with current best practices. Method Five databases were searched to identify studies of prenatal-onset MDP and DNAm. Quality scores were assigned to each article independently by two raters using a novel scale specific for MDP-DNAm research. Results Nineteen studies met inclusion criteria. Quality scores ranged from 10 to 17 out of 24 points (M = 12.8; SD = 1.9), with higher scores indicating increased study rigor. Poor covariate reporting was the most significant contributor to lower scores. Conclusion No longitudinal MDP-DNAm studies exist. Earlier MDP-DNAm studies should be interpreted with caution, and future research must commit to sharing methodology and data to facilitate cross-study comparisons and maximize dataset utility.

A brain tumor diagnosis and prognosis, the effects of the tumor on cognition and functionality, and the potential toxicity of treatments have rapid consequences on the everyday life of patients and their caregivers. These quality-of-life (QoL) issues are of extreme concern for many as they proceed through treatment; thus, it is important for the patient, caregiver, and even healthcare team to assess QoL throughout this process. Various factors, such as physical, cognitive-behavioral, and psychosocial factors of brain tumor treatment which impact a patient's QoL will be discussed, along with current challenges surrounding the utility of QoL assessment within neuro-oncology as it relates to clinical practice, clinical research, or policy decision-making.

BACKGROUND: Given the lack of curative treatment options, brain tumor patients may have increased vulnerability to death anxiety, yet the literature to date remains sparse. Two consistent findings associated with death anxiety are age and gender effects, with younger adult women reporting higher rates. Furthermore, death anxiety is often underreported and therefore goes untreated, which can negatively impact quality of life and functioning. The purpose of the present study was to address these gaps in the literature by preliminarily investigating prevalence of and associations with death anxiety in brain tumor patients. METHODS: Eighty-six (51% male, age range 19–81 years) patients diagnosed with primary brain tumors (PBT; grades I-IV) participated in routine neuropsychological evaluations including emotional questionnaires. A single-item question from the Beck Anxiety Inventory (BAI) assessed fear of dying. Descriptive analyses, t-tests, and Pearson correlations were conducted to explore age and gender effects on patients’ fear of death. RESULTS: Thirty percent (n=26) of patients reported fear of dying at the time of evaluation. Women endorsed higher fear severity than men (0.71 vs 0.33; p = .048). There was no relationship between fear severity and age. However, when examining the two effects together, there was a significant difference between men and women aged 30–39 years (0.00 vs. 1.17; p = .035). All descriptive statistics, comparisons, and relationships will be presented. CONCLUSIONS: Results suggest that a significant portion of PBT patients experience a fear of death, and this appears to be more severe in female compared to male patients. Age did not have an independent effect, but young women reported increased fear of death when compared to young men. These results support literature on death anxiety in other populations. Findings could inform intervention development. Importantly, future research should focus on methods to improve early identification of death anxiety in PBT.

Summary Hydroxychloroquine (HCQ) is one of the drugs frequently used for the treatment of interstitial lung disease (ILD) in children (chILD). This use is off-label and studies to analyze the effect and safety of HCQ in chILD are lacking. Therefore, a literature research on the usage of chloroquine (CQ) and HCQ in these conditions was done. Eighty-five case reports and small series in the period from 1984 to 2013 were identified in which children with different diagnoses of ILD were treated with CQ or HCQ, sometimes in combination with other medication including steroids. A favorable response to HCQ or CQ was reported in 35 cases, whereas in the other cases the effect was negative or not clear. The dose of HCQ used was between 5 and 10 mg/kg body weight/day (bw/d). No pharmacokinetic studies have been done. The side effect profile in children seemed to be similar to that in adults. Most often gastrointestinal symptoms were reported. Three patients were found developing retinal changes during the treatment with CQ, whereas in none of the patients treated with HCQ retinal changes were reported. Based on retrospective case reports and small series likely to be reported with bias, the use of HCQ in chILD might be classified as safe. As no prospective data on efficacy and safety of HCQ in chILD are available, systematic collection is necessary. This may be achieved by web-based registers like the European Management Platform for Childhood Interstitial Lung Diseases. Prospective and controlled investigations of HCQ in patients with chILD are mandatory. Pediatr Pulmonol. 2015; 50:410–419. © 2014 Wiley Periodicals, Inc.

