Tools aid in detection, treatment of cancer-related cognitive impairment
PHOENIX — A simple, computer-based tool allows clinicians to detect cancer-related cognitive impairment, according to a presentation at the Association of Community Cancer Centers National Oncology Conference.
Once detected, clinicians can offer a web-based, interactive cognitive training program as an alternative to traditional speech or occupational therapy to help restore cognitive function.
“Cognitive complaints, such as impaired memory, contraction and attention, is one area that so many patients experience,” Aileen Moreno, LCSW, neuropsychological technician at Miami Cancer Institute and Baptist Health South Florida, said at the conference. “Often, it negatively impacts their quality of life.”
Estimates of cancer-related cognitive impairment vary widely, according to Moreno, with some suggesting up to 75% of patients develop impairment during treatment. The exact cause is unknown, but it is likely multifactorial, Moreno said.
At her institution, Moreno administers the CNS Vital Signs test to patients with cancer who report symptoms of cognitive impairment, such as forgetting things, trouble concentrating and difficulty multitasking.
The test can be completed in 30 minutes and addresses all clinical domains impacted by cognitive impairment, including processing speed, attention and memory.
“It can be easily integrated into the daily clinic practice of an outpatient health care setting. It’s an efficient and practical assessment,” Moreno said. “It can be administered by a nonclinician [and] immediately generates a detailed report, and it’s clinical resource-friendly, cost-effective and time-efficient.”
This test can prevent unnecessary imaging or laboratory testing and reduce the likelihood of inappropriate referrals for lengthy neuropsychological tests.
“Without a tool like this, what may have been 6 hours of general psych testing, might now be 1.5 hours. So, it provides both time and cost savings to the health care provider/facility and to the patient,” Moreno said.
If clinicians detect cancer-related cognitive impairment, a comprehensive neuropsychological battery is conducted.
Patients are then recommended for one of two treatment options: traditional occupational or speech therapy or a remote online cognitive training program called BrainHQ (Posit Science).
BrainHQ consists of a variety of game-like training exercises that address various areas of cognitive impairment. The exercises increase and decrease in difficulty depending on the progress of the patient.
Moreno and colleagues recommend four 25-minute sessions per week of BrainHQ for 12 weeks.
The researchers are still assessing adherence and benefit outcomes with the online-based system.
“The promise of this virtual cognitive rehabilitation option is that it could potentially provide a way to eliminate potential barriers of access to care, reduce patient financial burden and hopefully — what we really want to see is — it improves treatment compliance and cognitive health outcomes,” Moreno said. – by Cassie Homer
Moreno A. Detecting and treating cancer-related cognitive impairment. Presented at: ACCC National Oncology Conference; Oct. 17-19, 2018; Phoenix.
Disclosure: Moreno reports no relevant financial disclosures.