Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. Reducing symptom limitations: a cognitive behavioral intervention randomized trial. A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life. Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial. A randomized trial on the efficacy of methylphenidate and modafinil for improving cognitive functioning and symptoms in patients with a primary brain tumor Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. Advanced cognitive training for breast cancer survivors: a randomized controlled trial The effect of modafinil on fatigue, cognitive functioning, and mood in primary brain tumor patients: a multicenter randomized controlled trial. Modafinil for attentional and psychomotor dysfunction in advanced cancer: a double-blind, randomised, cross-over trial Comparing methods for estimating premorbid intellectual functioning. Feasibility and efficacy of speed-feedback therapy with a bicycle ergometer on cognitive function in elderly cancer patients in Japan. Feasibility of quantifying the effects of epoetin alfa therapy on cognitive function in women with breast cancer undergoing adjuvant or neoadjuvant chemotherapy. Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study. The use of Ginkgo biloba for the prevention of chemotherapy-related cognitive dysfunction in women receiving adjuvant treatment for breast cancer, N00C9 Effect of medical Qigong on cognitive function, quality of life, and a biomarker of inflammation in cancer patients: a randomized controlled trial Altered cognitive function in men treated for prostate cancer with luteinizing hormone‐releasing hormone analogues and cyproterone acetate: a randomized controlled trial Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Neurobehavioral Effects of Interferon-α in Cancer Patients: Phenomenology and Paroxetine Responsiveness of Symptom Dimensions Donepezil and vitamin E for preventing cognitive dysfunction in small cell lung cancer patients: preliminary results and suggestions for future study designs The effects of cognitive behavioral therapy for postcancer fatigue on perceived cognitive disabilities and neuropsychological test performance. Granulocyte Macrophage Colony Stimulating Factor Treatment is Associated with Improved Cognition in Cancer Patients. A Randomized, Double-blind, 2-Period, Placebo-Controlled Crossover Trial of a Sustained-Release Methylphenidate in the Treatment of Fatigue in Cancer Patients The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial. A randomized trial of cognitive rehabilitation in cancer survivors. The effect of modafinil on cognitive function in breast cancer survivors
PURPOSE Adjuvant chemotherapy for breast cancer can have adverse effects on cognition shortly after administration . Whether chemotherapy has any long-term effects on cognition is largely unknown , yet it becomes increasingly relevant because of the widespread use of chemotherapy for early-stage breast cancer and the improved survival . We investigated whether cyclophosphamide , methotrexate , and fluorouracil ( CMF ) chemotherapy for breast cancer is associated with worse cognitive performance more than 20 years after treatment . PATIENTS AND METHODS This case-cohort study compared the cognitive performance of patients with breast cancer who had a history of adjuvant CMF chemotherapy treatment ( six cycles ; average time since treatment , 21 years ; n = 196 ) to that of a population -based sample of women never diagnosed with cancer ( n = 1,509 ) . Participants were between 50 and 80 years of age . Exclusion criteria were ever use of adjuvant endocrine therapy , secondary malignancy , recurrence , and /or metastasis . RESULTS The women exposed to chemotherapy performed significantly worse than the reference group on cognitive tests of immediate ( P = .015 ) and delayed verbal memory ( P = .002 ) , processing speed ( P < .001 ) , executive functioning ( P = .013 ) , and psychomotor speed ( P = .001 ) . They experienced fewer symptoms of depression ( P < .001 ) , yet had significantly more memory complaints on two of three measures that could not be explained by cognitive test performance . CONCLUSION Survivors of breast cancer treated with adjuvant CMF chemotherapy  more than 20 years ago perform worse , on average , than r and om population controls on neuropsychological tests . The pattern of cognitive problems is largely similar to that observed in patients shortly after cessation of chemotherapy . This study suggests that cognitive deficits following breast cancer diagnosis and subsequent CMF chemotherapy can be long lasting Until now , little research has been conducted examining the reactive dimension , or the degree to which a symptom limits an individual 's life , in a multiplicity of symptoms . This research examines how problem-solving therapy organizes an intervention to decrease symptom limitations . The purpose was threefold : to determine if a cognitive behavioral intervention decreases the impact of symptom limitations among individuals newly diagnosed with cancer , who are receiving chemotherapy ; to determine , after adjusting for covariates , how symptom limitations change over time ; and to describe which symptoms are most limiting . This r and omized control trial was conducted in two comprehensive and four community cancer centers . Two hundred thirty-seven individuals , aged 31 - 87 , newly diagnosed with solid