Evidence-Based Interventions for Cancer- and Treatment-Related Cognitive Impairment

Ah, Diane Von; Jansen, Catherine E.; Allen, Deborah H.

doi:10.1188/14.cjon.s3.17-25

Cited by 61 publications

(30 citation statements)

References 85 publications

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“…In addition, the development or application of appropriate interventions to ameliorate cognitive impairments and neurobehavioral symptoms are warranted. Numerous potential interventions have been examined so far, including cognitive rehabilitation (both compensatory approaches and computerized cognitive training), meditation, exercise, neuromodulation, and pharmacologic agents, but further research is still required as findings continue to be preliminary and limited to few cancer populations, most commonly breast cancer (Von Ah, Jansen, & Allen, 2014; J. S. Wefel, Kesler, Noll, & Schagen, 2015).…”

Section: Resultsmentioning

confidence: 99%

Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: A mixed methods study

Tanenbaum

Dijkers

et al. 2016

Social Science & Medicine

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BACKGROUND Few studies have investigated prostate cancer patients’ experiences of cognitive functioning or neurobehavioral symptoms (i.e., behavioral changes associated with neurological dysfunction) following androgen deprivation therapy (ADT). METHODS Semi-structured interviews conducted from the US by phone and in-person were used to explore and characterize the: 1) experience of cognitive and neurobehavioral functioning in non-metastatic prostate cancer patients undergoing ADT (n=19) compared with patients who had not undergone ADT (n=20); 2) perceived causes of cognitive and neurobehavioral symptoms; 3) impact of these symptoms on quality of life; and 4) strategies used to cope with or compensate for these symptoms. Neuropsychological performance was assessed to characterize the sample. RESULTS Overall, ADT patients experienced marginally more cognitive problems than non-ADT (nADT) patients even though there were no significant differences between groups in neuropsychological performance. ADT patients also experienced more declines in prospective memory and multi-tasking than nADT patients. Significant proportions of participants in both groups also experienced retrospective memory, attention and concentration, and information processing difficulties. With respect to neurobehavioral symptoms, more ADT patients experienced emotional lability and impulsivity (both aspects of disinhibition) than nADT patients. Among the causes to which participants attributed declines, both groups attributed them primarily to aging. A majority of ADT patients also attributed declines to ADT. For both groups, increased cognitive and neurobehavioral symptoms negatively impacted quality of life, and most participants developed strategies to ameliorate these problems. CONCLUSION ADT patients are more vulnerable to experiencing specific cognitive and neurobehavioral symptoms than nADT patients. This study highlights the importance of capturing: a) cognitive symptoms not easily detected using neuropsychological tests; b) neurobehavioral symptoms that can be confused with psychological symptoms, and c) causal beliefs that may affect how people cope with these symptoms. Effective interventions are needed to assist prostate cancer patients in managing these symptoms.

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Section: Resultsmentioning

confidence: 99%

Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: A mixed methods study

Tanenbaum

Dijkers

et al. 2016

Social Science & Medicine

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“…In contrast, an internet‐based Problem‐Solving Therapy intervention for depression did not demonstrate any significant effects. Although cognitive rehabilitation and Boswellia serrata did not demonstrate positive effects on HRQoL, they did have positive effects on cognitive impairment (see Von Ah et al for a review of evidence‐based interventions for cancer‐ and treatment‐related cognitive impairment; additionally, see Khan et al for a review of multidisciplinary interventions for brain tumor patients) and cerebral edema, respectively.…”

