Cognitive‐behavioral intervention for distress in patients with melanoma A randomised trial of a psychosocial intervention for cancer patients integrated into routine care: the PROMPT study (promoting optimal outcomes in mood through tailored psychosocial therapies) A randomised controlled trial of a cognitive behavioural intervention for women who have menopausal symptoms following breast cancer treatment (MENOS 1): Trial protocol Reducing symptom limitations: a cognitive behavioral intervention randomized trial. Attitudes toward information about genetic risk for cognitive impairment after cancer chemotherapy: breast cancer survivors compared with healthy controls. Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. Two different sides of 'chemobrain': determinants and nondeterminants of self-perceived cognitive dysfunction in a prospective, randomized, multicenter study. Long-term quality of life in premenopausal women with node-negative localized breast cancer treated with or without adjuvant chemotherapy Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Feasibility of neuropsychological assessment in leukaemia patients shortly after diagnosis: directions for future prospective research Neuropsychological functioning in postmenopausal breast cancer patients treated with tamoxifen or exemestane after AC-chemotherapy: Cross-sectional findings from the neuropsychological TEAM-side study Does neoadjuvant hormone therapy for early prostate cancer affect cognition? Results from a pilot study. Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. Neurophysiological Evaluation of Late Effects of Adjuvant High-dose Chemotherapy on Cognitive Function The effects of resistance training on well-being and memory in elderly volunteers. Cognitive complaints and cognitive impairment following BEP chemotherapy in patients with testicular cancer Cognitive function of older patients receiving adjuvant chemotherapy for breast cancer: a pilot prospective longitudinal study. Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer A Randomized, Wait-List Controlled Clinical Trial: The Effect of a Mindfulness Meditation-Based Stress Reduction Program on Mood and Symptoms of Stress in Cancer Outpatients The cognitive sequelae of standard‐dose adjuvant chemotherapy in women with breast carcinoma Cognitive function during neoadjuvant chemotherapy for breast cancer The impact of different definitions and reference groups on the prevalence of cognitive impairment: a study in postmenopausal breast cancer patients before the start of adjuvant systemic therapy. Pilot study of the prospective identification of changes in cognitive function during chemotherapy treatment for advanced ovarian cancer. Effects of anastrozole on cognitive performance in postmenopausal women: a randomised, double-blind chemoprevention trial (IBIS II). Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. Symptom management for cancer patients: a trial comparing two multimodal interventions. Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma The influence of priming and pre-existing knowledge of chemotherapy-associated cognitive complaints on the reporting of such complaints in breast cancer patients. The effect of modafinil on cognitive function in breast cancer survivors
Melanoma accounts for > 79 % of skin cancer‐related deaths , although it accounts for only 4 % of skin cancer incidence . Given the potential for lethality , it is likely that patients with melanoma may experience significant emotional distress . The current study was design ed to determine the effect of a cognitive‐behavioral intervention on distress and health‐related quality of life ( HRQOL ) in patients with melanoma who had medium‐to‐high distress Background Despite evidence that up to 35 % of patients with cancer experience significant distress , access to effective psychosocial care is limited by lack of systematic approaches to assessment , a paucity of psychosocial services , and patient reluctance to accept treatment either because of perceived stigma or difficulties with access to specialist psycho-oncology services due to isolation or disease burden . This paper presents an overview of a r and omised study to evaluate the effectiveness of a brief tailored psychosocial Intervention delivered by health professionals in cancer care who undergo focused training and participate in clinical supervision . Methods / design Health professionals from the disciplines of nursing , occupational therapy , speech pathology , dietetics , physiotherapy or radiation therapy will participate in training to deliver the psychosocial Intervention focusing on core concepts of supportive-expressive , cognitive and dignity-conserving care . Health professional training will consist of completion of a self-directed manual and participation in a skills development session . Participating health professionals will be supported through structured clinical supervision whilst delivering the Intervention . In the stepped wedge design each of the 5 participating clinical sites will be allocated in r and om order from Control condition to Training then delivery of the Intervention . A total of 600 patients will be recruited across all sites . Based on level of distress or risk factors eligible patients will receive up to 4 sessions , each of up to 30 minutes in length , delivered face-to-face or by telephone . Participants will be assessed at baseline and 10-week follow-up . Patient outcome measures include anxiety and depression , quality of life , unmet psychological and supportive care needs . Health professional measures include psychological morbidity , stress and burnout . Process evaluation will be conducted to assess perceptions of participation in the study and the factors that may promote translation of learning into practice . Discussion This study will provide important information about the effectiveness of a brief tailored psychological Intervention for patients with cancer and the potential to prevent development of significant distress in patients considered at risk . It will yield data about the feasibility of this model of care in routine clinical practice and identify enablers and barriers to its systematic implementation in cancer setting s . Trial registration Background This trial aims to evaluate the effectiveness of a group cognitive behavioural intervention to alleviate menopausal symptoms ( hot flushes and night sweats ) in women who have had breast cancer treatment .  