tumor cancers , participated . The experimental group ( 118 individuals ) received a 10-contact , 18-week cognitive behavioral intervention focused on cancer- and chemotherapy-related symptoms . The control group ( 119 individuals ) received conventional care . Interviews occurred at baseline , 10 , 20 , and 32 weeks . Data analysis used a two-level hierarchical linear model . Participants receiving the cognitive behavioral intervention had lower scores of symptom limitation than did participants in the control group . At the onset of the study , younger patients reported more symptom limitations than their older counterparts ; however , this was reversed by the end of the study . The cognitive behavioral intervention was key to decreasing symptom limitations . Findings also suggest that nursing interventions may be particularly helpful to younger individuals in managing cancer-related symptom limitations OBJECTIVE This research aim ed to address the gap in evidence -based treatment available for cancer survivors who are experiencing cognitive dysfunction , through piloting a novel treatment intervention . The overall research question was whether a group cognitive rehabilitation intervention would be feasible for improving cognitive function and quality of life for people who have completed cancer treatment . METHODS Three groups of adults were recruited as follows : an intervention group of 23 cancer survivors who completed a 4-week group cognitive rehabilitation treatment , a comparison group of nine cancer survivors , and a community sample of 23 adults who had never experienced cancer . Measures of objective and subjective cognitive function , quality of life , psychosocial distress , and illness perceptions were used . The research design was non-r and omised . RESULTS The results indicated that the intervention was effective in improving overall cognitive function , visuospatial/constructional performance , immediate memory , and delayed memory beyond practice effects alone . It was helpful in reducing participants ' perceptions of cognitive impairment and psychosocial distress , as well as promoting social functioning and underst and ing of cognition . The improvements were maintained at 3 months after the intervention . Participants reported a high level of satisfaction with the treatment . CONCLUSIONS The results provided evidence for the feasibility of a brief group-based cognitive rehabilitation intervention to treat cognitive problems experienced by cancer survivors OBJECTIVE Although chemotherapy-induced cognitive impairment is common among breast cancer patients , evidence for effective interventions addressing cognitive deficits is limited . This r and omized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation ( TSM ) program to improve cognitive function and quality of life in breast cancer patients . METHODS Forty-seven breast cancer patients ( mean age 56.3 years ) , who were staged I-III at diagnosis , 6 - 60 months post-chemotherapy , and reported cognitive impairment at study entry were recruited . Participants were r and omized to either two weekly TSM sessions for 6 weeks or a wait list control group . Neuropsychological assessment s  were completed at baseline and 1 month post-treatment . Self-report measures of cognitive function ( Functional Assessment of Cancer Therapy (FACT)-Cog ) , quality of life ( SF-36 ) , depressive symptoms ( Center for Epidemiologic Studies Depression Scale ) , sleep disturbance ( Pittsburgh Sleep Quality Index ) , fatigue ( Brief Fatigue Inventory ) , and spirituality ( FACT-Sp ) were completed at baseline , the end of treatment , and 1 month later . RESULTS Relative to the control group , women in the TSM group performed better on the verbal memory test ( Rey Auditory Verbal Learning Test trial 1 ) ( p = 0.06 ) and the short-term memory and processing speed task ( Digit Symbol ) ( p = 0.09 ) and reported improved cognitive function ( p = 0.06 ) , cognitive abilities ( p = 0.08 ) , mental health ( p = 0.04 ) , and spirituality ( p = 0.05 ) at the end of treatment but not 1 month later . CONCLUSIONS This r and omized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT BACKGROUND To determine the protective effects of memantine on cognitive function in patients receiving whole-brain radiotherapy ( WBRT ) . METHODS Adult patients with brain metastases received WBRT  and were r and omized to receive placebo or memantine ( 20 mg/d ) , within 3 days of initiating radiotherapy for 24 weeks . Serial st and ardized tests of cognitive function were performed . RESULTS Of 554 patients who were accrued , 508 were eligible . Grade 3 or 4 toxicities and study compliance were similar in the 2 arms . There was less decline in delayed recall in the memantine arm at 24 weeks ( P = .059 ) , but the difference was not statistically significant , possibly because there were only 149 analyzable patients at 24 weeks , result ing in only 35 % statistical power . The memantine arm had significantly longer time to cognitive decline ( hazard ratio 0.78 , 95 % confidence interval 0.62 - 0.99 , P = .01 ) ; the probability of cognitive function failure at 24 weeks was 53.8 % in the memantine arm and 64.9 % in the placebo arm . Superior results were seen in the memantine arm for executive function at 8 ( P = .008 ) and 16 weeks ( P = .0041 ) and for processing speed ( P = .0137 ) and delayed recognition ( P = .0149 ) at 24 