Proof of concept using vocational tele-cognitive rehabilitation to improve work status in primary brain tumor

BACKGROUND Survivors of primary brain tumors (SPBT) frequently struggle to return to work. This study investigated work status and outcomes after tele-based vocational cognitive rehabilitation (t-VCR) in SPBT. METHODS We retrospectively reviewed adults (≤65 years) with SPBT at an academic medical center who completed objective cognitive and patient-reported outcome measures between 5/2018 and 5/2022. Participants were grouped by employment status and compared on demographic and clinical characteristics. Work outcomes were analyzed in a subgroup who underwent t-VCR during standard clinical care. t-VCR treatment response was defined as return to work, increase to full-time work, or graduation from a workplace improvement plan versus baseline. Analyses used t-tests, chi-square, and McNemar tests, with content analysis identifying key interventions in responders. RESULTS Of seventy-seven participants, thirty-five were working and forty-two were unemployed upon referral. Unemployment was associated with worsened verbal learning and memory (P < .003). Among the twenty-eight people who received t-VCR (mean-10 sessions), 82% returned to work after t-VCR. In those who had improved work status, content analysis identified t-VCR interventions including executive and organizational skills training, mental health counseling, job simulations/accommodations, and fatigue/stimulation education were most common. CONCLUSION Worsened verbal learning and memory were associated with unemployment highlighting the impact these cognitive symptoms can have on occupational functioning. Work status improved in the context of t-VCR and warrants further study. Among participants who demonstrated improvement, t-VCR was delivered as a multimodal, individualized intervention that addressed cognitive, emotional, fatigue, and practical workplace-related challenges.