Hot flushes and night sweats are highly prevalent but challenging to treat in this population . Cognitive behaviour therapy has been found to reduce these symptoms in well women and results of an exploratory trial suggest that it might be effective for breast cancer patients . Two hypotheses are tested : Compared to usual care , group cognitive behavioural therapy will:1 . Significantly reduce the problem rating and frequency of hot flushes and nights sweats after six weeks of treatment and at six months post-r and omisation.2 . Improve mood and quality of life after six weeks of treatment and at six months post-r and omisation . Methods / Design Ninety-six women who have completed their main treatment for breast cancer and who have been experiencing problematic hot flushes and night sweats for over two months are recruited into the trial from oncology and breast clinics in South East London . They are r and omised to either six weekly group cognitive behavioural therapy ( Group CBT ) sessions or to usual care . Group CBT includes information and discussion about hot flushes and night sweats in the context of breast cancer , monitoring and modifying precipitants , relaxation and paced respiration , stress management , cognitive therapy for unhelpful thoughts and beliefs , managing sleep and night sweats and maintaining changes . Prior to r and omisation women attend a clinical interview , undergo 24-hour sternal skin conductance monitoring , and complete question naire measures of hot flushes and night sweats , mood , quality of life , hot flush beliefs and behaviours , optimism and somatic amplification . Post-treatment measures ( sternal skin conductance and question naires ) are collected six to eight weeks later and follow-up measures ( question naires and a use of medical services measure ) at six months post-r and omisation . Discussion MENOS 1 is the first r and omised controlled trial of cognitive behavioural therapy for hot flushes and night sweats that measures both self-reported and physiologically indexed symptoms . The results will inform future clinical practice by developing an evidence -based , non-medical treatment , which can be delivered by trained health professionals . Trial Registration Current Controlled Trials IS RCT 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 PURPOSE The trend toward personalized medicine will involve cancer treatment increasingly being tailored to the genetic characteristics of individuals . However , the availability of genetic information does not imply this information is desired or would impact treatment decision making . METHODS One hundred sixty breast cancer survivors ( BC group ) and 205 healthy controls ( HC group ) were r and omly assigned to respond to two different clinical scenarios varying in genetic-related risk of cognitive impairment ( CI ; little v very likely ) and severity of CI ( little v moderate problem ) after chemotherapy . Ratings of the importance of being told this genetic information ( information importance ) and the likelihood this information would affect their decision to receive chemotherapy ( information impact ) were obtained . RESULTS Results indicated the importance ascribed to genetic information was greatest when CI likelihood and severity were both high or low ( P < .05 ) . Information impact ratings were not sensitive to differences in CI likelihood or severity ; the BC group was less likely to indicate genetic information would affect their decision to receive chemotherapy than the HC group ( P < .001 ) . CONCLUSION Results suggest lessened enthusiasm for genetic information that maintains or increases uncertainty about a specific course of action and highlight the importance of including clinical ly relevant groups in treatment decision-making research that employs hypothetical scenarios . Although women generally believe it is important to receive genetic information , they might benefit from assistance ( eg , decision aid ) in the difficult task of integrating information about survival and risk for adverse late effects from cancer treatment PURPOSE To describe a r and omized trial of a cognitive behavioral intervention on reducing symptom severity among patients diagnosed with solid tumors and undergoing a first course of chemotherapy and to determine whether the intervention had an additive or interactive effect on symptom severity in the presence of supportive care medications . PATIENTS AND METHODS Patients ( N = 237 ) were accrued from comprehensive and community cancer centers , interviewed , and r and omly assigned to either the experimental intervention ( n = 118 ) or conventional care ( n = 119 ) . A symptom severity index , based on summed severity scores across 15 symptoms , was the primary outcome . Each patient 's site of cancer , stage at diagnosis , chemotherapy protocol s , and use of supportive medications were learned from medical records . RESULTS Groups were equivalent at baseline , and attrition by characteristics by group was not different . The proportion of patients not receiving chemotherapy at 10 and 20 weeks did not differ by group . At the 10- and 20-week observations , there was a significant