weeks . CONCLUSIONS Memantine was well tolerated and had a toxicity profile very similar to placebo . Although there was less decline in the primary endpoint of delayed recall at 24 weeks , this lacked statistical significance possibly due to significant patient loss . Overall , patients treated with memantine had better cognitive function over time ; specifically , memantine delayed time to cognitive decline and reduced the rate of decline in memory , executive function , and processing speed in patients receiving WBRT . RTOG 0614 , Clinical Trials.gov number CT00566852 Limited research is available regarding the efficacy of psychostimulants in treating cognitive function in primary brain tumor patients . An open-label , r and omized , pilot trial examined both the general and differential efficacy of 4 weeks of methylpheni date ( MPH ) and modafinil ( MOD ) in 24 brain tumor patients . Participants completed cognitive tests and self-report measures of fatigue , sleep disturbance , mood and quality of life at baseline and after 4 weeks . Following stimulant treatment , there was evidence of a beneficial effect on test performance in speed of processing and executive function requiring divided attention . Patients with the greatest deficit in executive function at baseline appeared to derive the greatest benefit following stimulant therapy . Inconsistent , differential effects were found on a measure of attention in favor of MPH and on a measure of processing speed in favor of MOD . There was also evidence of a general beneficial effect on patient-reported measures of fatigue , mood , and quality of life , with no statistically significant differences between treatment arms in these measures over time . The results from this small pilot study should be interpreted with caution , but appear to warrant additional research , in larger study sample s , targeting fatigue , processing speed and executive function , and exploring different doses of stimulants . Future studies may also wish to explore the specific patient factors that may be associated with responsiveness to psychostimulant treatment Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered 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 r and omized , 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 result ed 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 BACKGROUND Fatigue , cognitive deficits , and depression are frequently reported but often undertreated symptoms that can profoundly affect daily life in patients with primary brain tumors ( PBTs ) . To evaluate the effects of the psychostimulant modafinil on fatigue , depression , health-related quality of life ( HRQOL ) , and cognitive functioning in PBT patients , we performed a multicenter , double-blind placebo-controlled crossover trial . METHODS Patients r and omly received either 6 weeks of treatment with modafinil ( up to 400 mg/day ) or 6 weeks with placebo . After a 1-week washout period , the opposite treatment was provided . Assessment s took place at baseline and immediately after the first and second condition . Patients completed self-report question naires on fatigue ( Checklist Individual Strength [ CIS ] ) , depression ( Center for Epidemiologic Studies Depression Scale [ CES-D ] ) , HRQOL ( Short-Form Health Survey [ SF-36 ] ) , and self-perceived cognitive functioning ( Medical Outcomes Study [ MOS ] ) . They also underwent comprehensive neurocognitive testing . RESULTS In total , 37 patients participated . Relative to baseline , patients reported lower fatigue severity ( CIS ) and better motivation ( CIS ) in both the modafinil ( P = .010 and P = .021 , respectively ) and the placebo condition ( P < .001 and P = .027 , respectively ) . The same held for physical health ( SF-36 Physical Component Summary score ; P = .001 and P = .008 , respectively ) , working memory ( P = .040 and P = .043 ) , and information processing capacity ( P = .036 and P = .040 ) . No improvement in depressive symptoms was found in either condition . CONCLUSIONS Modafinil did not exceed the effects of placebo with respect to symptom management . Patient accrual was slow , and relatively many patients dropped out during the trial , due mostly to side effects . Other , preferably nonpharmacologic intervention studies should be considered to improve symptom management of PBT patients Cognitive impairment seems to be highly prevalent in patients with advanced cancer .  Modafinil , a novel vigilance and wake-promoting agent , may be an alternative treatment . We wanted to investigate this treatment on attentional and psychomotor dysfunction in cancer patients . 28 cancer patients with a tiredness score of 50 mm or more on a scale of 0 to 10 ( 0=no tiredness , 10=worst possible tiredness ) and Karnofsky Performance Status 40—70 were included . All medications were kept stable during the trial despite short acting opioids for breakthrough pain . On day 1 the patients were r and omly assigned to receive 200 mg Modafinil orally or placebo and on day 4 they crossed-over to the alternative treatment .  