For I Know the Plans I Have for You: God Locus of Control, Spiritual Change, and Death Anxiety in Primary Brain Tumor Patients

Background/Purpose. Primary brain tumor (PBT) patients risk experiencing death anxiety given the high mortality rate of their diagnosis. In line with Terror Management Theory (TMT), many diagnosed with cancer utilize religion as a method of coping with the disease. However, previous literature on the relation between death anxiety and religion in cancer patients indicates mixed findings of either a negative relationship or no association. To the authors’ knowledge, no study has analyzed these two constructs together in PBT patients. The current study sought to address this gap by investigating the relationship between religiosity and death anxiety in an understudied population. Methods. Adult PBT patients (N = 56, Mage = 49.38, 51.8% female, 71.4% Caucasian, Mmonths since diagnosis = 55.34) completed measures of religiosity and death anxiety at their routine medical appointment at an academic medical center, including: The God Locus of Health Control Scale (GLHCS), Posttraumatic Growth Inventory (PTGI), Death and Dying Distress Scale (DADDS), and the Death Distress Scale (DDS). Descriptives and Pearson correlations were utilized. Results. The results revealed that while the GLHCS was not significantly related to either measure of death anxiety, the Spiritual Change subscale of the PTGI was positively correlated to both the DADDS (r = .56, p \u3c .001) and the DDS (r = .41, p = .01). Conclusions and Implications. Results suggest that certain proxies of religiosity may be more closely associated with death anxiety than others. Although there was no evidence in our sample that PBT patient’s God locus of control was related to death anxiety, those who reported higher levels of death anxiety endorsed greater spiritual change (i.e., I have a stronger religious faith). Considering TMT, perhaps feelings of death anxiety prompt one to strengthen their religious beliefs. Future longitudinal analyses addressing the direction and course of these relationships are warranted. Acknowledgement of Funding: The current study was funded on behalf of Virginia Commonwealth University School of Medicine. Learning Objective. Participants will learn about the relationship between religiosity and death anxiety in oncology patients. Further, participants will consider how these findings may or may not differ for PBT patients and across various measures of religiosity.https://scholarscompass.vcu.edu/gradposters/1049/thumbnail.jp

Screening for Cognitive Impairment in Primary Brain Tumor Patients: A Preliminary Investigation with the MMSE and RBANS

Introduction: The prevalence of mild cognition impairment (MCI) among older adults (≥65) is estimated to range between 10-20% (Langa & Levine, 2014). Integrated primary care allows opportunities for interdisciplinary consultation, screening, and intervention. The aim of this study is to explore the percentage of older adults reporting cognitive concerns during their first primary care psychology visits. It is hypothesized that these rates will mirror prevalence rates in other older adult community dwelling samples in primary care settings. Methods: A patient sample of older adults (≥60) was introduced to services following a referral from their primary care physician. Clinicians then identified problems that were discussed in session, including “cognitive concerns.” Descriptive statistics will be used to assess the percentage of older adults with “cognitive concerns” in this sample, compared to other community dwelling samples. Results: 267 older adults were identified within a larger sample of patients who received primary care psychology services. The percentage of older adults who were referred for “cognitive concerns” was 10.5% (n = 28), with 12.7% (n = 34) reporting “cognitive concerns” during their visit. Interestingly of the 28 older adults referred by their provider for “cognitive concerns,” less than 50% (n = 13) of those patients reported “cognitive concerns” as one of their problems in session. Discussion: This sample of older adults reported cognitive concerns in primary care psychology sessions at a rate that falls within the range identified in other community dwelling samples. Future research could further improve upon identification and screening of older adults with cognitive concerns by psychologists in primary care settings, as intervention for MCI can improve quality of life and may delay progression of dementia (Campbell et al., 2018; Eshkoor et al., 2015).https://scholarscompass.vcu.edu/gradposters/1088/thumbnail.jp

An Analysis of Psychological Distress Profiles and their Correlates in Interdisciplinary Health-care Professional Students