interaction between the experimental group and baseline symptom severity . Patients in the experimental group who entered the trial with higher symptom severity reported significantly lower severity at 10 and 20 weeks . Controlling for chemotherapy treatment status at follow-up and supportive care medications did not alter the effect of the experimental intervention . CONCLUSION Compared with conventional care alone , the experimental intervention was effective among patients who entered the trial with higher levels of symptom severity . Age , sex , site or stage of cancer , and supportive medications did not modify the effect of this cognitive behavioral intervention on symptom severity OBJECTIVE Complaints of cognitive dysfunction are frequent among cancer patients . Many studies have identified neuropsychological compromise associated with cancer and cancer therapy ; however , the neuropsychological compromise was not related to self-reported cognitive dysfunction . In this prospect i ve study , the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance . Determinants of self-perceived cognitive dysfunction were investigated . METHODS Self-perceived cognitive function and cognitive performance were assessed before treatment , at the end of treatment , and 1 year after baseline in 101 breast cancer patients r and omized to st and ard versus intensified chemotherapy .  Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests , patient characteristics , and treatment variables to self-reported cognitive function . Change of cognitive performance was tested as a predictor of change in self-reports . RESULTS Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis . The personality trait negative affectivity , current depression , and chemotherapy regimen were consistently related to cognitive self-reports . No significant associations with performance in any of the 12 cognitive tests emerged . Change of cognitive performance was not reflected in self-reports of cognitive function . CONCLUSIONS Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients . Generally , cancer-associated neuropsychological compromise is not noticed by affected patients , but negative affectivity and treatment burden induce pessimistic self- appraisal s of cognitive functioning regardless of the presence of neuropsychological compromise . Clinicians should consider this when determining adequate therapy for patients who complain of ' chemobrain ' Our purpose was to evaluate the late physical and psychosocial difficulties of premenpausal patients treated for a localized breast cancer and to weigh the impact of chemotherapy on long-term quality of life . Two self-administered question naires , the EORTC core QLQ-C30 and the breast module ( BR23 ) were mailed to 179 premenopausal node-negative women continuously disease-free , previously enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy ( Espié et al , 1997 ) . The core question naire evaluates the physical , role , emotional , cognitive and social functioning and global health status . The breast module includes four functional scales : body image , sexual functioning , sexual enjoyment and future perspective . It also includes symptom scales such as arm or breast symptoms . Some specific professional and social states were added . 119 ( 68 % ) patients ( mean age 54 years , range 30–69 ) participated . Mean follow-up time since diagnosis was 9.6 years ( 4–16 ) . 68 % had conservative and 32 % radical surgery ( with reconstructive surgery in 50 % ) . CMF was given to 77 ( 65 % ) patients . Irradiation was administered in 75 % of patients irrespective of adjuvant therapy . QLQ-C30 scale scores were similar in patients who had or had not received chemotherapy .  Disturbance in body image , sex life and breast symptoms did not differ between patients who had or had not received adjuvant CMF . No major socioprofessional difficulties were reported except problems in borrowing from banks not related to past chemotherapy . With long follow-up , most premenopausal women treated for a localized breast cancer cope with the disease and its treatments . Adjuvant CMF chemotherapy does not appear to impair quality of life nor social and professional life in these patients . © 2000 Cancer Research PURPOSE To examine the impact of age and cognitive reserve on cognitive functioning in patients with breast cancer who are receiving adjuvant treatments .  PATIENTS AND METHODS Patients with breast cancer exposed to chemotherapy ( n = 60 ; mean age , 51.7 years ) were evaluated with a battery of neuropsychological and psychological tests before treatment and at 1 , 6 , and 18 months after treatment . Patients not exposed to chemotherapy ( n = 72 ; mean age , 56.6 years ) and healthy controls ( n = 45 ; mean age , 52.9 years ) were assessed at matched intervals . RESULTS Mixed-effects modeling revealed significant effects for the Processing Speed and Verbal Ability domains . For Processing Speed , a three-way interaction among treatment group , age , and baseline cognitive reserve ( P < .001 ) revealed that older patients with lower baseline cognitive reserve who were exposed to chemotherapy had lower performance on Processing Speed compared with patients not exposed to chemotherapy ( P = .003 ) and controls ( P < .001 ) . A significant group by time interaction for Verbal Ability ( P = .01 ) suggested that the healthy controls and no chemotherapy groups improved over time . The chemotherapy group failed to improve at 1 month after treatment but improved during the last two follow-up assessment s. Exploratory analyses suggested a negative effect of tamoxifen on Processing Speed ( P = .036 ) and Verbal Memory ( P = .05 ) in the no-chemotherapy group . CONCLUSION These data demonstrated that age and pretreatment cognitive reserve were related to post-treatment decline in Processing Speed in women exposed to chemotherapy and that chemotherapy had a short-term impact on Verbal Ability . Exploratory analysis of the impact of tamoxifen suggests that this pattern of results may be due to a combination of chemotherapy and tamoxifen BACKGROUND We conducted a r and omised , controlled trial of cognitive-existential group therapy ( CEGT ) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer . METHODS Women were r and omised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes . Assessment s , independently done at baseline , 6 and 12 months , included a structured psychiatric interview and vali date d question naires covering mood , attitudes to cancer , family relationships , and satisfaction with therapy . RESULTS Three hundred and three of 491 ( 62 % ) eligible patients participated over 3 years .  