Finger Tapping Test ( FTT ) , Trail Making Test ( TMT ) and Edmonton Symptom Assessment System ( ESAS ) were evaluated before tablet intake and again 4 , 5 hours after . FTT for the dominant h and as well as TMT were statistically significantly improved on modafinil ( p-values=0.006 and 0.042 , respectively ) . On ESAS , depression and drowsiness also improved statistically significantly ( p-values=<0.001 and 0.038 , respectively ) . Modafinil in a single dose regimen was significantly superior to placebo regarding two cognitive tests of psychomotor speed and attention . Furthermore subjective scores of depression and drowsiness were significantly improved by modafinil Efforts to determine premorbid intellectual functioning for a patient prior to their current evaluation has been attempted using demographic information , current performance data , or a combination of both . Five of these premorbid intellectual prediction methods were assessed in a sample of 104 neurological patients referred for neuropsychological evaluation and a matched control sample . Predicted Full-Scale Intelligence Quotient ( FSIQ ) scores of patients did not differ from the true FSIQ scores of the matched controls . Logistic regression analyses found no difference in classification accuracy among the prediction methods . The findings of this study found combined demographic and performance methods  developed by V and erploeg and Schinka ( 1995 ) , V and erploeg , Schinka , and Axelrod ( 1996 ) , Krull , Scott , and Sherer ( 1995 ) and Williamson , Krull , and Scott ( 1996 ) to be accurate estimates of premorbid functioning . This study found estimates of premorbid functioning based on demographic data alone ( Barona , Reynolds , & Chastain , 1984 ) not to differ from the other methods , which is at odds with prior studies . Prospect i ve studies employing all of these methods are recommended to clarify the utility of demographically based estimates OBJECTIVE We conducted this study with the aim of demonstrating the feasibility and efficacy of speed-feedback therapy with a bicycle ergometer on cognitive function  in elderly cancer patients . METHODS The subjects were patients with breast or prostate cancer who were 65 years of age or over . Among 146 patients , 78 were r and omly assigned to the intervention group ( n = 38 ) or the control group ( n = 40 ) . The intervention group received speed-feedback therapy with a bicycle ergometer once a week for four successive weeks . The control group was advised to spend the 4-week period engaged in their routine activities . Evaluations were carried out at the baseline and 4 weeks after the baseline ( week 4 ) using the Frontal Assessment Battery , the Barthel Index , the Lawton and Brody Instrumental Activities of Daily Living , and the Functional Assessment of Cancer Therapy-General ver.4 . Data were analyzed by a two-way repeated- measures analysis of variance . RESULTS The mean score of Frontal Assessment Battery for the intervention group was higher than that for the control group at week 4 . In addition to significant main effects of time and group , we also found a significant interaction between the two groups ( p = 0.006 ) . Moreover , all of the subjects in the intervention group could complete all the four sessions of therapy without any pain or distress . CONCLUSION These results suggest that speed-feedback therapy with a bicycle ergometer may be feasible as well as effective for improving the cognitive function in elderly cancer patients Impaired cognition , fatigue , and diminished quality of life ( QOL ) are commonly associated with breast cancer chemotherapy . This r and omized , double-blind , placebo-controlled pilot trial assessed the feasibility of quantifying the effects of epoetin alfa on cognitive function and mood , and evaluated its effects on fatigue and QOL in patients with breast cancer treated with anthracycline-based adjuvant or neoadjuvant chemotherapy . Patients were r and omized to receive epoetin alfa 40,000 U subcutaneously once weekly or  placebo at the beginning of 4 cycles of chemotherapy  administered over 12 weeks . Cognitive function was assessed by Executive Interview ( EXIT25 ) and Clock Drawing Tasks ;  mood by Profile of Mood States ; anemia-related symptoms , including fatigue , by the Functional Assessment of Cancer Therapy-Anemia ( FACT-An ) subscale ; and QOL by Linear Analog Scale Assessment . Ninety-four patients were evaluable for efficacy and safety . Mean change in EXIT25 scores from baseline to cycle 4 in the epoetin alfa group was 1.3 + /- 3.3 ; the mean change was 0.3 + /- 2.4 in the placebo group ( a negative change indicates improved executive function ) . There was no difference between groups in mean change in EXIT25 score from baseline to 6-month follow-up assessment . Mean hemoglobin levels were higher in the  epoetin alfa  group compared with the placebo group after 4 cycles of chemotherapy . Epoetin alfa recipients had less of a decrease in FACT-An subscale scores from baseline to cycle 4 and improvement in FACT-An subscale scores at 6-month follow-up assessment compared with placebo . Epoetin alfa therapy was well tolerated . These data suggest that epoetin alfa may have attenuated the cognitive impairment and fatigue that occurred during adjuvant breast cancer chemotherapy OBJECTIVE To evaluate the efficacy of a brief cognitive-behavioral therapy ( CBT ) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors .  