Purpose/Objective(s): Patients with brain tumors are typically treated with radiation, chemotherapy, and/or surgery which can result in cognitive-linguistic dysfunction. Speech-language pathologists (SLPs) are expected to provide appropriate services for patients, however, there is little data describing the potential cognitive-linguistic deficits experienced by patients with brain tumors in the SLP literature. The purpose of this study was to describe the incidence and characteristics of cognitive-linguistic dysfunction in an outpatient radiation oncology setting.

Materials/Methods: 28 subjects were enrolled on an IRB-approved prospective pilot study from December 2016 through November 2017. Patients were screened for study enrollment at the start of radiation (RT) using responses on the Functional Assessment of Cancer Therapy-Brain (FACT-Br), a quality of life questionnaire used in our standard clinical practice for assessing brain tumor patients. Subjects were eligible if they reported any amount of difficulty on at least 1 of the 5 items felt to have cognitive-linguistic relevance by the study team (see table). Patients were evaluated with the Cognitive Communication Survey (CCS) which includes an adapted version of the Mayo-Portland Adaptability Inventory and 45 potential symptoms to self-report in the physiological, cognitive, linguistic, and socio-emotional domains, as well as a battery of standardized cognitive and language assessments including the Cognitive-Linguistic Quick Test and subtests from the Comprehensive Aphasia Test (CAT). The CAT is normed on post-stroke patients with aphasia, but was chosen because there are currently no SLP assessments normed on patients with brain tumors. All 28 subjects completed the baseline CCS and 22 completed the standardized tests with an SLP while undergoing RT.

Results: 26 out of 28 subjects reported at least one of 45 potential symptoms on the CCS (average = 7, range = 0-21). However, only 9 subjects (32%) were referred for SLP consults before or during RT, and 7 subjects (78% of those who had consults) were determined to need and received SLP services. All 22 subjects who completed the CAT standardized assessment scored below normal on the “naming” section, which assesses the ability to name an item or action in a provided picture.

Conclusion: We have identified 5 items from the commonly utilized FACT-Br that identify brain tumor patients who may benefit from SLP evaluation. Our data suggests that patients may be under-referred for SLP services, and when referred, were often found to have cognitive-linguistic deficits beyond what was self-reported.

Selected Items from the FACT-Br
	Not at all	A little bit	Some-what	Quite a bit	Very much
I have difficulty expressing my thoughts	1	2	3	4	5
I am able to concentrate	1	2	3	4	5
I can remember new things	1	2	3	4	5
I am able to find the right word(s) to say what I mean	1	2	3	4	5
I get frustrated that I cannot do things I used to	1	2	3	4	5