Distress was high pre-intervention : 10 % were diagnosed as suffering from major depression , 27 % from minor depression and 9 % from anxiety disorders . On an intention-to-treat analysis , there was a trend for those receiving group therapy ( n=154 ) to have reduced anxiety ( p=0.05 , 2-sided ) compared to controls ( n=149 ) . Women in group therapy also showed a trend towards improved family functioning compared to controls ( p=0.07 , 2-sided ) . The women in the groups reported greater satisfaction with their therapy ( p<0.001 , 2-sided ) , appreciating the support and citing better coping , self-growth and increased knowledge about cancer and its treatment . They valued the CEGT therapy . Overall effect size for the group intervention was small ( d=0.25 ) , with cancer recurrence having a deleterious effect in three of the 19 therapy groups . Psychologists as a discipline achieved a moderate mean effect size ( d=0.52 ) . CONCLUSION CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer . Interaction effects between group members and therapists are relevant to outcome . Group-as-a-whole effects are powerful , but the training and experience of the therapist is especially critical to an efficacious outcome Aims : To study neuropsychological functioning of newly diagnosed children with acute lymphoblastic leukaemia ( ALL ) within two weeks after diagnosis in order to determine the feasibility of a sibling controlled prospect i ve study design . Methods : Fifty consecutive patients ( median age at testing 6.6 years , range 4–12 ) were included in a prospect i ve , longitudinal , nationwide study . Treatment would include intrathecal and systemic chemotherapy according to the DCLSG ALL-9 protocol . Children were evaluated with an extensive neuropsychological battery including measures of intelligence , memory , attention , language , visual-constructive function , and fine-motor abilities within two weeks after start of the chemotherapy . The control group consisted of 29 healthy siblings ( median age at testing 8.2 years , range 4–12 ) , who were tested < 4 weeks after the patients ’ assessment . Results : Mean scores on Wechsler Intelligence Scales did not differ significantly between patients and siblings ; mean IQ scores for both the patients and the controls were high average . To examine specific neuropsychological functions , norm scores based on the exact age were acquired by fitting procedures , but no significant differences were found . Conclusions : Neuropsychological assessment of patients during early hospitalisation is feasible . The results indicate no adverse effect of illness and psychological factors on IQ and neuropsychological functioning of patients with recently diagnosed ALL . The prospect i ve design of this study of cognitive late effects of chemotherapy will allow discrimination between adverse sequelae of disease and treatment Background . Previous studies have indicated that a subset of cancer patients treated with chemotherapy  show cognitive deficits and /or experience cognitive complaints , whereas literature about the influence of hormonal therapies on cognition is sparse . Because of the accumulating knowledge about the importance of estrogen for cognitive functioning , there is growing concern about adjuvant hormonal therapy for breast cancer ( BC ) affecting cognition . We examined the cognitive functioning of postmenopausal BC patients who were , following doxorubicin/cyclophosphamide ( AC ) chemotherapy , r and omized to tamoxifen or exemestane , and compared their performance with that of non-cancer controls . Material s and methods . Thirty BC patients using tamoxifen and 50 patients using exemestane  underwent interviews , question naires and cognitive tests , on average two years after completion of AC chemotherapy .  Forty eight healthy controls were tested with similar measures . Results . Memory complaints were reported by 28 % of AC/tamoxifen users , 24 % of AC/exemestane users and 6 % of healthy controls ( p=0.02 ) . Cognitive testing revealed no statistically significant differences between tamoxifen and exemestane users , but suggested that tamoxifen use is possibly related to worse verbal functioning , while exemestane use is possibly related to slower manual motor speed . Both patient groups performed significantly worse than healthy controls on verbal fluency and information processing speed . Discussion . Our findings show that sequential treatment of AC-chemotherapy and hormonal therapy in postmenopausal , primary BC is associated with lower test scores for certain cognitive functions , and provide indications for possibly distinctive associations for different types of hormonal treatment . Future research with larger groups is recommended to obtain a more definite picture OBJECTIVE To examine , in a prospect i ve study , the influence that temporary reversible medical castration for localized prostate cancer has on cognition , by assessing whether temporary 3 - 