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Study addresses ‘chemo brain’

In a new study that could help improve the day-to-day quality-of-life for women with breast cancer, UCLA researchers have developed a cognitive rehabilitation programme to address post-cancer treatment cognitive changes, sometimes known as "chemo brain," which can affect up to 35% of post-treatment breast cancer patients.

An estimated one in eight women will develop invasive breast cancer in their lifetime, and post-treatment, the mental "fogginess" or "chemo brain" can prevent them from staying organised and completing everyday activities, such as sticking to a schedule, planning a family gathering or forgetting where they left the car keys.

This new study, led by breast cancer research pioneer and UCLA Jonsson Comprehensive Cancer Centre member Dr Patricia Ganz, builds upon her earlier research that found a statistically significant association between neuro-psychological test performance and memory complaints in post-treatment, early stage breast cancer patients.

"We invited the women to participate in a research study that assigned them to early or delayed treatment with a five week, two-hour group training session, where a psychologist taught them strategies to help them with their memory and maintaining their ability to pay attention to things," said Ganz, director of prevention and control research at the Cancer Centre. "These are activities we call executive function and planning, or the things all of us do in order to organize our day."

Dr Linda Ercoli, an associate clinical professor of health sciences at the UCLA Semel Institute, was responsible for the development of the cognitive rehabilitation intervention programme and either delivered or supervised other clinicians who provided the group training sessions. "We gave women exercises on, for example, how to remember a 'To-Do' list, remembering to buy items at the store, or planning a party and deciding what type of food should be served to guests," said Ercoli, also a co-author of the study. "Participants were given real-life tasks to complete that would use these types of strategies to improve cognitive function." The intervention program also included homework and practice activities that they would discuss at the weekly sessions. The goals of these exercises were to improve memory and cognitive function.

All of the women who participated in the research study, whether they received the intervention early or at a delayed time point, completed questions about their mood and mental functioning and had detailed neuro-cognitive testing before learning which group they would be in, immediately after the end of the 5 weeks of training and then 2 months later. Most of the women also had resting EEG (brain wave) testing to see if this could measure changes in how the women fared throughout the study.

Ganz and Ercoli found that the early intervention group (32 women) reported improvement in memory complaints and test functioning, while the delayed intervention control group (16 women), did not improve in either their cognitive complaints or test performance. The intervention group participants showed continued improvement two months after completion of the rehabilitation program.

"The brain wave pattern in the intervention group actually normalised," said Ganz. "We hope that this might be an effective biologic way to assess the cognitive effects of cancer treatment in the future." The next steps are for other researchers to test out this cognitive rehabilitation program in larger numbers of patients, and to potentially develop strategies to provide intervention much earlier in the course of breast cancer treatment to either prevent difficulties or hasten recovery.

This study will be added to the growing body of literature demonstrating the validity of patient complaints. Furthermore, the intervention results provided important encouragement that these complaints can improve with appropriate training.

[link url="http://www.cancer.ucla.edu/index.aspx?recordid=805&page=644"]UCLA Jonsson Comprehensive Cancer Centre material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1002/pon.3769/abstract"]Psycho-Oncology abstract[/link]
[link url="http://jnci.oxfordjournals.org/content/105/11/791.abstract?sid=8203012f-9001-4a05-999d-a5db519210d4"]Journal of the National Cancer Institute abstract[/link]

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