Rhee, John Yohan

Introduction: Patients with cognitive impairments, who may be unable to engage in traditional psychotherapies, may require support through non-cognitive interventions. This review synthesizes the existing literature to assess the evidence base for these interventions and to propose future directions for research. Methods: A comprehensive literature search was conducted across seven electronic databases on October 17, 2024. Eligible studies assessed psychological, emotional, social, or spiritual outcomes. Results: Seventy-three studies were included, conducted across 18 countries. Music therapy and art therapy had the strongest empirical support, with consistent effects on distress, emotional expression, social and spiritual connectedness, and finding meaning. Other approaches, including movement therapy, spiritual interventions, and pet therapy, showed promising but preliminary results. Aromatherapy and massage therapy yielded mixed findings, while energy-based methods lacked robust evidence. Most studies had a high risk of bias, primarily due to confounding. Few interventions were conducted with patients with cognitive impairments, despite their potential relevance. Conclusion: A variety of interventions compatible with cognitive impairment show promise in palliative care settings. However, existing empirical support is constrained by bias and a lack of research in cognitively-impaired populations.

Abstract Background Adult onset medulloblastoma (aMB) is a rare tumor with limited available evidence. We present a large multi-institutional retrospective cohort of aMB patients treated in the modern era, with an emphasis on understanding the role of chemotherapy at initial diagnosis. Methods We included 267 consecutive patients with aMB treated at 7 different institutions from 2000-present, controlling for chemotherapy regimen and cycles received. Results Treatment factors were highly intercorrelated with one another and with treating institution. Concurrent chemotherapy was not associated with overall survival (OS). Adjuvant chemotherapy was associated with OS on univariable analyses (HR = 0.55, P = .029) and on multivariable analysis when adjusting for risk status (HR 0.55, P = .026) but not when also adjusting for treating institution. Proton craniospinal irradiation was associated with improved survival on univariable (HR = 0.50, P = .019) and multivariable analysis adjusting for risk status (HR = 0.51, P = .024) but not when treating institution was also considered. On subgroup analysis, adjuvant chemotherapy was associated with improved survival in M0 (HR = 0.55, P = .043) but not M1 disease, in patients with subtotal resection (HR = 0.43, P = .048) but not those with GTR. Similarly, progression-free survival was improved with chemotherapy in patients with M0 (HR = 0.57, P = .032) but not M1 disease, and in patients with subtotal (HR = 0.50, P = .054) but not gross total resection. Conclusions There was no benefit of concurrent chemotherapy. Adjuvant chemotherapy was associated with improved overall survival and this effect was driven by select subgroups, specifically those with M0 disease and those with residual tumor. We could not confirm that these associations are independent of the treating institution.