5 month treatment with a luteinizing-hormone releasing hormone ( LHRH ) agonist before radical radiotherapy had a short- or long-term affect on cognitive function . PATIENTS , SUBJECTS AND METHODS Thirty-two patients with localized prostate cancer had  cognitive assessment  s at baseline ( T1 ) before the start of drug treatment , at 3 months ( T2 ) or on completing drug treatment but before radiotherapy , and 9 months later ( T3 ) . Eighteen men with no prostate cancer ( controls subjects ) completed the  cognitive tests  at the same times . In addition , psychological functioning and quality of life were assessed at the same times , together with serum free and bound testosterone , beta-oestradiol and sex hormone-binding globulin levels . RESULTS There was a significant cognitive decline ( on at least one cognitive task ) at T2 in 15 ( 47 % ) patients vs three ( 17 % ) of controls ( odds ratio 4.412 , P = 0.033 ) . Most patients ( nine of 15 ) who had a change in performance declined on tasks of spatial memory and ability . At T3 there was significant cognitive decline in 11 ( 34 % ) patients and five ( 28 % ) control subjects ( odds ratio 1.37 , P = 0.631 ) . CONCLUSION This pilot study suggests that short-term LHRH therapy for early-stage prostate cancer has modest short-term consequences on men 's cognitive functioning ; a larger prospect i ve study is warranted 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 Abstract Objectives : To evaluate late neurotoxicity of  adjuvant high-dose ( HD ) chemotherapy versus st and ard-dose ( SD ) chemotherapy by event-related potentials ( ERP ) and quantitative electroencephalography ( qEEG ) . Patients and methods : From a r and omized study in high-risk breast cancer patients on the efficacy of high-dose versus st and ard-dose adjuvant chemotherapy , late effects on cognitive functioning were analyzed by neuropsychological tests . Cognitive impairment was found in 32 % of the HD group , 17 % of the SD group and in 9 % of a control group of stage I breast cancer patients not treated with chemotherapy . In 17 consecutive patients in the HD group and 16 consecutive patients in the SD group neurophysiological tests were performed , consisting of P300 and qEEG . Results of patients treated with chemotherapy were compared with results of 14 control patients not treated with chemotherapy . All patients were tested two years after treatment . Results : Asymmetry of the alpha rhythm of ≥0.5 Hz was found in 7 HD patients , 2 SD patients and in none of the control patients ( p = 0.01 ) . No differences were found between the groups with regard to frequency of alpha rhythm , alpha blocking and latency of P300 . No correlation was found between neurophysiological parameters and neuropsychological performance , except for an overall relation between the P300 latencies and the total number of deviant test scores . Conclusion : Although the neurophysiological differences are subtle and the relation with the cognitive functioning in individual patients as measured by the neuropsychological examination is equivocal , the results suggest that there is neurophysiological support for cognitive dysfunction as a late complication of high-dose systemic chemotherapy in breast cancer OBJECTIVE To determine the short- and long-term effects of resistance training on muscle strength , psychological well-being , control-beliefs , cognitive speed and memory in normally active elderly people . METHODS 46 elderly people ( mean age 73.2 years ; 18 women and 28 men ) , were r and omly assigned to training and control groups ( n=23 each ) . Pre- and post-tests were administered 1 week before and 1 week after the 8-week training intervention . The training sessions , performed once a week , consisted of a 10 min warm-up phase and eight resistance exercises on machines . RESULTS There was a significant increase in maximum dynamic strength in the training group . This training effect was associated with a significant decrease in self-attentiveness , which is known to enhance psychological well-being . No significant changes could be observed in control-beliefs . Modest effects on cognitive functioning occurred with the training procedure : although there were no changes in cognitive speed , significant pre/post-changes could be shown in free recall and recognition in the experimental group . A post-test comparison between the experimental group and control group showed a weak effect for recognition but no significant differences in free recall . Significant long-term effects were found in the training group for muscular strength and memory performance ( free recall ) 1 year later . CONCLUSION An 8-week programme of resistance training lessens anxiety and self-attentiveness and improves muscle strength Introduction . There is growing concern that some cytotoxic regimens for cancer affect cognitive functioning . This study examined the prevalence of cognitive complaints and deficits in testicular cancer ( TC ) patients treated with the worldwide st and ard BEP ( bleomycin , etoposide and cisplatin ) chemotherapy .  Material s and methods . Seventy TC patients treated with BEP chemotherapy after surgery ( S+CT )  were examined with  interviews  and  neuropsychological tests .  