Reducing Breast Cancer-related Fatigue and Improving Cognition With Non-Invasive Brain Stimulation

Study Overview
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Brief Summary
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This study will test the preliminary efficacy of transcranial direct current stimulation (tDCS) to improve fatigue and cognition in women with a history of breast cancer and persistent fatigue.

Detailed Description
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Fatigue and cognitive dysfunction are commonly reported symptoms associated with impaired quality of life and productivity in breast cancer survivors. Transcranial direct current stimulation (tDCS) has been shown to improve both fatigue and cognition. Here tDCS will be used in a randomized, sham-controlled, double-blind, cross-over trial in women who have finished treatment of breast cancer and who report persistent fatigue. Participants will complete measures of fatigue and cognition before and after five consecutive days of active or sham tDCS then complete questionnaires by phone one week later. Participants will return about one month later for another five days of participation, followed by another brief study phone call the following week.

Official Title
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Reducing Breast Cancer-related Fatigue and Improving Cognition With Non-Invasive Brain Stimulation

Conditions
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Breast Cancer, Cognitive Dysfunction, Fatigue

Intervention / Treatment
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* Device: tDCS
* Other: Sham tDCS


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women, 18 years of age or older Stage I-III breast cancer Treatment Status: At least 6 months and no more than 5 years after the conclusion of active breast cancer therapy, including surgery, radiation therapy and (neo)adjuvant chemotherapy, if administered. NOTE: Adjuvant HER2-targeted therapy and endocrine therapy may still be ongoing at the time of study enrollment. Fatigue: Moderate fatigue on most days within the past week (i.e., at least 4 out of the last 7 days), rated as ≥ 4 on a 0 (no fatigue) to 10 (worst fatigue) scale. Able and willing to complete study tasks as evidenced by at least the following: fluent English speaker; hearing and language comprehension; and, sufficient literacy to complete study forms and questionnaires. Patient understands the study regimen, its requirements, risks, and discomforts, and is able and willing to sign an informed consent form. Exclusion Criteria: Evidence of recurrent breast cancer at the time of enrollment. Depression or anxiety as defined either by ongoing pharmacological treatment for depression or anxiety or a HADS score on initial screening. Dementia as assessed by a MMSE score on initial screening. Known pregnancy or nursing. Any of the following: diagnosis of schizophrenia or bipolar disorder made by a physician, seizure disorder, pacemaker, hearing aids, any metal implanted in the head, or the presence of other known current untreated causes of fatigue such as anemia or untreated hypothyroidism. Use of stimulant medications, sleep medications, nicotine patch, and other drugs thought to interfere with tDCS efficacy for seven days prior to and during study participation. Use of narcotic pain medication, benzodiazepines, or illicit drugs for seven days prior to and during study participation. Consumption of >14 alcoholic drinks per week or positive screening on the CAGE. Skin conditions involving open sores on the scalp that would prevent proper application of the electrodes. Hairstyles that obstruct placement of the electrodes including cornrows, dreadlocks, braids or other hair accessories that cannot be removed. Other medical or other condition(s) that in the opinion of the investigators might compromise the objectives of the study.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Randomized, sham-controlled, double-blind, cross-over
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Active tDCS first<br>2 mA of active tDCS applied over a 30-minute study session once per day for 5 consecutive days then sham tDCS after washout. | Device: tDCS<br>* Transcranial direct current stimulation (tDCS) is a safe, portable, non-invasive form TDCS is a form of non-invasive electrical brain stimulation using low amplitude direct current to facilitate neuronal transmission beneath scalp electrodes.<br>* Other names: NeuroConn DC Stimulator Plus Model 0021;Other: Sham tDCS<br>* Sham Transcranial direct current stimulation (tDCS)..<br>|
| Sham Comparator: Sham tDCS first<br>Stimulation mimicking the tDCS applied only briefly over a 30-minute study session once per day for 5 consecutive days then active tDCS after washout. | Device: tDCS<br>* Transcranial direct current stimulation (tDCS) is a safe, portable, non-invasive form TDCS is a form of non-invasive electrical brain stimulation using low amplitude direct current to facilitate neuronal transmission beneath scalp electrodes.<br>* Other names: NeuroConn DC Stimulator Plus Model 0021;Other: Sham tDCS<br>* Sham Transcranial direct current stimulation (tDCS)..<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change on Paced Auditory Serial Attention Test (PASAT) | Change in auditory working memory as measured by the PASAT prior to and following the intervention. PASAT scores range from 0 to 120, with higher scores reflecting better working memory. Larger positive change scores reflect greater improvement in performance from baseline whereas greater negative change scores reflect declines in performance from baseline. | Baseline and Day 5 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change on Functional Assessment of Cancer Therapy Cognitive Scale (FACT-Cog) | Change in subjective cognitive functioning as measured by the FACT-Cog Perceived Cognitive Impairment scale prior to and following the intervention. Raw scores range from 0 to 72, with higher scores reflecting better perceived cognitive functioning. Larger positive change scores reflect greater improvement in subjective cognitive functioning from baseline whereas greater negative change scores reflect declines in subjective cognitive functioning from baseline. | Baseline and Day 5 | 
| Change in Multidimensional Fatigue Symptom Inventory- SF (MFSI-SF) | Change in subjective fatigue as measured by the MFSI-SF prior to and following the intervention. Raw scores range from -36 to + 144, with higher scores reflecting greater levels of fatigue. Larger positive change scores reflect greater improvement in fatigue from baseline whereas greater negative change scores reflect declines in fatigue from baseline. | Baseline and Day 5 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer, Cognition, Fatigue, Cancer-related Cognitive Impairment, Transcranial Direct Current Stimulation