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Brain metastases are the most common intracranial tumors, occurring in more than 15% of cancer patients. The treatment of brain metastases involves a multidisciplinary approach that may consist of surgery, radiation therapy (stereotactic radiosurgery or whole-brain radiation therapy), and/or systemic therapy. Unfortunately, all these treatment strategies, as well as the disease process itself, can be associated with debilitating and life-altering neurocognitive adverse effects. Balancing the benefits and toxicities of brain metastasis treatment is a challenging task that medical, radiation, and surgical oncologists face daily. Strategies have been developed to try mitigating these toxicities, such as stereotactic radiosurgery, hippocampal avoidance whole-brain radiation therapy, and “neuroprotective” drugs. Efforts have also been deployed in developing formal instruments/battery of tests to capture neurocognitive changes consistently in patients with brain metastases.

Brain metastases are the most common intracranial tumors, with an incidence rate ranging from 7 to 14 per 100,000. Both the disease process itself and its treatments can be associated with debilitating and life-altering neurocognitive adverse effects. The treatment of brain metastases involves a multidisciplinary team that aims to maximize the benefits and minimize the toxicities of treatment, which may include surgical resection, radiation therapy (stereotactic radiosurgery or whole-brain radiation therapy), and/or systemic therapy. Additionally, strategies have been investigated to prevent and treat these toxicities, such as stereotactic radiosurgery, hippocampal avoidance whole-brain radiation therapy, and “neuroprotective” drugs, respectively. In order to better detect and measure treatment toxicity, efforts have also been deployed in tracking neurocognitive changes consistently in patients with brain metastases.

Oncology has experienced positive shifts in survival curves for many cancers largely due to the development of earlier diagnostics and better therapeutics. This has increased the visibility and need for survivorship services, including clinical neuropsychology. Patients with cancer frequently experience cognitive dysfunction related to the presence of cancer itself and treatment neurotoxicity. These cognitive difficulties can profoundly impact patient functioning and autonomy with accompanying declines in quality of life. Clinical neuropsychologists are uniquely positioned to evaluate the cognitive and affective sequelae of cancer and treatment and provide interventions and recommendations that can benefit well-being and potentially alter the disease course. Despite increasing recognition of the importance of neuropsychological issues to cancer survivorship, many neuropsychologists have limited training and guidance regarding navigating and implementing services within the oncology setting. This article provides the basic rationale for neuropsychological practice and research activities in oncology, as well as the experience of the Section of Neuropsychology at The University of Texas MD Anderson Cancer Center.

Objective While neurocognitive functioning (NCF) and mood disturbance share a relationship with health-related quality of life (HRQOL), few studies have examined relationships between these constructs in glioma patients prior to treatment. Methods Newly diagnosed patients with glioma in the left (N = 73; 49% glioblastoma) or right (N = 30; 57% glioblastoma) temporal lobe completed neuropsychological testing and self-report measures of HRQOL (Functional Assessment of Cancer Therapy (FACT)-General and Brain module) and mood (Beck Depression Inventory-Second Edition and State-Trait Anxiety Inventory). Results Verbal learning and memory, executive function, and language abilities were associated with various HRQOL scales. Stepwise linear regression showed that verbal learning predicted scores on the general well-being scale and brain module, processing speed predicted social well-being scores, and executive functioning predicted functional well-being scores on the FACT. Upper extremity strength also predicted scores on the functional well-being subscale and brain module. Mood was more strongly associated with HRQOL domains than NCF, with depressive symptoms accounting for a large proportion of variance across most subscales. Conclusions In patients with temporal lobe glioma, depressive symptoms are strongly related to most aspects of HRQOL but not with NCF. NCF, specifically verbal learning and memory, executive functioning, and processing speed, also show direct relationships with numerous aspects of HRQOL. These findings underscore the importance of multimodal assessment of NCF and mood in this population. Copyright © 2015 John Wiley & Sons, Ltd.

BACKGROUND: BT survivors commonly have impairments in attention/memory that adversely impact independence, home, school and work roles, mood and quality of life. Adults produce new brain cells, replace dead brain cells, and adaptively recruit new brain regions to perform certain tasks. We sought to determine the feasibility, acceptability, and early efficacy signals of an at-home, internet accessible, adaptive, brain-plasticity based computerized intervention designed to enhance attention/memory processes (Plasticity-based Adaptive Cognitive Remediation, PACR). METHODS: Adult BT survivors with self-reported and tested attention/memory impairment, status post surgery and radiation were enrolled (n = 34) into a longitudinal, single-arm study. Patients completed neuropsychological testing before and after intervention. Patients were instructed to complete 40 PACR sessions (1 hour/day, 5 days/week for 8 weeks). A priori feasibility was defined as >80% of patients completing >10 sessions in the first month and not skipping >10 consecutive sessions thereafter. Secondary objectives were to assess improvement on trained tasks (near transfer), unrelated cognitive tests (far transfer), and acceptability. RESULTS: PACR was considered feasible in 40% of patients; 77% reported being "somewhat" or "very satisfied" with PACRs "usefulness in helping to minimize the impact of cognitive symptoms on ability to function effectively in daily activities"; and 100% of subjects would recommend PACR to others. Near transfer of training effects were significant (P < 0.05) on most trained tasks with effect sizes ranging from 0.32 to 1.29. Far transfer of training effects were only seen on the COWA (p = 0.02). CONCLUSIONS: Only 40% of BT survivors completed the PACR intervention as it was prescribed in this study. Near transfer of training but not far transfer of training was observed. Most participants found the intervention useful and all would recommend it to other patients. Consideration of dose-response curves, alternative treatment delivery, and patient selection appears warranted if PACR is to be a viable intervention.