These patients were compared with 57 TC patients treated with radiotherapy after surgery ( S+RT ) and with 55 TC patients that received surgery only ( S ) . Patients were examined a median of 3 years after completion of treatment . Results . Thirty two percent of the S+CT patients reported cognitive complaints compared with 32 % of the S+RT patients and 27 % of the S patients ( p=0.85 ) . No differences in mean cognitive test performance were observed between the groups . On individual impairment scores , more S+CT patients showed cognitive dysfunction compared with S patients , but not compared with S+RT patients ( S+CT versus S [ p=0.038 , OR=4.6 , CI=1.1–19.7 ] , S+CT versus S+RT [ p=0.70 , OR=0.8 , CI=0.3–2.4 ] and S+RT versus S [ p=0.070 , OR=3.7 , CI=0.8–15.7 ) . Cognitive complaints were not related to cognitive test performance , but to emotional distress and fatigue . Discussion . Cognitive complaints are common among TC patients , independent of treatment modality . These complaints are related to emotional distress and fatigue and not to formal cognitive deficits . The finding of a small group of TC patients treated with chemotherapy exhibiting cognitive deficits should be confirmed in a prospect i ve study before we can decide on its cause and relevance OBJECTIVES To report on the longitudinal cognitive functioning of older women receiving adjuvant chemotherapy for breast cancer . DESIGN Neuropsychological and functional status testing were performed before chemotherapy and 6 months after chemotherapy . SETTING Cancer center . PARTICIPANTS Thirty-one patients aged 65 and older with Stage I to III breast cancer . Of the 31 patients enrolled , three refused post-testing , and 28 were evaluable . MEASUREMENTS The following domains of cognitive function were examined : attention ; verbal memory ; visual memory ; and verbal , spatial , psychomotor , and executive functions . RESULTS Participants had a mean age of 71 ( range 65 - 84 ) : 39 % Stage I , 50 % Stage II , and 11 % Stage III . The number of scores 2 st and ard deviations ( SDs ) below the norm were calculated for each patient before and 6 months after chemotherapy ; 14 ( 50 % ) had no change , 11 ( 39 % ) worsened , and three ( 11 % ) improved ( P=.05 ) . Seven patients ( 25 % ) experienced a decline in cognitive function , defined as a 1-SD decline from pre- to post-testing in two or more neuropsychological domains . Exploratory analyses revealed no significant difference between functional status , comorbidity , and depression scale scores and change in overall quality -of-life scores before and after chemotherapy . CONCLUSION In this cohort of older women receiving adjuvant chemotherapy , a subset experienced a decline in cognitive function from before chemotherapy to 6 months after chemotherapy . Further prospect i ve study is needed to confirm these observations and to identify the subgroup at special risk BACKGROUND A diagnosis of breast cancer and treatment are psychologically stressful events , particularly over the first year after diagnosis . Women undergo many dem and ing and anxiety-arousing treatments such as surgery , radiation and chemotherapy . Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes ( neuroendocrine and immune ) that are relevant for health outcomes in breast cancer patients . METHODS Women with Stages 1 - 3 breast cancer recruited 4 - 8 weeks after surgery were r and omized to either a 10-week group-based cognitive behavioral stress management ( CBSM ) intervention or a 1-day psychoeducational control group and completed question naires and late afternoon blood sample s at study entry and 6 and 12 months after assignment to experimental condition . RESULTS Of 128 women initially providing psychosocial question naire and blood sample s at study entry , 97 provided complete data for anxiety measures and cortisol analysis at all time points , and immune assays were run on a subset of 85 of these women . Those assigned to a 10-week group-based CBSM intervention evidence d better psychosocial adaptation ( lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms ) and physiological adaptation ( lower cortisol , greater Th1 cytokine [ interleukin-2 and interferon-gamma ] production and IL-2:IL-4 ratio ) after their adjuvant treatment compared to those in the control group . Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period . Th1 cytokine regulation changes held only over the initial 6-month period . CONCLUSIONS This intervention may have facilitated a " recovery or maintenance " of Th1 cytokine regulation during or after the adjuvant therapy period . Behavioral interventions that address dysregulated neuroendocrine function could play a clinical ly significant role in optimizing host immunologic resistance during a vulnerable period Objective The objective of this study was to assess the effects of participation in a mindfulness meditation – based stress reduction program on mood disturbance and symptoms of stress in cancer out patients . Methods A r and omized , wait-list controlled design was used . A convenience sample of eligible cancer patients enrolled after giving informed consent and were r and omly assigned to either an immediate treatment condition or a wait-list control condition . Patients completed the Profile of Mood States and the Symptoms of Stress Inventory both before and after the intervention . The intervention consisted of a weekly meditation group lasting 1.5 hours for 7 weeks plus home meditation practice . Results Ninety patients ( mean age , 51 years ) completed the study . The group was heterogeneous in type and stage of cancer . Patients ’ mean preintervention scores on dependent measures were equivalent between groups . After the intervention , patients in the treatment group had significantly lower scores on Total Mood Disturbance and subscales of Depression , Anxiety , Anger , and Confusion and more Vigor than control subjects . The treatment group also had fewer overall Symptoms of Stress ; fewer Cardiopulmonary and Gastrointestinal symptoms ; less Emotional Irritability , Depression , and Cognitive Disorganization ; and fewer Habitual Patterns of stress . Overall reduction in Total Mood Disturbance was 65 % , with a 31 % reduction in Symptoms of Stress . Conclusions This program was effective in decreasing mood disturbance and stress symptoms in both male and female patients with a wide variety of