Memory and Attention Adaptation Training ( MAAT ) is a brief CBT design ed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints . METHODS An initial , two-group  ( MAAT versus waitlist , no treatment control ) , r and omized clinical trial ( RCT ) was conducted . Forty stage I and II female breast cancer survivors ( mean age = 50 ; SD = 6.4 ) were r and omized to conditions and assessed at baseline , post-treatment ( 8 weeks ) and 2-month follow-up assessment points on measures of : ( 1 ) self-reported daily cognitive failures ; ( 2 ) quality of life ; and ( 3 ) neuropsychological performance . Participants were also assessed for satisfaction with MAAT . RESULTS With education and IQ as covariates , MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory , but statistical significance was not achieved on self-report of daily cognitive complaints . However , moderate-to-large effect sizes were observed on these outcomes . Participants gave MAAT high satisfaction ratings . CONCLUSIONS Although this initial RCT is a small study , MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction . These data are encouraging and support the continued development and evaluation of MAAT efficacy BACKGROUND Many women with breast cancer need psychological help to cope more effectively after treatment . Cognitive and behavioural techniques are not yet well established in France . A multi-site r and omized study was conducted to evaluate the effects of a psycho-educational group intervention in this population . METHODS Two hundred and three patients , recruited after primary treatment , were r and omly assigned either to a treatment group ( psycho-educational intervention ) or to a waiting-list control group . The 8-week programme of 2 h sessions comprised of thematic discussion s , information and training in stress management techniques . Evaluation at baseline , after 8 sessions , and 1 month after programme completion , included evaluations using the STAI , POMS , MAC , EORTC QLQ-C30 and EORTC QLQ-BR23 breast module scales . RESULTS We observed a significant reduction in anxiety ( STAI , POMS ) among group participants , a reduction in anger , depression and fatigue ( POMS ) , a significant improvement in vigor and interpersonal relationships ( POMS ) , in emotional and role functioning , in health status and fatigue level ( EORTC QLQ-C30 ) . In contrast , coping strategies ( MAC ) were not significantly different between groups . No group-related negative effects were observed and the global satisfaction levels were very high . CONCLUSION This study demonstrates the feasibility and effectiveness of a psycho-educational intervention , which can accelerate the reduction of those negative affects which are present at the end of treatment . It represents an excellent complement or an alternative to individual psycho-oncologic therapeutic support , widely proposed in France , and should now be tested in groups with other types of cancer and at other disease phases Purpose Patients undergoing treatment for cancer often report problems with their cognitive function , which is an essential component of health-related quality of life . Pursuant to this , a two-arm r and omized , placebo-controlled , double-blind , phase III clinical trial was conducted to evaluate Ginkgo biloba ( EGB 761 ) for the prevention of chemotherapy-related cognitive dysfunction in patients with breast cancer . Methods Previously chemotherapy naïve women about to receive adjuvant chemotherapy for breast cancer were r and omized to receive 60 mg of EGB 761 or a matching placebo twice daily . The study agent was to begin before their second cycle of chemotherapy and to be taken throughout chemotherapy and 1 month beyond completion . The primary measure for cognitive function was the High Sensitivity Cognitive Screen ( HSCS ) , with a secondary measure being the Trail Making Tests ( TMT ) A and B. Subjective assessment of cognitive function was evaluated by the cognitive subscale of the Perceived Health Scale ( PHS ) and the Profile of Mood States ( POMS ) . Data were collected at baseline and at intervals throughout and after chemotherapy , up to 24 months after completion of adjuvant treatment . The primary statistical analysis included normalized area under the curve ( AUC ) comparisons of the HSCS , between the arms . Secondary analyses included evaluation of the other measures of cognition as well as correlational analyses between self-report and cognitive testing . Results One hundred and sixty-six women provided evaluable data . There were no significant differences in AUC up to 12 months on the HSCS between arms at the end of chemotherapy or at any other time point after adjuvant treatment . There were also no significant differences in TMT A or B at any data point . Perceived cognitive functions , as measured by the PHS and confusion/bewilderment subscale of the POMS , were not different between arms at the end of chemotherapy . There was also little correlation between self-reported cognition and cognitive testing . No differences were observed in toxicities per Common Terminology Criteria for Adverse Events ( CTCAE ) assessment between Ginkgo biloba and placebo throughout the study ; however , after chemotherapy , the placebo group reported worse nausea ( p = .05 ) . Conclusion This study did not provide any support for the notion that Ginkgo biloba , at a dose of 60 mg twice a day , can help prevent cognitive changes from chemotherapy . These analyses do provide data to further support the low associations between patients ' self-report of cognition and cognitive performance , based on more formal testing Purpose Cancer patients often experience diminished cognitive function ( CF ) and quality of life ( QOL ) due to the side effects of treatment and the disease symptoms . This study evaluates the effects of medical Qigong ( MQ ; combination of gentle exercise and meditation ) on CF , QOL , and inflammation in cancer patients . Methods Eighty-one cancer patients recruited between October 2007 and May 2008 were r and omly assigned to two groups : a control group ( n = 44 ) who received the usual health care and an intervention group ( n = 37 ) who participated in a 10-week MQ program .  