) Cognitive deficits associated with cancer treatment can have a dramatic effect on patients' quality of life and have been recognized as a problem by the President's Cancer Panel (1999) and the National Coalition for Cancer Survivorship for those living with cancer (Ferrell Hassey & Dow, 1997). Increasing evidence suggests that standard dose, systemic chemotherapy can produce memory and concentration deficits in adult 5-year cancer survivors (Ahles, 1999). While more research on the cognitive effects of chemotherapy is needed, mounting evidence suggests strongly that development of interventions to improve cognitive functioning following chemotherapy is important. The present application proposes pilot testing a brief cognitive-behavioral treatment program (4 visits with 3 phone contacts) designed to assist breast cancer survivors in compensating for cognitive impairment associated with systemic chemotherapy. The principal long-term objective of this work is to examine the treatment program's feasibility to be carried out in clinical oncology settings at this pilot-phase of treatment development and examine its preliminary effectiveness in a small sample of cancer survivors. Results will aid planning and carry-through of a randomized controlled trial of efficacy in future investigation.
Specific aims of the present project are: 1. To evaluate the feasibility of a brief cognitive-behavioral treatment program designed specifically for rehabilitation of cognitive deficits resulting from systemic chemotherapy. Breast cancer survivors will be the target population. 2. Pilot-test the effectiveness of the brief cognitive-behavioral treatment as a first-phase of treatment development (one-group, repeated measures design). 3. Quantify the proportion of treatment participants who achieve clinically significant improvement using statistical methods to determine clinically significant outcomes in behavioral research (Jacobson, Roberts, Berns, & McGlinchey, 1999). Clinically significant change will be defined as exceeding the reliable change index (RCI) in pre- to post-test scoring on self-report measures of cognitive functioning and quality of life measures. 4. Evaluate participant satisfaction with treatment. Thirty-three breast cancer survivors (5 years after disease remission) with attention and memory deficits will enroll in the pilot treatment. A single-group, 3 (time: pre-treatment, post-treatment, 2-month follow-up) X 1 (treatment group) repeated-measures, multivariate analysis of variance (MANOVA) design will be used to evaluate effects of treatment on three dependent measures: 1) standardized self-report measure of cognitive function; 2) a global neuropsychological test performance score; and 3) a self-report measure of survivor quality of life. Participant satisfaction and adherence to behavioral and cognitive homework tasks will also be assessed by quantifying these variables with descriptive statistics. Implications for future study are discussed.