cancer diagnoses , stages of illness , and ages Retrospective trials have reported that  chemotherapy‐induced cognitive dysfunction was experienced by a subset of patients with breast carcinoma . However , recent evidence indicated that a subset also exhibited impaired cognitive function at baseline , before the start of chemotherapy . A prospect i ve , longitudinal trial that incorporates baseline neuropsychologic evaluations is necessary to determine to what extent cognitive dysfunction is attributable to chemotherapy in this population It is believed widely that chemotherapy‐induced  cognitive impairment occurs in a subgroup of patients with breast cancer . However , recent reports have provided no evidence that chemotherapy affects cognition . In this study , the authors question ed whether cognitive compromise in patients with breast cancer is attributable to chemotherapy . In addition , the effects of therapy‐induced menopause and of the erythropoiesis‐stimulating factor darbepoetin α on cognitive performance were assessed OBJECTIVE Several prospect i ve studies into the effects of adjuvant systemic therapy on cognitive functioning suggest that a proportion of breast cancer patients show cognitive deficits already before the start of systemic therapy . Owing to , among others , method ological inconsistency , studies report different rates of this pre-treatment cognitive impairment . We examined the impact of four different criteria of cognitive impairment and two types of reference groups ( a study -specific healthy reference group versus published normative data ) on the prevalence of cognitive impairment . METHODS Two hundred and five postmenopausal breast cancer patients underwent a battery of neuropsychological tests before the start of endocrine therapy , 124 healthy subjects underwent the same tests .  Proportions of cognitive impaired patients were calculated for each of four criteria for cognitive impairment , using ( 1 ) study -specific healthy controls and ( 2 ) published norms of healthy controls as reference groups . RESULTS The prevalence of cognitive impairment varied greatly with the strictness of the criterion , as expected , but also was dependent on the reference group used . Cognitive impairment , relative to published norms , ranged from 1 % for the strictest to 36.6 % for the less strict criterion , cognitive impairment relative to study -specific healthy controls , ranged from 13.7 to 45.4 % for the same criteria . CONCLUSION This study highlights contrasting proportions of cognitive impairment by using different criteria for cognitive impairment and different reference groups . (Dis)advantages of the methods using a criterion for cognitive impairment , and of the use of published norms versus a study -specific reference group are discussed Change in cognitive function is increasingly being recognized as an adverse outcome related to chemotherapy treatment . These changes need not be severe to impact patient functional ability and quality of life . The primary goal of this study was to determine if there is evidence of changes in the cognitive function domains of attention , processing speed , and response time among women with newly diagnosed advanced ovarian cancer who receive chemotherapy . Eligible patients were women diagnosed with stage III-IV epithelial ovarian or primary peritoneal cancer who had not yet received chemotherapy but who were prescribed a minimum of six cycles ( courses ) of chemotherapy treatment .  Cognitive function was assessed by a computerized , Web-based assessment ( attention , processing speed , and reaction time ) and by patient self-report .  Cognitive function was assessed at three time points : prior to the first course ( baseline ) , course three , and course six . Medical records were review ed to abstract information on chemotherapy treatment , concomitant medications , and blood test results ( e.g. , hemoglobin , CA-125 ) . Of the 27 eligible participants , 92 % and 86 % demonstrated cognitive impairments from baseline to course three and from baseline to course six of chemotherapy , respectively . Impairment was detected in two or more cognitive domains among 48 % ( 12 of 25 ) and 41 % ( 9 of 22 ) of participants at course three and course six of chemotherapy , respectively . This study shows evidence of decline in cognitive function among women being treated for ovarian cancer . There is a need for additional , prospect i ve research to better underst and the impact of chemotherapy on cognitive function among ovarian cancer patients so that effective preventive and treatment strategies can be developed BACKGROUND Mild cognitive impairments have been recorded in cross-sectional studies of women with breast cancer receiving endocrine treatment . More comprehensive studies were warranted because aromatase inhibitors are being used increasingly in both chemoprevention and adjuvant setting s. We report findings from the cognitive sub protocol of the International Breast Intervention Study ( IBIS II ) , a double-blind placebo-controlled trial of anastrozole in postmenopausal women at high risk of developing breast cancer . We aim ed to study and compare the effect of anastrozole versus placebo on memory and attention in these women . METHODS Between Jan 3 , 2003 , and Dec 21 , 2005 , participants were recruited into the cognitive sub protocol from five UK centres .  Cognitive assessment s were done before r and omisation , at 6 months , and at 24 months . 227 of 249 women approached completed a comprehensive set of st and ardised cognitive tasks at baseline and were r and omly assigned to receive anastrozole ( 1 mg/day for 5 years ) or placebo .  