Group Cognitive Rehabilitation for Cancer Survivors: Enhancing Cognitive Function and Quality of Life

Group Cognitive Rehabilitation for Cancer Survivors:
Enhancing Cognitive Function and Quality of Life
Alana Schuurs DPsych(Clin) & Heather J Green PhD
School of Applied Psychology & Behavioural Basis of Health
Research Program, Griffith Health Institute
Griffith University
University, Gold Coast
Coast, Australia
ICCTF International
I t
ti
l Cognition
C
iti & Cancer
C
Taskforce
T kf
Conference
C f
Paris, France 15-17 March 2012
Cognitive Function After Cancer
•
Problems with cognitive functions such as attention and memory are
increasingly recognised as an issue for some cancer survivors
(Oxman & Silberfarb, 1987; Vardy et al., 2007; Vearncombe &
Pachana, 2009).
•
Both objective and subjective deficits have been found, but
subjective deficits often show a closer relationship with emotional
distress than with objective tests of cognitive function (Cull et al.,
1996).
•
A promising treatment is cognitive rehabilitation (CR), which has the
potential to improve both objective and subjective dysfunction as well
as emotional
ti
l di
distress
t
(B
(Butler
tl & M
Mulhern,
lh
2005
2005; F
Ferguson ett al.,
l 2007
2007;
Gabanelli, 2005; Meyers, 2000).
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Proposed Model (Green et al., 2005, Psychology,
Health and Medicine)
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Conflicting Perspectives/Emphases
Researchers
Patients
 “Mild”, “subtle”
 Objective
 Absolute deficits
ICCTF International Cognition and Cancer Task Force Conference
 Functional outcome
 Subjective
 Relative deficits
March 15
15--17
th
2012 – PARIS - FRANCE
Responding to Cognitive Concerns Project (“ReCog”)
•
Aim:
 This project aimed to evaluate the acceptability and feasibility of
a group psychological intervention intended to improve actual
and perceived cognitive performance in people who have
completed treatments for cancer
cancer.
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Intervention: “Re-Cog Program”
Session 1: Aging, Health, Cancer and Cognitive
Function
Session 2: Memory
Session 3: Attention
Session 4: Fatigue, Emotions and Cognition
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Intervention: “Re-Cog Program”
Small groups (4-8 participants)
Two co-therapists
Weekly sessions, 2 hours including
refreshment break
Clinician and participant manuals
Between session homework
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Methods
•
Open-label intervention study with pre- & post-intervention assessment plus
3 month follow-up
•
Participants: Intervention: 23 adults who had been treated for adult-onset
cancer in the past and had completed treatments at least 4 months
previously. Cancer comparison n=9, Community Comparison n=23
•
Measures:
 Objective cognition: Repeatable Battery for the Assessment of
Neuropsychological Status & Trailmaking Test
 Subjective cognition: Multiple Ability Self-Report Questionnaire and
Functional Assessment of Cancer Therapy – Cognitive Scale
 Distress: K-10
 Quality of life: EORTC-QLQ-C30
 Illness perceptions: Brief Illness Perceptions Questionnaire
 Patient satisfaction: Satisfaction survey and verbal feedback
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Demographics
•
•
•
•
•
•
•
•
23 participants from four groups (13 female, 10 male)
Age: 34
34-84
84 years (M = 58.2, SD = 11.8 yrs)
Education: 10-20 years (M = 15.4, SD = 3.2 yrs)
All but one had English as a first language
C
Cancer
ttypes:
 Breast 11, Prostate 4, Colorectal 4, Neck 1, Testicular 1, Mixed 2
Treatments:
 Surgery 19, Chemotherapy 17, Radiotherapy 14, Other 12
Time since initial diagnosis: 19 months-14 years (M = 5.7, SD = 3.7 yrs)
Time since last treatment: 4 months
months-10
10 years (M = 3.8,
3 8 SD = 2
2.7
7 yrs)
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Cognitive Concerns
•
According to baseline self-report
 History of cancer-related
cancer related cognitive problems: 19
 Had made adaptations due to these problems: 18
 Current cancer-related cognitive problems: 15
•
Cognitive problems attributed to cancer or cancer treatment:
•
•
•
