Evaluation of an interactive, multi-language, neurocognitive app in CNS radiation oncology
PD-0656
Abstract
Evaluation of an interactive, multi-language, neurocognitive app in CNS radiation oncology
Authors: Rupesh Kotecha1, Tugce Kutuk1, Muni Rubens2, Amber Balda1, Yazmin Odia3, Matthew Hall1, Suyen Ramos1, Miguel Ramirez1, Alexander Mohler3, Michael McDermott4, Manmeet Ahluwalia5, Minesh Mehta1
1Miami Cancer Institute, Baptist Health South Florida, Radiation Oncology, Miami, USA; 2Miami Cancer Institute, Baptist Health South Florida, Office of Clinical Research, Miami, USA; 3Miami Cancer Institute, Baptist Health South Florida, Neuro-Oncology, Miami, USA; 4Miami Neuroscience Institute, Baptist Health South Florida, Neurosurgery, Miami, USA; 5Miami Cancer Institute, Baptist Health South Florida, Medical Oncology, Miami, USA
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Purpose or Objective
Neurocognitive decline following radiotherapy for CNS malignancies significantly affects functional status and clinical outcomes. Yet, conventional in-person neuropsychological tests are time-consuming and have had limited penetration into practice. The objective of this study was to implement an app-based solution, facilitating management of multiple patients simultaneously with several domains tested along temporal assessments and being suitable for cross-cultural use in multiple languages.
Material and Methods
Patients undergoing radiotherapy for CNS malignancies from December 2021 to September 2022 who enrolled onto a single institution prospective clinical trial (NCT05504681) using an app-based neurocognitive evaluation program were analyzed. The interactive app-based assessment consisted of 5 domains in 6 languages: learning and memory (Hopkins verbal learning test-revised [HVLT-R]), attention and processing speed (Digit symbols modalities test [SDMT]), verbal fluency (Controlled oral word association test [COWAT]), and executive function (Trail making test [TMT]). Patients underwent neurocognitive evaluation prior to treatment as well as with routine imaging and clinical follow-up, typically at 3-month intervals. In order to evaluate the program’s functionality and usefulness, participants completed a patient feedback survey after at least 2 assessments. Reliable change index (RCI) was analyzed at 3- and 6-month assessments compared to baseline.
Results
92 patients (57 brain metastases and 35 primary brain tumors) with a median age of 69 (range: 32-86) were enrolled. The median KPS was 90, 62% were female, 65% were Hispanic, and 55% had a high school or equivalent level of education. Of those enrolled, 41% successfully completed neurocognitive evaluation in Spanish. At 3 months, there was a statistically significant change in HVLT-R-delayed recall (DR) (Z score: 3.97, p<0.001), HVLT-R-immediate recall (IMM) (3.68, p<0.001), and TMT A (-4.21, p<0.001). At 6 months, there was a statistically significant decline in SDMT (-5.45, p=0.001) across all patients; on subset analysis, this was driven by a significant decline in brain metastasis patients only (-6.31, p=0.003). Among 35 patients who completed the patient feedback survey, the majority found the system and questions easy to understand (100%), easy to use (95%), and relevant to their care (71%). Most patients reported that neurocognitive evaluation improved discussions with clinicians (62%), made them feel more in control of their own care (67%), and 81% reported that they would recommend the app to other patients with CNS malignancies.
Conclusion
Implementation of this novel interactive, multi-language, app-based neurocognitive evaluation program demonstrated changes post-radiotherapy in a majority of patients across multiple domains, warranting further dosimetric and treatment technique evaluation. This app-based assessment was easy to use, perceived as useful to a patient’s care, and highly recommended to other patients.