Oncology patients referred for cognitive training in a military treatment facility: Demographics, symptom reporting and cognitive functioning for CNS and non CNS cancers.

Background: The Brain Fitness Center (BFC) at Walter Reed National Military Medical Center (WRNMMC) offers computerbased cognitive training, biofeedback, and brain-health classes. Originally designed for service members with traumatic brain injury, the BFC is experiencing an increase in patients with oncology-related cognitive complaints, prompting the need to better understand symptom reporting and objective cognitive functioning in this population. The goal of this analysis is to gain a better understanding of this patient population and compare the presenting symptoms and concerns of cancer patients with and without a history of central nervous system (CNS) involvement. Methods: Retrospective review and analysis of six validated symptom self-report questionnaires and objective cognitive functioning assessed by the Automated Neuropsychological Assessment Metrics (ANAM). Participants were 97 Military medical beneficiaries with cancer-related treatments referred to the BFC. Data are derived from an IRB-approved retrospective analysis protocol and were compared with published norms. Results: The average age of the study sample at time of referral was 47.3 years (SD 13.3; 49% men, 51% women), with 49% classified as CNS cancer (primary or metastatic disease) and 51% as non CNS cancer. Questionnaire results indicated moderate resilience, low adverse headache impact on daily function, reduced satisfaction with life, mild-to-moderate self-reported functional and neurobehavioral concerns, and subclinical posttraumatic stress symptoms. Average cognitive processing efficiency was poorer than demographicallymatched controls ( > 1 SD below average) and was inversely associated with self-reported symptom concerns (r -.273 to -.339, p < .05). There were no differences between the CNS and non CNS groups on symptom reporting or objective cognitive performance (p > .05). Conclusions: CNS and non CNS oncology patients produce comparable symptoms and cognitive scores and demonstrate less cognitive efficiency than sex, military service, and age- matched normative groups. Limitations and clinical implications are discussed. .