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

Study protocol for Cognitive Behavioral Therapy for Insomnia in patients with primary brain tumor: A single-arm phase 2a proof-of-concept trial

Background: Sleep disturbance is among the most common symptoms endorsed by patients with primary brain tumor (PwPBT), with many reporting clinically elevated insomnia and poor management of their sleep-related symptoms by their medical team. Though Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the front-line treatment for sleep disturbance, CBT-I has yet to be evaluated in PwPBT. Thus, it is unknown whether CBT-I is feasible, acceptable, or safe for patients with primary brain tumors. Methods: PwPBT (N = 44) will enroll and participate in a six-week group-based CBT-I intervention delivered via telehealth. Feasibility will be based on pre-determined metrics of eligibility, rates and reasons for ineligibility, enrollment, and questionnaire completion. Acceptability will be measured by participant retention, session attendance, satisfaction ratings, and recommendation to others. Safety will be assessed by adverse event reporting. Sleep will be measured both objectively via wrist-worn actigraphy and subjectively via self-report. Participants will also complete psychosocial questionnaires at baseline, post-intervention, and three-month follow-up. Conclusion: CBT-I, a non-pharmacological treatment option for insomnia, has the potential to be beneficial for an at-risk, underserved population: PwPBT. This trial will be the first to assess feasibility, acceptability, and safety of CBT-I in PwPBT. If successful, this protocol will be implemented in a more rigorous phase 2b randomized feasibility pilot with the aim of widespread implementation of CBT-I in neuro-oncology clinics

Quality of Life and Cognitive Function Evaluations and Interventions for Patients with Brain Metastases in the Radiation Oncology Clinic

Brain metastases (BMs) account for a disproportionately high percentage of cancer morbidity and mortality. Historically, studies have focused on improving survival outcomes, and recent radiation oncology clinical trials have incorporated HRQOL and cognitive assessments. We are now equipped with a battery of assessments in the radiation oncology clinic, but there is a lack of consensus regarding how to incorporate them in modern clinical practice. Herein, we present validated assessments for BM patients, current recommendations for future clinical studies, and treatment advances that have improved HRQOL and cognitive outcomes for BM patients

The Alliance AMBUSH Trial: Rationale and Design

Unlike medulloblastoma (MB) in children, robust prospective trials have not taken place for older patients due to the low incidence of MB in adults and adolescent and young adults (AYA). Current MB treatment paradigms for older patients have been extrapolated from the pediatric experience even though questions exist about the applicability of these approaches. Clinical and molecular classification of MB now provides better prognostication and is being incorporated in pediatric therapeutic trials. It has been established that genomic alterations leading to activation of the sonic hedgehog (SHH) pathway occur in approximately 60% of MB in patients over the age of 16 years. Within this cohort, protein patched homolog (PTCH) and smoothened (SMO) mutations are commonly found. Among patients whose tumors harbor the SHH molecular signature, it is estimated that over 80% of patients could respond to SHH pathway inhibitors. Given the advances in the understanding of molecular subgroups and the lack of robust clinical data for adult/AYA MB, the Alliance for Clinical Trial in Oncology group developed the AMBUSH trial: Comprehensive Management of AYA and Adult Patients with Medulloblastoma or Pineal Embryonal Tumors with a Randomized Placebo Controlled Phase II Focusing on Sonic Hedgehog Pathway Inhibition in SHH Subgroup Patients (Adult & Adolescent MedulloBlastoma Using Sonic Hedgehog Trial). This trial will enroll patients 18 years of age or older with MB (any molecular subgroup and risk stratification) or pineal embryonal tumor. Patients will be assigned to one of three cohorts: (1) average risk non-SHH-MB, (2) average risk SHH-MB, and (3) high risk MB or pineal embryonal tumors. All patients will receive protocol-directed comprehensive treatment with radiation therapy and chemotherapy. Patients with SHH-MB in cohort 1 will be randomized to a smoothened inhibitor or placebo as maintenance therapy for one year