Introduction The aim of this study was to assess the relationship between burnout, depressive symptoms and suicidal ideation in dental and dental hygiene students and to evaluate the influence of gender, programme type and year of study. Subjects and methods Third- and fourth-year dental (DS) and first- and second-year hygiene students (DHS) completed the Patient Health Questionnaire (PHQ-9) and an abbreviated Maslach Burnout Inventory online as measures of depressive symptoms/suicidality and burnout, respectively. The statistical analyses included summary statistics and tests for intergroup comparisons (chi-square) to evaluate the influence of gender, programme type (DHS or DS) and year of study. Correlations between depression, suicidality and burnout were also conducted. Results A total of 32 dental hygiene and 119 dental students participated. 40% of the dental and 38% of the hygiene students met criteria for burnout. No differences were found between years or between programmes. Nine per cent of both dental and hygiene students were above the cut-off for moderate depressive symptoms, but there were no statistical differences between the third- and fourth-year dental and the first- and second-year hygiene students. Six per cent of the dental and 9% of the dental hygiene students were above the cut-off for clinically significant suicidal ideation, but there were no statistical differences between dental and hygiene students. There were no differences noted in the dental students based on gender for any of the measures. Depression was significantly associated with all three subscales of burnout. Suicidal ideation was only significantly related to the lack of personal accomplishment subscale of burnout. Discussion These findings suggest the need for introducing preventive measures for such affective states in dental and dental hygiene training programmes.

High levels of stress and related burnout in healthcare professionals (HCPs) are prevalent and costly conditions. Mindfulness training has received recent attention as a possible prevention/intervention strategy to enhance resilience to stress and reduce risk of burnout in HCPs. The purpose of this mixed-methods pilot study was to evaluate the preliminary feasibility, acceptability, and preliminary effects of an 8-week mindfulness curriculum for interprofessional HCPs and trainees (n = 27). Qualitative findings supported feasibility and acceptability of the course for a wide variety of HCP disciplines, including nursing, dentistry, medicine, pharmacy, social work, mental health, and clinical research. Despite being limited by a small sample size, there were statistically significant reductions in perceived stress, anxiety, and specific aspects of burnout from pre-to post-intervention and there was a trend in an enhanced sense of personal accomplishment over time.

e21565 Background: Historically, use of integrative health (IH) therapies among patients with cancer is high. Less is known about provider use and provider perceptions. The study aim was to evaluate the use of IH approaches among patients and providers and to gauge provider knowledge, familiarity, and referrals. Methods: We conducted a single-institution patient and provider survey in the outpatient hematology/oncology clinics at a NCI designated cancer center. Results: In 145 patients surveyed (mean age 58±13, 64% female, 56% white), 66% reported use of at least one IH approach. Of these, the highest reported were vitamins/herbs/special diets (66%), physical activity (54%), and mindfulness/meditation/prayer (44%). In 53% of patients who used IH, the therapy was recommended by someone; of these, 58% of the recommendations came from their oncologist or PCP. In all, 37% of patients wished their provider would supply more information regarding IH approaches. In 87 providers surveyed (46% MD/DO, 30% RN, mean age 46±12, 61% male, 79% white), 89% reported prior personal use of an IH therapy. Seventy-four percent reported that they received IH inquiries from patients “sometimes” or more, with 9% receiving inquiries frequently. Thirty-six percent rated their knowledge of IH low, with 24% not feeling comfortable discussing IH approaches with patients. Provider comfort level with IH therapies was positively correlated with frequency of reported patient inquiries ( r= .391, p= .01). Overall, 85% of providers thought IH therapies had the potential to be beneficial and 77% had recommended their use. The highest reported barrier to referral was lack of knowledge (18%) followed by lack of resources (14%). Conclusions: Use of IH therapies among cancer patients and providers is high and most providers have recommended IH approaches to their patients. Patients would like more provider-directed education on IH, yet more than 1/3 of providers rate their knowledge of IH low with a correlation between provider comfort level and frequency of reported patient inquiries. These data suggest that efforts should be aimed at improving educational resources and programs for providers to increase their awareness and comfort level with IH approaches.