A Randomised Controlled Trial Evaluating Two Cognitive Rehabilitation Approaches for Cancer Survivors with Perceived Cognitive Impairment

Overview

Journal J Cancer Surviv

Specialty Oncology

Date 2022 Oct 14

PMID 36241767

Authors

Janette L Vardy

Gregory R Pond

Melanie L Bell

Corrinne Renton

Ann Dixon

Haryana M Dhillon

Affiliations

Soon will be listed here.

Abstract

Purpose: Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors.

Methods: Study population were adult cancer survivors with cognitive symptoms 6-60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6-week, 2-h/week small group sessions.

Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes.

Results: Sixty-five participants were randomised (APT n = 21; CST n = 24; controls n = 20): 94% breast cancer, median age 54. Median time since chemotherapy 20.7 months. FACT-COG-PCI, clinical neuropsychological T-scores, and FIA improved in all groups over time, but no significant differences between arms. On mean neuropsychological T-scores 19/65 (29%) were impaired at baseline; post-intervention impairment controls 31.3%, CST 16.7%, APT 20.0%. On FIA at baseline, nine were impaired; this decreased to three post-intervention (one/group). FACT-COG-PCI was weakly associated with neuropsychological tests (rho = 0.24, p = 0.051) at baseline, and had no association with FIA. Neuropsychological total mean T-score was moderately positively associated with FIA (rho = 0.37, p = 0.003).

Conclusion: There were no significant differences between intervention groups and controls using linear mixed models adjusted for baseline scores.

Implications For Cancer Survivors: Cognitive symptoms and neuropsychological test scores improve over time.

Citing Articles

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References

Lange M, Licaj I, Clarisse B, Humbert X, Grellard J, Tron L . Cognitive complaints in cancer survivors and expectations for support: Results from a web-based survey. Cancer Med. 2019; 8(5):2654-2663. PMC: 6536919. DOI: 10.1002/cam4.2069. View

Vardy J, Pond G, Cysique L, Gates T, Lagopoulos J, Renton C . Lack of cognitive impairment in long-term survivors of colorectal cancer. Support Care Cancer. 2022; 30(7):6123-6133. PMC: 9135780. DOI: 10.1007/s00520-022-07008-3. View

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

Loewenstein D, Ardila A, Rosselli M, Hayden S, Duara R, Berkowitz N . A comparative analysis of functional status among Spanish- and English-speaking patients with dementia. J Gerontol. 1992; 47(6):P389-94. DOI: 10.1093/geronj/47.6.p389. View

Boscher C, Joly F, Clarisse B, Humbert X, Grellard J, Binarelli G . Perceived Cognitive Impairment in Breast Cancer Survivors and Its Relationships with Psychological Factors. Cancers (Basel). 2020; 12(10). PMC: 7602817. DOI: 10.3390/cancers12103000. View

Dhillon H, Tannock I, Pond G, Renton C, Rourke S, Vardy J . Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy. J Cancer Surviv. 2017; 12(2):178-185. DOI: 10.1007/s11764-017-0656-6. View

Dos Santos M, Hardy-Leger I, Rigal O, Licaj I, Dauchy S, Levy C . Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A 3-arm randomized trial. Cancer. 2020; 126(24):5328-5336. PMC: 7756299. DOI: 10.1002/cncr.33186. View

Patton D, Woods S, Franklin Jr D, Cattie J, Heaton R, Collier A . Relationship of Medication Management Test-Revised (MMT-R) performance to neuropsychological functioning and antiretroviral adherence in adults with HIV. AIDS Behav. 2012; 16(8):2286-96. PMC: 3575112. DOI: 10.1007/s10461-012-0237-7. View

Cicerone K . Remediation of "working attention" in mild traumatic brain injury. Brain Inj. 2002; 16(3):185-95. DOI: 10.1080/02699050110103959. View

10.

Hutchinson A, Hosking J, Kichenadasse G, Mattiske J, Wilson C . Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev. 2012; 38(7):926-34. DOI: 10.1016/j.ctrv.2012.05.002. View

11.

Vardy J, Dhillon H, Pond G, Rourke S, Bekele T, Renton C . Cognitive Function in Patients With Colorectal Cancer Who Do and Do Not Receive Chemotherapy: A Prospective, Longitudinal, Controlled Study. J Clin Oncol. 2015; 33(34):4085-92. PMC: 5683012. DOI: 10.1200/JCO.2015.63.0905. View

12.

Carey C, Woods S, Gonzalez R, Conover E, Marcotte T, Grant I . Predictive validity of global deficit scores in detecting neuropsychological impairment in HIV infection. J Clin Exp Neuropsychol. 2004; 26(3):307-19. DOI: 10.1080/13803390490510031. View

13.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

14.

Van der Elst W, van Boxtel M, van Breukelen G, Jolles J . A large-scale cross-sectional and longitudinal study into the ecological validity of neuropsychological test measures in neurologically intact people. Arch Clin Neuropsychol. 2008; 23(7-8):787-800. DOI: 10.1016/j.acn.2008.09.002. View

15.

Van Dyk K, Crespi C, Petersen L, Ganz P . Identifying Cancer-Related Cognitive Impairment Using the FACT-Cog Perceived Cognitive Impairment. JNCI Cancer Spectr. 2020; 4(1):pkz099. PMC: 7015054. DOI: 10.1093/jncics/pkz099. View

16.

Klaver K, Duijts S, Engelhardt E, Geusgens C, Aarts M, Ponds R . Cancer-related cognitive problems at work: experiences of survivors and professionals. J Cancer Surviv. 2019; 14(2):168-178. PMC: 7182611. DOI: 10.1007/s11764-019-00830-5. View

17.

Ahles T, Saykin A . Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer. 2007; 7(3):192-201. PMC: 3329763. DOI: 10.1038/nrc2073. View

18.

Fernandes H, Richard N, Edelstein K . Cognitive rehabilitation for cancer-related cognitive dysfunction: a systematic review. Support Care Cancer. 2019; 27(9):3253-3279. DOI: 10.1007/s00520-019-04866-2. View

19.

Heaton R, Marcotte T, Rivera Mindt M, Sadek J, Moore D, Bentley H . The impact of HIV-associated neuropsychological impairment on everyday functioning. J Int Neuropsychol Soc. 2004; 10(3):317-31. DOI: 10.1017/S1355617704102130. View

20.

Vardy J, Wefel J, Ahles T, Tannock I, Schagen S . Cancer and cancer-therapy related cognitive dysfunction: an international perspective from the Venice cognitive workshop. Ann Oncol. 2007; 19(4):623-9. DOI: 10.1093/annonc/mdm500. View