“During [cognitively demanding work task], it feels like I have lost my train of thought and the
purpose of what I was saying”
“Slow down in thought capacity”
Adaptations:
•
•
“When my brain was getting ‘stuck’, I felt very embarrassed & avoided people except for close
friends and family”
“Write lists of things to do”
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Change in RBANS Total Score Over Time for Each Group
d= 1.00/1.19 for intervention improvement cf
cancer/community comparison groups respectively
RBANS Total; Visuospatial/constructional; Immediate
Memory; Delayed Memory
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Self-Report Measures
Measure (potential range)
Preintervention
PostIntervention
p, Effect size cf cancer/
community comparison
Subjective cognition:
MASQ total (38-190)
88.5 (18.1)
88.5 (14.3)
.983, 0.04/ -0.29
Subjective cognition:
FACT-Cog3 perceived
cognitive impairments total (080)
38 7 (17
38.7
(17.7)
7)
46 7 (17
46.7
(17.0)
0)
.011,
011 0.15/
0 15/ --
Subjective cognition: FACTCog3 perceived cognitive
ability total (0-36)
16.8 ( 5.8)
20.0 ( 5.9)
.041, 0.38/ --
Global Quality of Life:
EORTC Global (0-100)
68.7 (13.2)
68.7 (13.4)
.999, -0.40/ 0.02
Quality of Life:
EORTC Social Function (0-100)
69.8 (31.9)
83.3 (21.1)
.027, 0.48/ 0.57
Psychosocial Distress:
K10 (10-50)
19.4 ( 7.9)
17.5 ( 5.5)
.090, 0.26/ 0.32
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Illness Perceptions
p
((Brief-IPQ;; item range
g 0-10))
Measure
Pre-intervention
Post-Intervention
p, Effect size cf
cancer/communityy
comparison
Consequences
4.0 (3.0)
3.8 (3.0)
.550, 0.24/-0.17
Timeline
6.1 (3.5)
5.1 (3.4)
.265, 0.22/ 0.36
Personal control
4.9 (2.9)
5.8 (2.4)
.192, 0.24/ 0.23
Treatment control
6.1 (2.8)
6.4 (2.9)
.433, 0.40/ 0.04
Identity
3 9 (3
3.9
(3.0)
0)
3 9 (2
3.9
(2.7)
7)
.999,
999 -0.10/0.20
-0 10/0 20
Concern
5.6 (3.7)
4.9 (3.3)
.175, 0.22/ 0.28
Illness
comprehension
4.8 (3.0)
6.7 (2.7)
.003, 0.26/ 0.49
Negative emotions
4.8 (3.4)
4.9 (3.2)
.827, -0.13/ 0.15
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Participant Satisfaction
Item (Potential range)
Mean (SD; range)
Proportion positive ratings
Satisfied (1-5)
4.8 (0.4, 4-5)
21/21
Cognition improved (1-5)
4.0 (0.4, 3-5)
19/21
Would recommend to a
friend with same problem
(1-5)
4.6 (0.6, 3-5)
20/21
g ((1-10))
Overall rating
9.0 ((0.9, 7-10))
21/21
“Program itself & group dynamic of sharing experiences”
“I liked talking about cancer, normally I don’t”
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Conclusions
•
The program was feasible to conduct for participants with mixed
ages, genders, tumour types and treatment types
•
Participants found the program acceptable and all were satisfied or
very satisfied with the intervention
•
Neuropsychological performance on the main outcome measure
improved much more than practice effects: d=1 & 1.2 respectively
after subtracting practice effects of cancer comparison & community
comparison groups
•
Participants
p
reported
p
improved
p
comprehension
p
of cognitive
g
function,,
reduced perceived cognitive impairments and improved perceived
cognitive abilities
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Future Directions
•
•
•
Randomised study
Further understanding of mechanisms
mechanisms, e
e.g
g cognitive self-efficacy
self-efficacy,
mood
Generalisability
• Neurocognitive problems associated with a general medical
condition?
• Adjustment/trauma?
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE
Acknowledgements
 Funding: Griffith University Research Grant GURG 36603; Psycho-Oncology
Cooperative Research Group Protocol Development Workshop Funding 2007
 Research Assistants: Kerrie Woods, Leah Pischek-Simpson, Louise Kelso, Phillip Law
 Honours Students: Elizma Piffero, Melissa Cheras
 Research Interns: Jessica Davis, Joanne Hughes
 Clinical Interns: Brooke Mitchell, Jacinta McKay, Lauren Baker, Chrystal Gray
 Protocol Development: Dr Bettina Meiser, Prof David Shum, Dr Tamara Ownsworth
 Recruitment Assistance: Gold Coast Health Service District,, Cancer Council
Queensland, Prostate Cancer Foundation of Australia, University of the Third Age
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE