In a new study that could help improve the day-to-day quality-of-life for women with breast cancer, UCLA researchers have developed a cognitive rehabilitation program to address post-cancer treatment cognitive changes, sometimes known as “chemo brain,” which can affect up to 35 percent of post-treatment breast cancer patients.
An estimated 1 in 8 women will develop invasive breast cancer in their lifetime, and post-treatment, the mental “fogginess” of “chemo brain” can prevent them from staying organized and completing everyday activities, such as sticking to a schedule, planning a family gathering or forgetting where they left the car keys.
This new study, led by breast cancer research pioneer and UCLA Jonsson Comprehensive Cancer Center member Dr. Patricia Ganz, builds upon her earlier research that found a statistically significant association between neuropsychological test performance and memory complaints in post-treatment, early stage breast cancer patients.
“We invited the women to participate in a research study that assigned them to early or delayed treatment with a five-week, two-hour group training session, where a psychologist taught them strategies to help them with their memory and maintaining their ability to pay attention to things,” said Ganz, director of prevention and control research at the Cancer Center. “These are activities we call executive function and planning, or the things all of us do in order to organize our day.”
The intervention program also included homework and practice activities that they would discuss at the weekly sessions. The goals of these exercises were to improve memory and cognitive function.
Dr. Linda Ercoli, an associate clinical professor of health sciences at the UCLA Semel Institute, was responsible for the development of the cognitive rehabilitation intervention program and either delivered or supervised other clinicians who provided the group training sessions.
“We gave women exercises on, for example, how to remember a ‘To-Do’ list, remembering to buy items at the store, or planning a party and deciding what type of food should be served to guests,” said Ercoli, also a co-author of the study. Participants were given real-life tasks to complete that would use these types of strategies to improve cognitive function.”
All of the women who participated in the research study, whether they received the intervention early or at a delayed time point, completed questions about their mood and mental functioning and had detailed neurocognitive testing before learning which group they would be in, immediately at the end of the training course and then again two months later. Most of the women also had resting EEG (brain wave) testing to see if this would measure changes in how the women fared throughout the study.
Ganz and Ercoli found that the early intervention group (32 women) reported improvement in memory complaints and test functioning, while the delayed intervention control group (16 women), did not improve in either their cognitive complaints or test performance. The intervention group participants showed continued improvement two months after completion of the rehabilitation program.
“The brain wave pattern in the intervention group actually normalized,” said Ganz. “We hope that this might be an effective biologic way to assess the cognitive effects of cancer treatment in the future.”
• Breast cancer survivors with cognitive complaints participated in five-week training program to help with memory and concentration and were compared to survivors who received delayed treatment at end of study
• The early intervention group (32 women) had significant improvement in cognitive complaints and improved performance on standard memory tests compared to the delayed treatment group (16 women)
• EEG brain wave patterns improved in the early intervention group, suggested that abnormal brain changes can be reversed with cognitive rehabilitation
The next steps will allow other researchers to review and test this cognitive rehabilitation program in larger groups of patients, and to potentially develop strategies to provide intervention much earlier in the course of breast cancer treatment to either prevent difficulties or hasten recovery.
This study, which found agreement between improvements in patient-reported cognitive complaints and neurocognitive test performance added to the growing body of literature demonstrating the validity of patient complaints. Furthermore, the intervention results provided important encouragement that these complaints can improve with appropriate training.
The study was funded by the Breast Cancer Research Foundation and the Jonsson Comprehensive Cancer Center Foundation.
The randomized clinical trial results are now available online in the journal Psycho-Oncology.