Date Presented 04/7/21
This study describes the feasibility of a combined telehealth intervention of computerized cognitive training together with occupation-based treatment for patients with cancer-related cognitive impairment (CRCI). The intervention was found feasible, and positive outcomes on occupational performance, cognitive functions, quality of life, and mood were revealed. This treatment can possibly add to the therapeutic landscape of CRCI, which currently impairs the life of millions worldwide.
Primary Author and Speaker: Yafit Gilboa
Contributing Authors: Anita Tollen, Marie Holmefur
PURPOSE: Cancer survival rates have increased dramatically in recent years. Up to 75% of the survivors experience Cancer-Related Cognitive Impairment (CRCI). Although CRCI significantly impairs survivors daily functioning and quality of life (QOL), it remains undertreated (Von Ah, 2015). Computerized Cognitive Training (CCT) has shown promise in improving cognitive functions in CRCI patients. However, transfer to daily life is limited. Recent cognitive rehabilitation guidelines suggest integrating CCT with individualized, goal-directed interventions aimed at promoting occupational functioning (Cicerone et al., 2019). The Cognitive Orientation to Occupational Performance approach (CO-OP) is as an occupation-based client-centered goal directed approach aimed at enabling individuals to identify strategies to improve daily function. The CO-OP and has been studied in CRCI (Wolf et al., 2016). Combining the two approaches ‘computerized retraining and functional treatment' (CRAFT) has the potential to improve cognitive and everyday function. Additionally, telehealth administration may increase its ecology and accessibility (Ferguson et al., 2016) Therefore, the purpose of this study was to test the feasibility of a telehealth intervention combining CCT and occupation-based treatment among adults with CRCI.
DESIGN: a quasi-experimental feasibility study in preparation for a RCT. Feasibility was measured in terms of recruitment, adherence, acceptability, and potential effectiveness.
METHODS: Participants were recruited through medical staff from an oncology center in Jerusalem. Key eligibility criteria: (1) age > 18; (2) subjective concern about cognitive functioning; (3) Active treatment completed at least 6-mo. prior enrollment; (4) cognitive decline without dementia (21 < MMSE < 27 or 19 < MOCA < 26). All participants completed an average of 10 weeks of CRAFT intervention including CO-OP sessions with trained OT (1 hr/week) in which they set at least 5 personal goals using the Canadian Occupational Performance Measure (3 were trained and 2 untrained). In addition, they were instructed to complete three 30 min. sessions a week of CCT. Assessments were administered at baseline, post-intervention and at 3-month follow up and included measures of occupational performance, objective cognitive functions, quality of life and mood questionnaires. Wilcoxon signed rank test was conducted to assess treatment effects.
RESULTS: From the 34 potential participants identified, nine were enrolled in the study, and six (median age: 51, 5 females) completed the study. Full adherence was found to the CO-OP component of the treatment, whereas 4/6 participants completed the CCT schedule. Overall, reported satisfaction rates from the intervention were high (4.67±.33). Positive and significant improvements were found in occupational performance of both trained and untrained goals (p < 0.05). Clinically significant change (> 2-point change) was revealed in 26/34 goals set in the study, with each participant achieving 60-83% clinically significant gains. In addition, positive and significant improvements were found for useful field of view (neurocognitive assessment) and social QOL (all p < 0.05). A positive trend was found on sustained attention, emotional and functional QOL, and all mood measures. The positive gains were maintained at 3-mo follow up.
CONCLUSION: A combined telehealth model of CCT and occupation-based treatment for adults with CRCI was found feasible and may improve occupational performance, cognitive functions, and QOL. This treatment can possibly add to the therapeutic landscape of CRCI which currently impairs the life of millions worldwide.
References
Cicerone, K. D., Goldin, Y., Ganci, K., Rosenbaum, A., Wethe, J. V., Langenbahn, D. M., . . . Nagele, D. (2019). Evidence-Based Cognitive Rehabilitation: Systematic Review of the Literature From 2009 Through 2014. Archives of Physical Medicine and Rehabilitation.
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.
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.
