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Cognitive Dysfunction in Cancer Survivors

Cognitive Dysfunction in Cancer Survivors
Author Information (click to view)

Robert J. Ferguson, PhD

Assistant Professor of Medicine

Biobehavioral Oncology Program

University of Pittsburgh Cancer Institute

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Robert J. Ferguson, PhD (click to view)

Robert J. Ferguson, PhD

Assistant Professor of Medicine

Biobehavioral Oncology Program

University of Pittsburgh Cancer Institute

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Research indicates that about 40% to 50% of those who undergo chemotherapy for cancer develop “chemo brain,” a condition in which patients exhibit signs of cognitive dysfunction.

“Most of these cases are mild in nature, but they can still have a significant effect on patients’ quality of life, job performance, and relationships,” explains Robert J. Ferguson, PhD. “Although long-term chemotherapy-related cognitive dysfunction (CRCD) affects a large number of cancer survivors, little is known about the biologic mechanisms and causes of this problem.” In addition, while studies have been conducted to find an effective treatment for this important cancer survivorship issue, none are yet conclusively ready for clinical use.

Addressing a Need

For a small study published in Cancer, Dr. Ferguson and colleagues conducted a randomized controlled trial that assessed the effect of Memory and Attention Adaptation Training (MAAT), a type of cognitive behavioral therapy (CBT), compared an attention control condition. The study was conducted in 47 female breast cancer survivors who reported CRCD an average of 4 years earlier.

“Intervention patients were assigned to receive eight MAAT sessions that lasted about 30 to 45 minutes each,” says Dr. Ferguson. “These individuals were educated on recognition of CRCD symptoms, compensatory strategies, and the importance of self-monitoring their cognition.” The other participants received supportive talk therapy sessions.

Treatment for those receiving MAAT and supportive therapy was delivered over a videoconference device to minimize patients’ travel time. The investigation required participants to complete tests of verbal memory and processing speed, and answer questionnaires about their memory problems and related anxiety at baseline. Patients were retested after completing all eight MAAT sessions and again 2 months.

Intriguing Results

According to Dr. Ferguson, CRCD patients who received MAAT reported experiencing significantly fewer memory problems and better processing speed than those who received supportive therapy. A large effect size was seen in the MAAT group at the 2-month follow-up with regard to having reduced anxiety about cognitive problems. Smaller positive effects were also seen in this group with regard to general function, fatigue, and anxiety.

“CRCD patients were highly satisfied with MAAT and the videoconference delivery approach used in our study,” adds Dr. Ferguson. “This type of CBT may be able to help cancer survivors deal with the long-term memory problems that many patients experience after treatment with chemotherapy and other therapies, such as hormonal therapy. Use of videoconference technology to deliver CBT was well-received by patients and may increase access to care to a larger number of survivors.”

Assessing Implications

Dr. Ferguson notes that his study group’s research is important because it helps to identify a treatment option for survivors that also may improve access to survivorship services. “Results of this study are limited because of the small sample size,” he says. “We need a larger study with more testing sites and include more patients, but our analysis suggests that we can use CBT to improve cognitive symptoms in breast cancer survivors with persistent memory complaints. Interventions like MAAT may help reduce anxiety without requiring additional medications. CBT interventions that are delivered via videoconference technology may potentially improve access to survivorship care.”

Robert J. Ferguson, PhD, has indicated to Physician’s Weekly that he has no financial disclosures to report.

Readings & Resources (click to view)

Ferguson RJ, Sigmon ST, Pritchard AJ, et al. A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer. 2016;122:1782-1791. Available at: http://onlinelibrary.wiley.com/doi/10.1002/cncr.29891/abstract.

Ferguson RJ, McDonald BC, Rocque MA, et al. Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. Psychooncology. 2012;21:176-186

Ferguson RJ, Ahles TA, Saykin AJ, et al. Cognitive-behavioral management of chemotherapy-related cognitive change. Psychooncology. 2007;16:772-777.

Sleight A. Coping with cancer-related cognitive dysfunction: a scoping review of the literature. Disabil Rehabil. 2016; 38:400-408.

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