Self-reported CF was measured by the European Organization for Research and Treatment of Cancer ( EORTC-CF ) and the Functional Assessment of Cancer Therapy — Cognitive ( FACT-Cog ) . The Functional Assessment of Cancer Therapy — General ( FACT-G ) was used to measure QOL . C-reactive protein ( CRP ) was assessed as a biomarker of inflammation . Results The MQ group self-reported significantly improved CF ( mean difference ( MD ) = 7.78 , t51 = −2.532 , p = 0.014 ) in the EORTC-CF and all the FACT-Cog subscales [ perceived cognitive impairment ( MD = 4.70 , t43 = −2.254 , p = 0.029 ) , impact of perceived cognitive impairment on QOL ( MD = 1.64 , t45 = −2.377 , p = 0.024 ) , and perceived cognitive abilities ( MD = 3.61 , t45 = −2.229 , p = 0.031 ) ] compared to controls . The MQ group also reported significantly improved QOL ( MD = 12.66 , t45 = −5.715 , p < 0.001 ) and had reduced CRP levels ( MD = −0.72 , t45 = 2.092 , p = 0.042 ) compared to controls . Conclusions Results suggest that MQ benefits cancer patients ’ self-reported CF , QOL , and inflammation . A larger r and omized controlled trial including an objective assessment of CF is planned Objective To report the first systematic investigation of the cognitive effects of luteinizing hormone‐releasing hormone ( LHRH ) analogues in male patients , as LHRH analogues have been associated with memory impairments in women using these drugs for gynaecological conditions BACKGROUND A majority of breast cancer ( BC ) survivors , particularly those treated with chemotherapy , experience long-term cognitive deficits that significantly reduce quality of life . Among the cognitive domains most commonly affected include executive functions ( EF ) , such as working memory , cognitive flexibility , multitasking , planning , and attention . Previous studies in other population s have shown that cognitive training , a behavioral method for treating cognitive deficits , can result in significant improvements in a number of cognitive skills , including EF . MATERIAL S AND METHODS In this study , we conducted a r and omized controlled trial to investigate the feasibility and preliminary effectiveness of a novel , online EF training program in long-term BC survivors . A total of 41 BC survivors ( 21 active , 20 wait list ) completed the 48 session training program over 12 weeks . The participants were , on average , 6 years after therapy . RESULTS Cognitive training led to significant improvements in cognitive flexibility , verbal fluency and processing speed , with marginally significant downstream improvements in verbal memory as assessed via st and ardized measures . Self-ratings of EF skills , including planning , organizing , and task monitoring , also were improved in the active group compared with the wait list group . CONCLUSIONS Our findings suggest that EF skills may be improved even in long-term survivors by using a computerized , home-based intervention program . These improvements may potentially include subjective EF skills , which suggest a transfer of the training program to real-world behaviors We have previously shown that the risk of major depression in patients with malignant melanoma undergoing interferon-α ( IFN-α ) therapy  can be reduced by pretreatment with the antidepressant , paroxetine . Using dimensional analyses , the present study assessed the expression and treatment responsiveness of specific clusters of neuropsychiatric symptoms over the first three months of IFN-α therapy .  Forty patients with malignant melanoma eligible for IFN-α treatment  were r and omly assigned to receive either paroxetine or placebo in a double-blind design . Neuropsychiatric assessment s were conducted at regular intervals during the first twelve weeks of IFN-α therapy and included the 21-item Hamilton Depression Rating Scale , the 14-item Hamilton Anxiety Rating Scale and the Neurotoxicity Rating Scale . Neurovegetative and somatic symptoms including anorexia , fatigue and pain appeared within two weeks of IFN-α therapy in a large proportion of patients . In contrast , symptoms of depressed mood , anxiety and cognitive dysfunction appeared later during IFN-α treatment and more specifically in patients who met DSM-IV criteria for major depression . Symptoms of depression , anxiety , cognitive dysfunction and pain were more responsive , whereas symptoms of fatigue and anorexia were less responsive , to paroxetine treatment . These data demonstrate distinct phenomenology and treatment responsiveness of symptom dimensions induced by IFN-α , and suggest that different mechanisms mediate the various behavioral manifestations of cytokine-induced “ sickness behavior . Background Up to 90 % of small cell lung cancer ( SCLC ) patients suffer cognitive dysfunction . Since donepezil and vitamin E have been somewhat successful in treating other dementias , this study tested the hypothesis that these agents can prevent cognitive decline in SCLC patients . Because accrual was poor , this trial also offered opportunities for suggesting other study design s for future clinical trials on cognitive dysfunction in this group of patients . Methods This double blind , placebo controlled trial tested oral donepezil 5 mg/day ( with dose escalation to 10 mg after 1 month ) and oral vitamin E 1,000 IU/day in SCLC patients after completion of all cancer therapy  , including prophylactic cranial irradiation ( PCI ) .  