Video-Based Behavioral Therapy May Ease "Chemobrain" in Breast Cancer Survivors

Research suggests that 25% to 40% of individuals receiving chemotherapy experience persistent mild to moderate cognitive changes, and a study of breast cancer survivors suggests that a new type of psychotherapy delivered by videoconference may help reduce these effects, often referred to as “chemobrain.”

Research suggests that 25% to 40% of individuals receiving chemotherapy experience persistent mild to moderate cognitive changes, and a study of breast cancer survivors suggests that a new type of psychotherapy delivered by videoconference may help reduce these effects, often referred to as “chemobrain.”

The novel therapy explored in this study, labeled Memory and Attention Adaptation Training (MAAT), is designed to help individuals in four areas: education, self-awareness, stress management, and cognitive compensatory strategies. Ultimately, the objective of MAAT is to “optimize behavioral, cognitive and emotional adaptation” to living with chemobrain, the authors wrote.

The study involved Caucasian female breast cancer survivors who met the following inclusion criteria: a diagnosis of stage I-IIIa breast cancer; treatment involving adjuvant chemotherapy; were 6 months out from treatment; and currently disease free. Participants also had to have reported cognitive problems attributed to chemotherapy and score 10 or lower on the FACT-Cog Impact of Quality of Life Scale.

Thirty-five individuals were included in the study population analyzed, of whom 22 were randomized to MAAT and 13 to supportive talk therapy, which also was delivered via videoconference. Survivors on both arms of the study received therapy for 8 weekly visits of 30 to 45 minutes each.

The first component of MAAT, education, a common characteristic of any cognitive behavioral therapy, and is intended to help make survivors aware of the possibility that other factors, eg, stress, age or inattention, can contribute to memory issues.

“We want people to not get into a habit of attributing all memory failures to chemotherapy,” explained study author Robert J. Ferguson, MD, in an interview with Oncology Nursing News. He also emphasized that his intention is not to dismiss any experiences of a cancer survivor. Ferguson led the research at Eastern Maine Medical Center and Lafayette Family Cancer Center in Bangor, Maine. He is now an assistant professor of medicine in the Biobehavioral Oncology Program at the University of Pittsburgh Cancer Institute.

While education is a discussion between patient and clinician, the second component of MAAT, self-awareness, moves the patient toward taking action. As part of this, individuals are asked to self-monitor and record memory failures that bother them.

“Obviously, [patients are] not going to record every memory failure they had,” Ferguson noted. “We want individuals to identify and be more aware of—through this self-monitoring or recording process—of the situations where they're at risk for memory failure in daily life.”

The third component, stress management and self-regulation, will typically include relaxation training, “cognitive restructuring,” and sleep quality improvement. Finally, cognitive compensatory strategies training includes “self-instructional training, verbal rehearsal, visualization strategies, keeping an organized schedule, and active listening to enhance verbal-auditory encoding,” according to the study’s authors.

Survivors on the other arm of the trial who received supportive therapy worked on building an alliance with their physician through empathy, support, and warmth, without any behavioral training.

Following MAAT or supportive therapy, individuals were assessed using the following: the Perceived Cognitive Impairments (PCI) questionnaire asked individuals to rate perceived memory issues over the previous week, on a scale of 0 (never) to 4 (several times a day). Survivors were also asked to rate their memory and cognitive abilities with the Perceived Cognitive Abilities questionnaire. Individuals were assessed before therapy, immediately after therapy, and 2 months after completion of therapy.

There was a trend towards benefit in perceived cognitive impairment for individuals in the MAAT group in the posttreatment analysis. That benefit became “significant” at 2-month follow up, according to the authors. A benefit for MAAT was also observed for survivors in processing speed in the posttreatment analysis, though the 2-month follow-up data were not statistically significant.

Participants in either group did not differ in posttreatment results with regard to anxiety about cognitive problems (quality of life). At the 2-month follow up, though, MAAT individuals had decreased anxiety, suggesting they “continued to build coping skills beyond the cessation of clinician interaction,” study authors noted.

Ferguson said that future research is warranted to improve methods of preventing and treating cognitive failure. These studies must be expanded to include men, survivors of other types of cancer, survivors of different ethnic backgrounds, and at other sites.

Ferguson RJ, Sigmon ST, Pritchard AJ, et al. A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer. 2016;122(11):1782-1191.