In the Journals

Videoconference behavior therapy improves chemotherapy-related cognitive dysfunction in breast cancer survivors

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May 2, 2016

Memory and Attention Adaptation Training via videoconference technology led to improvements in cognitive impairments and neuropsychological processing speed in survivors of breast cancer, according to results of a randomized trial.

Although cognitive dysfunction affects 25% to 40% of patients treated with chemotherapy, there are no established therapies for this survivorship issue.

Robert J. Ferguson, PhD, clinical psychologist at University of Pittsburgh Cancer Institute who worked at Eastern Maine Medical Center and Lafayette Family Cancer Center at the time of the study’s conduct, and colleagues evaluated the efficacy of Memory and Attention Adaptation Training (MAAT), a cognitive therapy used to treat patients with chemotherapy-related cognitive dysfunction. The therapy — delivered through videoconferencing — addresses survivor cognitive performance and emphasizes the promotion of adaptive behavior changes in work and home life, as well as in social activity.

“This is what we believe is the first randomized study with an active control condition that demonstrates improvement in cognitive symptoms in breast cancer survivors with long-term memory complaints,” Ferguson said in a press release. “MAAT participants reported reduced anxiety and high satisfaction with this cognitive-behavioral, non-drug approach.”

The analysis included data from 35 female survivors of breast cancer (median age, 54.6 years; 100% non-Hispanic white) who reported having chemotherapy-related cognitive dysfunction. Researchers randomly assigned the women to eight 35- to 40-minute visits of MAAT (n = 22) or supportive therapy (n = 13), a “behavioral placebo” that emphasizes reflective listening and summarization to improve understanding of the survivor’s emotional experience.

The women completed questionnaires regarding their cognitive symptoms and quality of life, as well as a brief telephone-based neuropsychological assessment. They underwent evaluations at baseline, posttreatment and 2-month follow-up.

Overall, women assigned MAAT self-reported greater improvements in cognitive impairment (P = .02) and neuropsychological processing speed (P = .03) compared with control women.

With regard to quality of life, at 2-month follow-up women in the MAAT group reported greater improvements in anxiety regarding their cognitive problems (Cohen’s d for standard differences in effect sizes, 0.9), with intermediate improvements in general function (d, 0.5), fatigue (d, 0.46) and anxiety (DASS-21 anxiety scale; d, 0.55).

“This suggests that MAAT participants continued to build coping skills beyond the cessation of clinician interaction, which is consistent with the treatment design,” the researchers wrote.

Women assigned MAAT reported higher satisfaction ratings with their therapy immediately posttreatment and at 2-month follow-up (P value range, .003-.05). These women also rated MAAT as more helpful in compensating for cognitive problems rather than improving cognitive performance.

Women in the MAAT and standard treatment groups highly rated the videoconferencing technology. Seventy-five percent of women in the MAAT group reported they would not have engaged in therapy without videoconferencing.

“Because treatment was delivered over videoconference device, this study demonstrates MAAT can be delivered electronically and survivors can reduce or eliminate travel to a cancer center,” Ferguson said. “This can improve access to survivorship care.”

Additional research is needed with more individuals with varied ethnic and cultural backgrounds and multiple clinicians delivering treatment, Ferguson added. – by Alexandra Todak

Disclosure : Ferguson reports holding a copyright for the treatment manuals for the cognitive behavioral therapy used in this study. The other researchers report no relevant financial disclosures.

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