Abstract
BACKGROUND: The Neurological Assessment in Neuro-Oncology (NANO) scale is a tool used to objectively assess nine clinically relevant domains of neurological function in patients with brain tumors to complement radiographic assessment and other clinician and patient-reported outcomes. Virtual visits for brain tumor patients are feasible and can improve clinical trial access for patients. The use of NANO in virtual care has not been validated, and we aim to determine whether a virtual NANO (vNANO) assessment is a feasible and reproducible alternative to in-person NANO for patients with glioblastoma. METHODS: The study is a single-centre prospective study designed to evaluate and validate a modified NANO assessment for virtual visits. Instructions for the vNANO assessment were formulated and verified by 4 different neurologists including 3 neuro-oncologists and 1 expert in virtual neurological care. As part of the study design, a virtual visit is scheduled within one week of the routine standard of care in-person clinic visit and is done over Zoom for Healthcare. vNANO is performed independently using the vNANO scorecard by two providers sequentially and separately to assess inter-observer variability. Both evaluators are blinded to the MRI results to limit bias. An in-person visit is scheduled within one week of vNANO, and a NANO is performed by the same first provider to assess intra-observer variability. The duration of the virtual and in-person assessments are captured. Patients and clinicians are asked to complete a telehealth satisfaction survey at the end of the in-person visit. The primary endpoints are to demonstrate that 1) an adapted vNANO assessment is feasible and 2) to determine inter- and intra-observer concordance between in-person and vNANO. The secondary endpoint is to assess patient and clinician satisfaction with virtual versus in-person visits. RESULTS: Sixty patients with glioblastoma will be enrolled in the study and accrual is ongoing at the time of submission (> 18 years old, English-speaking, KPS > 60). Preliminary results indicate that vNANO is time efficient and feasible with all patients completing the vNANO assessments without significant logistical or technological difficulties to date. CONCLUSION: Our study will compare in-person and virtual NANO assessments in glioblastoma patients. If validated, vNANO may be adopted for virtual visits in the context of clinical trials for glioblastoma patients. The study is funded by the Academic Health Science Centre Alternative Funding Plan Innovation Fund.