An Acceptance and Commitment Therapy-Based Psychosocial Intervention to Alleviate Distress and Promote Adaptive Coping Skills in Patients with Malignant Primary Central Nervous System Tumors

Project Summary/Abstract Malignant primary central nervous system (CNS) tumors are incurable tumors characterized by high symptom burden and poor survival. In addition to the symptoms and challenges common to patients with other advanced cancers, patients diagnosed with malignant primary CNS tumors face unique stressors related to the effects of the cancer on their nervous system. In an effort to cope with distress about their poor prognosis and neurological dysfunction, these patients commonly engage in avoidant behavior that may ultimately heighten their distress and lead to social isolation, with adverse effects on their mood and quality of life. This proposal details a five- year plan to refine and pilot test a supportive psychosocial intervention that incorporates elements of Acceptance and Commitment Therapy to address the unmet supportive care needs of patients with primary malignant CNS tumors and alleviate their distress. Specifically, the aims of this projects are to 1) refine a population-specific psychosocial intervention based on interviews with stakeholders (N=15) and an open pilot study (N=10), incorporating adaptations for patients with cognitive or communication deficits, as are common among these patients; and 2) perform a pilot randomized controlled trial (N=100) to evaluate the feasibility of the study protocol and acceptability of the intervention, and estimate the preliminary effects of the intervention on intervention targets (coping skills and values-driven behavior) and proposed outcomes (prognostic distress, mood, quality of life and social isolation). This proposal also details the plans of the candidate, Dr. Deborah Forst, a neuro- oncologist and outcomes researcher, to gain mentorship, didactic training and career development to facilitate her transition to research independence. Dr. Forst’s long-term career goal is to become an independent physician-investigator and leader in supportive care research in neuro-oncology. With this project, Dr. Forst will gain essential experience and skills in 1) developing psychosocial interventions; 2) adapting supportive care to accommodate the needs of patients with cognitive and communication deficits; and 3) conducting supportive care trials in seriously ill patients. She will receive this training through a combination of expert mentorship, coursework and conference participation, and the design and execution of the proposed project. Dr. Forst has assembled a team of mentors who are experts in designing and conducting supportive care trials (Dr. Jennifer Temel, primary mentor) and refining psychosocial interventions (Dr. Lara Traeger, co-mentor), and she will receive additional guidance and support from scientific advisors with expertise in cognitive dysfunction in patients with CNS tumors, cognitive-linguistic rehabilitation, neuro-oncology trials, and biostatistics. Dr. Forst’s training will be supplemented by structured coursework and participation in pertinent workshops and conferences. This K08 award will prepare Dr. Forst to become an independent R01-funded investigator and leader in supportive care in neuro-oncology, focused on the development of novel evidence-based psychosocial interventions to improve outcomes for patients with malignant primary CNS tumors and other vulnerable cancer populations.