Rehabilitation of cognitive dysfunction in survivors of breast cancer: a pilot study involving survivor-partner dyads

Abstract

Purpose: Cancer-related cognitive impairment (CRCI) has been associated with fatigue, emotional distress, reduced quality of life, and caregiver strain. A potential treatment option for those with CRCI is cognitive rehabilitation, a behavioural approach to improve cognitive skills and quality of life. There have been some studies that involve caregivers in aspects of rehabilitation. There are no studies in the literature however, that include direct retraining of survivors on lost functions and concurrent participation by their caregivers across all sessions. To fill this gap, a comprehensive 10-week cognitive rehabilitation program (CRP) was created, with aims to generalize improvement to everyday life in survivors of breast cancer. Methods: A manualized CRP was developed and piloted with breast cancer survivors (BCSs) and their training partners. The program focused on psychoeducation and direct training on communication strategies, breathing/relaxation techniques, simple and complex attention, and higher-order thinking. Outcome measures included feasibility (retention and attendance rates), acceptability (homework compliance, session and program satisfaction), and measures of cognitive functioning and quality of life. BCSs and their individual partner underwent assessments at baseline, immediately after completing the program, and approximately 10 weeks later in order to investigate maintenance effects. Results: Six BCSs (ages 44-59; ≥1 year post-chemotherapy) and their training partners enrolled and completed this study with a (100% retention rate). Rates of attendance were high for both BCSs and their training partners (94% and 92.5% respectively) with all participants indicating high levels of satisfaction with the iv program. Repeated measures analyses of variance (ANOVAs) did not reveal a significant main effect for time on measures of sustained attention, processing speed, executive function, fluency (semantic and phonemic), verbal and visuospatial learning, recall and recognition. Repeated measures ANOVA revealed a significant main effect for time on measures of attentional capacity, focused attention, motor dexterity with the non-dominant hand, confrontation naming, and overall quality of life. Additionally, analyses using adjusted reliable change indices (RCI) were conducted on individual cases. RCIs yielded no change on most measures across time.