Cognition , adverse events , and quality of life were assessed throughout the study period . Results Only nine of 104 patients enrolled over 15 months ( four donepezil and vitamin E-treated versus five placebo-exposed ) , and thus no definitive conclusions could be drawn . Nonetheless , the only patient who manifested a precipitous decline in cognition was taking donepezil and vitamin E. There was also a slight trend of increased gastrointestinal side effects among donepezil and vitamin E-treated patients . There were no notable differences in cognitive stability , adverse events , or quality of life between treatment arms . Conclusion These preliminary findings do not provide enthusiasm for testing donepezil and vitamin E in the manner undertaken here for preventing cognitive dysfunction in SCLC patients . Eligibility criteria and timing of trial intervention are discussed as potential impediments to successful trial completion CONTEXT After successful cancer treatment , a substantial number of survivors continue to experience fatigue and related concentration and memory problems . Severe fatigue after cancer treatment can be treated effectively with cognitive behavioral therapy ( CBT ) , but it is unclear whether CBT has an effect on cognitive functioning . OBJECTIVES We hypothesized that patients would report less cognitive disability after treatment with CBT for cancer-related fatigue . CBT was not expected to affect neuropsychological test performance , as it has been shown that fatigue is not associated with test performance . METHODS Data were used from a r and omized controlled trial in which 98 severely fatigued cancer survivors , treated at least one year previously , were assessed at baseline ( T1 ) and six months post-baseline ( T2 ) . Patients were r and omly assigned to receive CBT ( n = 50 ) or to a waiting list ( WL ) control condition ( n = 48 ) . Self-reported cognitive disability was assessed by the Concentration subscale of the Checklist Individual Strength and the Alertness Behavior subscale of the Sickness Impact Profile . Neuropsychological test performance was measured by the symbol digit modalities task and two reaction time tasks . RESULTS Patients who received CBT for post-cancer fatigue reported significantly less cognitive disability compared with those in the WL group . CBT also was associated with a clinical ly relevant reduction in concentration problems ( CBT , 32 % vs. WL , 2 % ) . There were no significant differences in neuropsychological test performance between the CBT and WL groups . CONCLUSION CBT for post-cancer fatigue has already been shown to be an effective therapy . The present study demonstrates that CBT also may lead to a decrease in perceived cognitive disability BACKGROUND : Endogenous Granulocyte Macrophage Colony Stimulating Factor ( GMCSF ) is released in rheumatoid arthritis patients , who are largely protected from Alzheimer 's disease ( AD ) . Introducing exogenous GMCSF into an AD mouse model reduced amyloid deposition by 55 % and restored normal cognition . No published studies have examined exogenous GMCSF and cognitive functioning in humans . OBJECTIVES / DESIGN : The goal of the current study was to examine the association between receipt of GMCSF and cognitive functioning in patients receiving colony stimulating factors as part of routine supportive care for hematopoietic cell transplantation ( HCT ) . SETTING AND PARTICIPANTS : Archived neuropsychological data were examined from a longitudinal study of cognitive functioning in 95 patients receiving HCT at the Moffitt Cancer Center . INTERVENTION : Receipt of GMCSF and /or Granulocyte Colony Stimulating Factor ( GCSF ) was ascertained through patient billing records . MEASUREMENTS : Patients were assessed with a battery of neuropsychological tests prior to transplant and 6 and 12 months post-transplant . RESULTS : Patients treated with GMCSF and GCSF ( n=19 ) showed significantly greater improvement in total neuropsychological functioning ( TNP ) at 6 months than patients treated with GCSF only ( n=76 ) ( p=.04 ) . There was no group difference in TNP at 12 months ( p=.24 ) . Improvement in TNP from baseline to 6 months post-HCT was significant in the GMCSF+GCSF group ( p=.01 ) but not the GCSF only group ( p=.33 ) . Improvement in TNP from baseline to 12 months post-HCT was significant in both groups ( ps<.01 ) . CONCLUSION : Preliminary data from this study of humans receiving colony stimulating factors suggest that receipt of GMCSF+GCSF was associated with greater cognitive improvement than GCSF alone . R and omized controlled trials of the effects of GMCSF on cognitive functioning in humans are warranted and underway to confirm these findings Purpose This study assessed the efficacy of methylpheni date versus placebo for  cancer-related fatigue reduction .  