Feasibility and Acceptability of a Virtual 'Coping With Brain Fog' Intervention for Young Adults With Cancer

Cancer-related cognitive problems, also known as "brain fog", have a significant impact on patients with cancer and cancer survivors. Previous studies indicate that cancer and cancer treatments can negatively affect memory, attention and thinking abilities. Adolescents and young adults (AYAs) are individuals with a cancer diagnosis, who are currently between 18 to 40 years old. These individuals are especially vulnerable to brain fog symptoms due to the effect these symptoms have on their education, employment, health behaviors, mental health, and social relationships. There is a clear need for programming directed at brain fog symptoms among AYAs with cancer diagnoses. The 'Coping with Brain Fog' program, developed by Maximum Capacity Inc., is an eight-week group program that has been designed to educate patients about their brain fog symptoms and develop strategies to manage these symptoms. In this study the investigators will aim to determine the feasibility of adapting the 'Coping with Brain Fog' program to the virtual setting for AYAs with cancer during the COVID-19 pandemic. The investigators will also aim to explore the efficacy of the program on cognitive functioning and symptoms of anxiety, depression and fatigue. This study is an important step towards finding ways to treat brain fog symptoms in cancer patients, and could help guide future studies and programs.

Background: Cancer-related cognitive deficits, also known as "brain fog", are a well-established morbidity among patients with cancer and cancer survivors. Associations between cancer or cancer treatment with difficulties in short-term and working memory, attention, processing speed, verbal fluency, and executive function have been previously described. Adolescents and young adults (AYA) are individuals who have had a cancer diagnosis and are currently between 18 to 40 years of age. Mitigating cognitive symptoms in the AYA population is especially important, as these cognitive symptoms affect education and employment, health behaviors, mental health, and social relationships. Further, as more AYAs with cancer survive their cancer and live into adulthood, improving their quality of life is even more vital. There is a clear need for programming directed at brain fog symptoms among AYAs with a cancer diagnosis.

Objective: The primary objective of this study is to determine the feasibility and acceptability/satisfaction of a virtual 'Coping with Brain Fog' intervention to AYAs with cancer during the COVID-19 pandemic. Secondary objectives of the study are to determine the preliminary effect of the intervention on the cognitive functioning and symptoms of distress (anxiety/depression/fatigue) of AYAs with cancer.

Methods: This prospective pilot study will involve an 8-week virtual "Coping with Brain Fog" program, with one 90-minutes session per week. The 'Coping with Brain Fog' program, developed by Maximum Capacity Inc., has been designed as an in-person group program to educate participants about brain fog and help them enhance their cognition and overall wellbeing. Sessions are designed to enhance memory, task management, and psychological wellbeing skills. Sessions will be delivered over Zoom in a group setting by a Master's-prepared registered social worker and AYA psychosocial oncology clinician at CancerCare Manitoba. Individuals who are between the ages of 18-40 and are (a) diagnosed with any type or stage of cancer, (b) seeking intervention for self-reported symptoms of brain fog (such as poor memory, mental slowness, or task insufficiency), and (c) currently living in Manitoba, Northwestern Ontario or Nunavut, will be eligible for this study. Before starting the intervention, the study participants will be sent a survey link to collect background patient information and measure self-reported cognitive function and symptoms of distress. The participants will also complete a post-intervention questionnaire to measure self-reported cognitive function, symptoms of distress, and satisfaction within one week of completing the intervention and at 6-8 weeks after the intervention. Semi-structured exit phone interviews will be conducted with the participants within two weeks of completing the intervention to collect their narrative feedback and experiences with the intervention.

Significance: This pilot project will help determine the feasibility and acceptability/satisfaction of a virtual 'Coping with Brain Fog' program and measure its preliminary effects on cognitive function and symptoms of distress among AYAs with cancer.

Eligibility Criteria:
Inclusion Criteria:

* Age 18-40 years
* Diagnosed with any type or stage of cancer
* Seeking intervention for self-reported symptoms of brain fog (such as poor memory, mental slowness, or task insufficiency)
* Must be currently living in Manitoba, Nunavut or Northwest Ontario
* Must be able to attend eight virtual sessions of the 'Coping with Brain Fog' intervention
* Must have reliable access to the internet and the audio-visual platform Zoom
* Should also be able to read, speak and write English (as the sessions will be conducted in English)

Exclusion Criteria:

* Age younger than 18 or older than 40 years at the time of enrollment
* Must not have a previously diagnosed severe intellectual disability (self-reported by the participants)
* Should not be receiving any new interventions to enhance their cognitive function during the period of this study
* Must attend the first two sessions and should not miss two consecutive sessions (if a participant misses two consecutive sessions due to extenuating circumstances, they will be encouraged to withdraw from the group and be prioritized on the wait-list for the next brain fog group)