Advanced cognitive training for breast cancer survivors: a randomized controlled trial
- 1.3k Downloads
The purpose of this study was to evaluate the preliminary efficacy and satisfaction/acceptability of training in memory or speed of processing versus wait-list control for improving cognitive function in breast cancer survivors. 82 breast cancer survivors completed a three-group randomized, controlled trial. Primary outcomes were objective neuropsychological tests of memory and speed of processing. Secondary outcomes were perceived cognitive functioning, symptom distress (mood disturbance, anxiety, and fatigue), quality of life, and intervention satisfaction/acceptability. Data were collected at baseline, post-intervention, and 2-month follow-up. Using repeated-measures mixed-linear ANCOVA models, each intervention was compared to wait-list control while adjusting for age, education, and baseline measures. The effect sizes for differences in means and the reliable improvement percentage were reported. The results show that domain-specific effects were seen for both interventions: memory training improved memory performance at 2-month follow-up (p = 0.036, d = 0.59); speed of processing training improved processing speed post-intervention (p = 0.040, d = 0.55) and 2-month follow-up (p = 0.016; d = 0.67). Transfer effects to non-trained domains were seen for speed of processing training with improved memory post-intervention (p = 0.007, d = 0.75) and 2-month follow-up (p = 0.004, d = 0.82). Both interventions were associated with improvements in perceived cognitive functioning, symptom distress, and quality of life. Ratings of satisfaction/acceptability were high for both interventions. It was concluded that while both interventions appeared promising, speed of processing training resulted in immediate and durable improvements in objective measures of processing speed and verbal memory. Speed of processing training may have broader benefits in this clinical population.
KeywordsMemory Speed of processing Breast cancer survivors Symptom distress Quality of life
This study was supported by Robert Wood Johnson Foundation Nurse Faculty Scholar Program (#64194), American Cancer Society Institutional Research Grant (#84-002-25), Indiana University School of Nursing Center for Enhancing Quality of Life in Chronic Illness and the Mary Margaret Walther Program of the Walther Cancer Institute (#0097.01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation, which funded this trial. The funding agency had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. Dr. Patrick Monahan had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Conflict of interest
The authors declare that they have no conflict of interest. Posit Science Corporation is the developer of the speed of processing (Insight®) program used in this study. Posit Science Corporation holds the patent for and a proprietary interest in this software. The software was provided at cost of the CD by Posit Science. Dr. Karlene Ball is on the Board of Directors of Posit Science and has stock in the company. Dr. Unverzagt has received support for training for an investigator initiated research from Posit Science.
This study was conducted in accordance with all laws of the United States and the study was approved by the Indiana University Simon Cancer Center Scientific Review Group and Institutional Review Board in which was conducted.
- 7.Mehnert A, Scherwath A, Schirmer L, Schleimer B, Petersen C, Schultz-Kindermann F, Zander AR, Koch U (2007) The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue, and quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Educ Couns 66(1):108–118PubMedCrossRefGoogle Scholar
- 12.Smith GE, Housen P, Yaffe K, Ruff R, Kennison RF, Mahncke HW, Zelinski EM (2009) A cognitive training program based on principles of brain plasticity: results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study. J Am Geriatr Soc 57(4):594–603PubMedCrossRefGoogle Scholar
- 17.Mahncke HW, Conner BB, Appelman J, Ahsanuddin ON, Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, Merzenich MM (2006) Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci USA 103(33):12523–12538PubMedCrossRefGoogle Scholar
- 18.Rey A (1941) L’examen psychologique dans les cas d’encephalopathie traumatique. Archives de Psychologie 28:286–340Google Scholar
- 19.Wilson B, Cockburn J, Baddeley A (1985) The rivermead behavioral memory test. Thames Valley Test Co., Reading and National Rehabilitation Services, GaylordGoogle Scholar
- 25.Spielberger CD, Gorsuch RI, Lushene RG (1971) Manual for the state-trait anxiety inventory. Consulting Press, Palo AltoGoogle Scholar
- 29.Ware JE Jr, Snow KK, Kosinski M, Gandek B (1993) SF-36 health survey manual and interpretation guide. The Health Institute, The New England Medical Center, BostonGoogle Scholar
- 32.Blom G (1958) Statistical estimates and transformed beta variables. Wiley, New YorkGoogle Scholar
- 34.Uchiyama CL, D’Elia LF, Dellinger AM, Becker JT, Seines DA, Wescln JE, Chen BB, Satz P, van Gorp WG, Miller EN (1995) Alternate forms of the auditory-verbal learning test: issues of test comparability, longitudinal reliability and moderating demographic variables. Arch Clin Neuropsychol 10(2):133–145PubMedGoogle Scholar