‘Chemobrain’ is the colloquial term for changes in cognitive functioning following chemotherapy for cancer treatment. As a result of a growing need, more cancer centers started testing interventions for cancer-related cognitive dysfunction, notably cognitive behavioral therapy (CBT). The paper presents an overview on current studies investigating the effectiveness of cognitive rehabilitation strategies.
Many previous studies found no association between patient reported cognitive problems (so called “subjective cognition”) and test-based psychologist reported findings (so called “objective cognition”). More recently, structural changes in the brain associated with both subjective and objective cognition, mounting evidence in animal models and the availability of more sophisticated imaging methods have started to show evidence of brain changes associated with cancer in a subgroup of patients. This has led to the launch of randomized controlled studies in major cancer centers of the US and Australia in order to address the rehabilitation of cancer-related cognitive dysfunction in the most effective way.
Mixed results were obtained from some pharmacologic intervention studies (e.g. Modafinil, Methylphenidate, Donepezil), and therefore current research focus is on cognitive rehabilitation approaches. The present article outlines seven intervention studies:
- Two CBT studies with an active control group (individuals who receive an alternative intervention such as counseling) are underway (completion 2013)
- Two “Memory and Attention Adaptation Training” (MAAT) studies, one with a waitlisted control group (individuals randomly assigned to the control group who will receive the same intervention later), the other with an active control group (supportive counseling instead of MAAT). Both interventions are through a video-conference network.
- Two CBT studies which test group sessions focused on thinking and memory skills with a waitlisted control group. One of these trials showed improved overall cognitive function, memory, and visual and spatial skills in the CBT group. A larger study based on the same intervention opened this year.
- Another CBT study taught its participants assistive techniques, such as using a calendar to track daily activities, as well as memory and other cognitive skills. This intervention significantly improved their working memory and attention compared to the waitlisted control group.
All “chemobrain intervention trials” listed in this publication launched 2010 – 2012 and the questions to be answered on completion (2013-2014) are:
- Is there an optimal intervention method?
- Is there an optimal intervention frequency and duration?
- Should it be individual- or group therapy?
- Should therapy be done in person (face to face) or could it be ‘computerized’ (e.g. via video-conference)?
The outcomes of these trials will guide future recommendations on how to effectively rehabilitate cancer patients who experience cognitive decline as the result of the disease or its treatment.
Published By :
Journal of the National Cancer Institute (JNCI)
Date :
Nov 21, 2012
