Combined Model of Remote Interventions for Adults With Cancer-Related Cognitive Impairment: Pilot Study

Abstract

Date Presented 03/27/20

This pilot study describes the impact of a combined remote intervention of computerized cognitive training together with occupational-based treatment on patients with cancer-related cognitive impairment. Positive outcomes were found in occupational performance, cognitive functions, quality of life, and mood. This treatment can possibly add to the therapeutic landscape of cancer-related cognitive impairment, which currently impairs the lives of millions worldwide.

Primary Author and Speaker: Talia Maeir

Additional Authors and Speakers: Yafit Gilboa

Contributing Authors: Afik Hoba, Mor Nahum, Chen Makranz, Tamar Peretz-Yablonsky

PURPOSE: Cancer survival rates have increased dramatically in recent years. However, due to multiple factors, up to 75% of survivors experience Cancer-Related Cognitive Impairment (CRCI). Although CRCI significantly impairs survivors daily functioning and quality of life (QOL), it remains underrecognized and undertreated (Von Ah, 2015).

Computerized Cognitive Training (CCT) has shown promise in improving cognitive functions in CRCI patients. However, the transfer to daily life is limited. Therefore, the current pilot study aims to test the impact of a combined model of remote interventions that include CCT and occupation based treatment (The Cognitive Orientation to occupational performance (CO-OP) Approach™). The CO-OP is a client-centered goal directed approach aimed at enabling individuals to identify strategies that will improve daily function (Mandich & Polatajko, 2004), which has been studied in CRCI (Wolf et al., 2016). Combining the two approaches (cogMCST) can allow patients to benefit from the virtues of both and has the potential to improve cognitive and everyday function. Additionally, remote administration (patient in home) may increase its ecology and accessibility (Ferguson et al., 2016).

DESIGN: a quasi-experimental pre- post study, in preparation for a RCT.

METHODS: Participants were recruited from an oncology center in Jerusalem. Key eligibility criteria: (1) age ≥ 18; (2) subjective concern about cognitive functioning; (3) chemotherapy completed at least 6- mo. and targeted brain radiotherapy completed at least 12 mo. prior enrollment; (4) cognitive decline without dementia (21<MMSE <27 or 19< MOCA <26); (5) stable psychiatric condition.

Outcome measures included patient-specific occupational goals (COPM; performance and satisfaction and PQRS) QOL (FACT GP: physical, social, emotional and functional well-being), neurocognitive assessments (Brain HQ), Mood (PHQ-9-depressive symptoms, GAD-anxiety, RRS–rumination), satisfaction questionnaires and feedback interviews.

Intervention- Participants set at least 5 personal goals using the COPM (3 were trained and 2 untrained). All participants completed 8-13 weeks of remote cogMCST including CO-OP sessions with trained OT (1 hr/week) and CCT (30 min X 3/ week). Wilcoxon signed rank test was conducted to assess treatment affects.

RESULTS: Six participants (median age: 51, 5 females) completed the study. Altogether, 34 occupational goals were set at baseline, representing broad occupational domains of self-care, productivity and leisure. Significant improvements were found in performance and satisfaction ratings using the COPM and PQRS of both trained and untrained goals (p< 0.05). Clinically significant change (≥ 2-point change) was revealed in 26/34 goals, with each participant achieving 60-83% clinically significant gains.

For the neurocognitive assessments, a statistically significant improvement was found in processing speed (p< 0.05), in addition to moderate to large effect sizes in executive functions (0.30-0.52).

Results of the FACT GP show that social well-being improved significantly (p< 0.05) and moderate to large effect sizes (0.33-0.91) were found on emotional and functional well-being. Similarly, the measures of mood show moderate to large effect-sizes (0.39-0.72).

Overall the reported satisfaction rates from the intervention were high (4.67±.33). Content analysis of feedback interview elaborated the positive and negative aspects of the intervention.

CONCLUSION: cogMCST was found effective with positive outcomes in terms of occupational performance, cognitive and QOL and satisfaction. This treatment can possibly add to the therapeutic landscape of CRCI which currently impairs the life of millions worldwide.

References

Ferguson, R. J., Sigmon, S. T., Pritchard, A. J., LaBrie, S. L., Goetze, R. E., Fink, C. M., & Garrett, A. M. (2016). A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer, 122(11), 1782-1791.

Mandich, A., & Polatajko, H. J. (2004). Enabling occupation in children: The cognitive orientation to daily occupational performance (CO-OP) approach: Canadian Association of Occupational Therapists.

Von Ah, D. (2015). Cognitive changes associated with cancer and cancer treatment: state of the science. Clinical journal of oncology nursing, 19(1).

Wolf, T. J., Doherty, M., Kallogjeri, D., Coalson, R. S., Nicklaus, J., Ma, C. X., . . . Piccirillo, J. (2016). The feasibility of using metacognitive strategy training to improve cognitive performance and neural connectivity in women with chemotherapy-induced cognitive impairment. Oncology, 91(3), 143-152.