New Psychotherapy May Help Fight Chemobrain in Cancer Survivors

A new type of psychotherapy delivered by videoconference may help reduce the effects of chemobrain, according to a study of 35 breast cancer survivors.

Study authors note that the body of evidence suggests that 25 to 40 percent of individuals receiving chemotherapy experience “persistent mild to moderate cognitive changes”: Today, more than 650,000 patients with cancer receive chemotherapy every year, and by 2022, it is estimated that 18 million people in the U.S. will be living with a cancer diagnosis. Both numbers underscore the need for a better understanding of and treatment for 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 hypothesis was that compared to controls, we would have improvements in self-reported cognitive function as well as neuropsychological outcomes — verbal memory and processing speed,” said Robert J. Ferguson, a clinical psychologist who led the research effort at Eastern Maine Medical Center and Lafayette Family Cancer Center in Bangor, Maine, in an interview with CURE.

Ferguson is now an assistant professor of medicine in the Biobehavioral Oncology Program at the University of Pittsburgh Cancer Institute.

In the study, survivors were included who had a diagnosis of stage 1, 2 or 3A breast cancer, treatment involving adjuvant chemotherapy, were six 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.

“Breast cancer survivors and lymphoma survivors are the largest populations from which to draw samples,” Ferguson says, though he acknowledged that future studies must include survivors of other types of cancer.

“There is some evidence to suggest that cancer type may make a difference in cognitive effects,” he says, citing longitudinal evidence that has shown cognitive abnormalities occurring prior to cancer. “It may be the cancer itself that is contributing to these memory deficits or memory changes.”

In this study, 35 Caucasian female survivors of breast cancer met inclusion criteria and were eligible for analysis. In total, 22 individuals were randomized to MAAT and 13 individuals were randomized to videoconference supportive talk therapy.

A Four-Part Approach

MAAT was delivered by Ferguson while Sandra T. Sigmon, the second author on the study and also a clinical psychologist, delivered the supportive talk therapy. Survivors on both arms of the study received therapy for eight weekly visits of 30 to 45 minutes each.The first component of MAAT, education, is a common trait of any cognitive behavioral therapy and is put in place to make survivors aware of the possibility that other factors — such as 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,” Ferguson says, but he emphasized that his intention is not to dismiss any experiences of a cancer survivor.“We want patients to understand what the problem is — the best scientific explanations we can give — and where and when it can occur.”

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

“Obviously, you’re not going to record every memory failure you had,” Ferguson says. “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 and fourth components are focused entirely on action.

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.

Participants Report Cognitive Gains

Survivors on the other arm of the trial — those receiving 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 in two ways. 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 two months after completion of therapy.

There was a trend towards benefit in perceived cognitive impairment for individuals in the MAAT group in the post-treatment analysis. That benefit became “significant” at two-month follow up, according to the authors.

There was also a benefit for MAAT survivors in processing speed in the post-treatment analysis, though the two-month follow-up data were not statistically significant.

What All Survivors Can Do

Participants in either group did not differ in post-treatment results with regard to anxiety about cognitive problems (quality of life). At the two-month follow up, though, MAAT individuals had decreased anxiety, suggesting they “continued to build coping skills beyond the cessation of clinician interaction.”Much of this research boils down to the need for physicians to assess and treat the whole patient.

Ferguson cited physical activity (primarily aerobic exercise) as a way to improve cognitive health and depression or an anxiety disorder as two conditions that can add to cognitive failures.

"Not all patients are going to have cognitive problems, but there are some things that all cancer survivors can do to help prevent cognitive problems,” Ferguson says.

Future research is warranted, he says, 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.

Further, the methods of measuring cognitive change can also be improved.

“Unfortunately, in my clinical experience, [I've known] people who've been fired from work or have been demoted or moved to a lateral position without as many cognitive demands,” Ferguson says. “I think it's good that we get this treatment out there and we can prevent things like that from happening.”