Abstract P6-09-01: Investigating the effectiveness of a psycho-educational behavioral intervention for cancer-related cognitive dysfunction in women with breast and gynecological cancer: Knowledge, self-efficacy, and behavioral change.
Authors: Bernstein LJ , Dissanayake D , Tirona KM , Nyhof-Young JM , Catton PA 
Published: August 2014

Background: Approximately one third of individuals receiving chemotherapy for breast cancer experience cancer-related cognitive dysfunction (CRCD). CRCD significantly impacts quality of life, employment, and social relationships, and can hinder ability to return to pre-cancer activities. The cause is likely multi-factorial, and currently no medical treatment exists. The Cancer Survivorship Program at Princess Margaret Hospital provides a behavioral-intervention for patients with CRCD. The single, one-on-one, hour long session provides information and compensatory strategies to improve knowledge, self-management skills, and decrease the impact of cognitive dysfunction on daily life.

Methods: A mixed-method study assessed patient perceptions. Eligible women had been or were currently being treated for a diagnosis of breast or gynecological cancer and were English speakers. Likert-scale based questionnaires were administered immediately before, immediately after, and 6 weeks post-intervention. Six parameters were evaluated quantitatively: i) program delivery, ii) perception of knowledge, iii) distress, iv) self-efficacy, v) behavior change, and vi) behavioral change effectiveness. Ten individuals also participated in qualitative, semi-structured audio-recorded interviews 1–6 weeks post questionnaire completion. Responses were analyzed using the constant comparative method.

Results: 72 female cancer survivors (61 breast; 11 gynecological; mean age 51.3) completed questionnaires. Immediately post-intervention, patients reported significant increases in perception of knowledge, self-efficacy, and decreases in CRCD-related distress, and these improvements were maintained at 6 week follow up (p &lt; .01 in all cases). Participants reported numerous benefits associated with increased knowledge, including a sense of validation and reassurance, and increased confidence and success in managing their symptoms. No statistically significant differences in intervention effectiveness were observed as a function of patient age (older or younger than 50), education (greater or less than grade 12), or employment status (skilled worker or higher vs lower). However, individuals of low employment status were less satisfied with the volume of information in the intervention. Interviews indicated their preference for an additional session to reinforce the techniques discussed. Thematic analysis also indicated that adoption of new compensatory strategies was associated with a sense of control, confidence and pride for all patients; although barriers were identified for some that prevented long-term use (e.g. techniques take time and effort). Employment distress was mainly tied to difficulties with work tasks.

Conclusions: A one-hour, psycho-educational behavioral intervention can be effective for breast and gynecological cancer patients suffering from CRCD. Benefits can last at least 6 weeks. Results suggest a need for better intervention integration with oncology appointments, a follow-up session to help individuals assimilate CRCD information, and increased session personalization to address individual difficulties and job concerns.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-09-01.