Section: Discussionmentioning

confidence: 99%

Patient‐reported health‐related quality of life outcomes in supportive‐care interventions for adults with brain tumors: A systematic review

et al. 2018

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Objectives The objectives of this systematic review were to (a) identify supportive‐care (psychosocial/behavioral, pharmacological, complementary, or alternative) interventions that have been evaluated via randomized controlled trials (RCTs) to improve patient‐reported health‐related quality of life (HRQoL) among adults with brain tumors, (b) evaluate the quality of the intervention studies, and (c) evaluate if developed interventions have been efficacious at improving HRQoL, as compared with control conditions in RCTs. Methods This systematic review was conducted using preferred reporting items for systematic reviews and meta‐analyses (PRISMA) guidelines. Four databases were searched for RCTs of supportive‐care interventions for adults with brain tumors, primary or metastatic, that included a patient‐reported HRQoL outcome. Quality of the included studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results Ten RCTs involving 640 patients with either a primary or metastatic brain tumor investigating supportive‐care interventions with a HRQoL outcome were identified. In terms of quality, three of the studies received a “strong” rating, three received a “moderate” rating, and four of the studies received a “weak” rating. Only two of the interventions (ie, a home‐based psychosocial intervention and individualized acupuncture with standard rehabilitation) demonstrated improvements in HRQoL over control conditions. Conclusions HRQoL is of the utmost importance when treating patients with brain tumors. Yet there is a notable paucity of research to inform clinical decisions and evidence‐based practice. More high‐quality studies of interventions aimed at improving HRQoL are needed.

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“…Although CRCI is a potentially debilitating symptom for cancer survivors, few intervention trials have been conducted to address this symptom [13]. The newly released Survivorship Guidelines from the National Comprehensive Cancer Network (NCCN) recommend stress reduction and optimized management of other symptoms, including fatigue, pain, depression, and sleep disturbance, as general strategies to address CRCI [45]; however, no further information is provided.…”

Section: Discussionmentioning

confidence: 99%

“…Despite CRCI’s prevalence, few interventions targeting this symptom have been evaluated [13]. A number of interventional studies have shown promise in reducing the stress associated with CRCI [11]; however, few have directly addressed CRCI itself.…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment

et al. 2015

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Purpose Cancer-related cognitive impairment (CRCI) is a common, fatigue-related symptom that disrupts cancer survivors’ quality of life. Few interventions for CRCI exist. As part of a randomized pilot study targeting cancer-related fatigue, the effects of mindfulness-based stress reduction (MBSR) on survivors’ cognitive outcomes were investigated. Methods Breast and colorectal cancer survivors (n=71) with moderate-to-severe fatigue were randomized to MBSR (n=35) or a fatigue education and support (ES; n=36) condition. The Attentional Function Index (AFI) and the Stroop test were used to assess survivors’ cognitive function at baseline (T1), after the 8-week intervention period (T2), and 6 months later (T3) using intent-to-treat analysis. Mediation analyses were performed to explore mechanisms of intervention effects on cognitive functioning. Results MBSR participants reported significantly greater improvement on the AFI total score compared to ES participants at T2 (d=0.83, p=0.001) and T3 (d=0.55, p=0.021). MBSR also significantly outperformed ES on most AFI subscales, although both groups improved over time. MBSR produced greater Stroop accuracy rates relative to ES at T2 (r=0.340, p=0.005) and T3 (r=0.280, p=0.030), with improved accuracy over time only for the MBSR group. There were no significant differences in Stroop reaction time between groups. Improvements in mindfulness mediated the effect of group (e.g., MBSR vs. ES) on AFI total score at T2 and T3. Conclusions Additional randomized trials with more comprehensive cognitive measures are warranted to definitively assess the efficacy of MBSR for CRCI. Implications for Cancer Survivors This pilot study has important implications for all cancer survivors as it is the first published trial to show that MBSR offers robust and durable improvements in CRCI.

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Evidence-Based Interventions for Cancer- and Treatment-Related Cognitive Impairment

Cited by 61 publications

References 85 publications

Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: A mixed methods study

Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: A mixed methods study

Patient‐reported health‐related quality of life outcomes in supportive‐care interventions for adults with brain tumors: A systematic review

Randomized controlled pilot trial of mindfulness-based stress reduction for breast and colorectal cancer survivors: effects on cancer-related cognitive impairment

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