Other objectives were to analyze cytokine levels and to determine the effects of methylpheni date on other symptoms , cognitive function , work yield , and patients ’ perceptions and preferences . Methods Patients were r and omly assigned ( 1:1 ) to receive methylpheni date -placebo or placebo-methylpheni date for 4 weeks . Patients crossed over after 2 weeks . Wilcoxon signed rank tests and McNemar tests were used to assess continuous and categorical variables . The primary efficacy endpoint was change in the level of worst fatigue on the Brief Fatigue Inventory ( BFI ) at the end of each 2-week period . Results The mean baseline BFI score was moderate ( 5.7 ) . Methylpheni date treatment did not affect patients ’ worst level of fatigue or other symptoms . Results from the Wechsler Adult Intelligence Scale Digit Symbol Test and the Hopkins Verbal Learning Test with BFI interference questions and BFI activity questions showed significant improvement in the methylpheni date -treated patients ’ verbal learning , memory , visual perception , analysis , and scanning speed . Patients treated with methylpheni date missed significantly fewer work hours owing to health reasons and worked significantly more hours . After 4 weeks , 64 % of patients reported that methylpheni date improved their cancer-related fatigue , and 58 % wanted to continue treatment . Significant difference in interleukin 6R ( positive ) , interleukin 10 ( negative ) , and tumor necrosis factor & agr ; ( positive ) was noted between the methylpheni date and the placebo group . Conclusions Low-dose methylpheni date did not improve  cancer-related fatigue .  Patients taking methylpheni date had better cognition and were able to work more hours . Patients tolerated methylpheni date well , and the majority felt better and wanted to continue treatment Studies applying exercise , relaxation training , and psychoeducation have each indicated a positive impact on physical performance and /or psychological factors in patients diagnosed with cancer . We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) . Forty-two patients ( 18 - 65 years ) were r and omized either to an intervention or a control group . The intervention group received st and ard treatment and care , and a supervised four- to six-week structured exercise program , progressive relaxation , and psychoeducation during hospitalization , one hour per day for five days per week . The control group received st and ard treatment , care , and physiotherapy . A 24-item symptom assessment question naire was completed weekly during hospitalization , and at three and six months after allo-HCST . Through principal component analysis with varimax rotation , individual symptoms were grouped into five symptom clusters : mucositis , cognitive , gastrointestinal , affective , and functional symptom clusters . Then , a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups , but in the intervention group , there was an overall significant reduction ( P<0.05 ) in symptom intensity over time for all clusters except the affective symptom cluster . This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT AIMS The second most frequently reported post-treatment symptom in cancer survivors are concerns about impaired cognition . Despite numerous studies demonstrating significant impairments in a portion of survivors , information on effective treatments remains an emerging area of research . This study examined the effectiveness of a group-based cognitive rehabilitation intervention in cancer survivors . MAIN METHODS This study was a r and omized , controlled study of a 7-week cognitive rehabilitation intervention delivered in group format . Participants were evaluated with subjective symptom question naires and objective neurocognitive tests prior to and following treatment . KEY FINDINGS Twenty-eight participants ( mean age 58 years ) with a median of 3 years ( ± 6 years ) post- primary /adjuvant treatment and various cancer sites ( breast , bladder , prostate , colon , uterine ) completed the study . Compared to baseline , the treatment group demonstrated improvements in symptoms of perceived cognitive impairments ( p<.01 ) , cognitive abilities ( p<.01 ) and overall quality of life with regard to cognitive symptoms ( p<.01 ) as measured by the FACT-Cog . The treatment group also improved on objective measures of attention ( p<.05 ) and a trend toward improvement on verbal memory . Significant improvement was not observed on all cognitive tests . SIGNIFICANCE A group based cognitive rehabilitation intervention in cancer survivors was effective for improving attention abilities and overall quality of life related to cognition . Results suggest that group based cognitive rehabilitation may be an effective intervention for treating cognitive dysfunction in cancer patients and should be further studied in a larger trial with an active control condition The authors conducted a r and omized clinical trial examining the effects of modafinil in reducing persistent fatigue in patients after treatment for cancer and performed secondary analyses to assess the effect of modafinil on cognitive function
PURPOSE Cognitive alterations are reported in breast cancer patients receiving chemotherapy .
This has adverse effects on patients ' quality of life and function .
This systematic review investigates the effectiveness of pharmacologic and non-pharmacologic interventions to manage cognitive alterations associated with breast cancer treatment .