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Emerging From the Haze: A Multicenter, Controlled Pilot Study of a Multidimensional, Psychoeducation-Based Cognitive Rehabilitation Intervention for Breast Cancer Survivors Delivered With Telehealth Conferencing

Published:March 13, 2020DOI:https://doi.org/10.1016/j.apmr.2020.01.021

      Abstract

      Objective

      To quantify the effect of a psychoeducation-based cognitive rehabilitation intervention on breast cancer survivors’ self-report of cognitive function and investigate the feasibility of accrual, adherence, and multisite program delivery using secure telehealth conferencing.

      Design

      Prospective, nonblinded, wait-list controlled pilot study.

      Setting

      Nonprofit academic medical center and university medical center with associated community practice affiliates.

      Participants

      Adult female survivors of stage I-III breast cancer reporting cognitive complaints 2 months to 5 years after chemotherapy (N=61). Ongoing endocrine and/or anti-HER-2 therapy was allowed. Patients were excluded for history of other conditions involving impaired cognitive function. Combination referred and volunteered sample. In total, 107 women were screened, 61 consented, and 52 analyzed. No attrition due to adverse events. Group allocation was based on consent timing and next scheduled cohort to minimize wait time for wait-list controls.

      Intervention

      Psychoeducation-based cognitive rehabilitation intervention delivered in a group setting during 6 weekly 2.5-hour classes. Included presentation, class exercises, discussion, and homework exercises. Provided in-person and virtually by Health Insurance Portability and Accountability Act compliant and encrypted telehealth conferencing.

      Main Outcome Measures

      Primary: self-report of perceived cognitive function (PCF) was compared between the intervention group (n=27) and wait-list controls (n=28) with the Functional Assessment of Cancer Therapy-Cognition perceived cognitive impairment subscale. Secondary: feasibility for multisite delivery via teleconferencing was measured by total accrual, percent adherence to 4 of the 6 weeks of content, and participant satisfaction ratings.

      Results

      The intervention group demonstrated improvement in PCF both at the conclusion of the intervention and 1 month later (P<.01). Within-group improvement in PCF was maintained at 6 and 12 months (P<.01).

      Conclusion

      These study results provide further preliminary evidence of the efficacy of psychoeducation-based cognitive rehabilitation as an intervention for decreased PCF in breast cancer survivors with cognitive complaints after chemotherapy. Feasibility for accrual, adherence, and participant satisfaction with secure telehealth conferencing was demonstrated. These positive pilot study results will inform future work.

      Keywords

      List of abbreviations:

      BCS (breast cancer survivor), CRCI (cancer-related cognitive impairment), FACT-Cog (Functional Assessment of Cancer Therapy-Cognition), KUMC (University of Kansas Medical Center), PCA (perceived cognitive abilities), PCF (perceived cognitive function), PCI (perceived cognitive impairment), PROMIS (Patient-Reported Outcomes Measurement Information System), QOL (quality of life), UCLA (University of California Los Angeles)
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