Cognitive Performance at Diagnosis and Beyond Disease Progression in Newly Diagnosed Glioblastoma Patients
Introduction: All patients with central nervous system malignancies can develop impairments in cognition.  This includes patients with glioblastoma (GBM), the most common and most lethal glial tumor in adults.
Objectives: Cognitive impairment can come from the underlying tumor, treatments (surgery, radiation, and chemotherapy) and tumor progression.   Measures of cognition are commonly integrated into clinical trials, but after progression are rarely obtained or followed.  We evaluated cognition after tumor progression in newly diagnosed GBM patients participating in a study of bevacizumab (BV) with concurrent chemoradiation, followed by BV and temozolomide with the continuation of BV following progression.   
Methods: In this prospective single-center trial, cognition was measured using a computerized battery of cognitive tests at time of study enrollment (before chemoradiation), after chemoradiation, and every 6 mos until study discontinuation or demise. 
Results:  The trial accrued 68 newly diagnosed GBM patients with mean age 55.4 yrs and 53% KPS ≥ 90%.    Subjects who continued study participation 6 mos following completion of chemoradiation were divided into two groups: subjects with (n=16) and without (n=33) tumor progression 6 mos after chemoradiation completion. Cognition for modalities including verbal and visual memory, reaction time, and psychomotor speed degraded in the tumor progression group in comparison to the group without progression.  Previous work has shown that perceived subjective cognition did not decline over time in these groups.  
Conclusions: Objective cognition, in contrast to subjective cognitive performance, declines after tumor progression in newly diagnosed GBM.  Continued attention should be paid to monitoring cognitive performance in clinical trials at and beyond progression.

13 / COGNITIVE PERFORMANCE AT DIAGNOSIS AND BEYOND DISEASE PROGRESSION IN NEWLY DIAGNOSED GLIOBLASTOMA PATIENTS