Psychological morbidity , endocrine symptoms , and self-reported cognitive complaints were also measured . The main outcomes were cognitive task scores at baseline , 6 months , and 24 months . Analyses were done by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31488319 . FINDINGS 111 women were assigned to anastrozole and 116 women to placebo . At 6 months , ten women in each group were excluded from analysis , leaving a total of 207 of 227 ( 91 % ) women available for further assessment s. At 24 months , 24 women were excluded from the anastrozole group and 32 from the placebo group , leaving 151 of 227 ( 67 % ) women . We did not note any significant differences between the groups for any of the cognitive tasks . By 6 months , 13 women in both groups reported changes to their memory and this had decreased to five women in the placebo group and three women in the anastrozole group by the 24-month assessment . Significantly more women in the anastrozole group complained of hot flushes at 24 months ( 23 of 76 [ 30 % ] vs 11 of 73 [ 15 % ] , p=0.032 , not corrected for multiple comparison ) , but this was the only difference in reported endocrine symptoms . INTERPRETATION These findings show little or no impairment of cognitive performance with the use of anastrozole compared with placebo in postmenopausal women at high risk of developing breast cancer who were able to tolerate endocrine-related side-effects . Future studies assessing cognition should be done within r and omised trials with baseline assessment s to ascertain the true extent of the putative effects that treatments for breast cancer might have on memory and attention . FUNDING Cancer Research UK , London , UK ( grant numbers C6280/A3162 and C6280/A6764 ) Some breast cancer survivors experience cognitive decline following chemotherapy . We prospect ively examined changes in cognitive performance among high-risk breast cancer patients who had received high-dose chemotherapy with cyclophosphamide , thiotepa , and carboplatin ( CTC group ; n = 28 ) or st and ard-dose chemotherapy with 5-fluorouracil , epirubicin , and cyclophosphamide ( FEC group ; n = 39 ) ; stage-I breast cancer patients who had received no systemic chemotherapy ( no-CT group ; n = 57 ) ; and healthy control subjects ( n = 60 ) . All patients underwent  neuropsychologic testing  before and 6 months after treatment ( 12-month interval ) ; control subjects underwent repeated testing over a 6-month interval . No differences in cognitive functioning between the four groups were observed at the first assessment . More of the CTC group than the control subjects experienced a deterioration in cognitive performance over time ( 25 % versus 6.7 % ; odds ratio [ OR ] = 5.3 , 95 % confidence interval [ CI ] = 1.3 to 21.2 , P = .02 ) . No such difference was observed for the FEC or the no-CT groups ( FEC versus control : OR = 2.2 , 95 % CI = 0.5 to 9.1 , P = .27 ; no-CT versus Control : OR = 2.2 , 95 % CI = 0.6 to 8.0 ; P = .21 ) . Some cytotoxic treatment for breast cancer affects cognition in a subset of women The results of a r and omized controlled trial that tested the effects of eight-week , six-contact multidimensional interactive interventions for symptom management are presented . Four hundred and thirty-five cancer patients with solid tumors undergoing chemotherapy were r and omized to receive either nurse-assisted symptom management ( NASM ) or automated telephone symptom management ( ATSM ) . A prior trial established the effectiveness of NASM compared with conventional care . Seventeen symptoms commonly experienced by patients undergoing chemotherapy were rated on a scale from 0 to 10 and were evaluated at baseline , at each of the six intervention contacts , and postintervention observation at 10 weeks . Both groups achieved significant reduction in symptom severity over baseline , and there was no difference between groups on symptom severity at 10 weeks . R and omization accounted for possible reductions in severity due to response shifts . Severity of symptoms reported by patients at each of the six intervention contacts was measured using a Rasch model . Symptom pattern was different for lung and non-lung cancer patients , and they were analyzed separately . Longitudinal analyses revealed that lung cancer patients with greater symptom severity withdrew from later intervention contacts of the ATSM . The results suggest that both NASM and ATSM achieved a clinical ly significant reduction in symptom severity . The NASM may be more effective than ATSM in retaining lung cancer patients in the intervention . Further testing of ATSM supplemented by NASM for patients with severe symptoms is warranted A number of patients who have undergone adjuvant ( CMF ) chemotherapy for operative primary breast carcinoma have reported impaired cognitive function , sometimes even years after completion of therapy . The possible role of cytostatic treatment as a causative factor has scarcely been investigated . The objective of the current study was to examine the late effects on neuropsychologic functioning of CMF adjuvant chemotherapy given to patients with breast carcinoma OBJECTIVE Many cancer patients report cognitive changes following  chemotherapy .  In social psychology , there is ample evidence that psychological and physical complaints can increase with increased accessibility of relevant schemata . The accessibility of related concepts in memory may be facilitated through priming or by pre-existing knowledge , result ing in an increase of reported complaints . We examined whether pre-existing knowledge of chemotherapy-associated cognitive problems and priming the ' chemo-brain ' schema increase the reporting of cognitive complaints . METHODS Two hundred and sixty-one breast cancer patients were interviewed about cognitive problems and other cancer-related symptoms . Preceding the interview , half of the patients were primed with an introduction letter to the study in which the occurrence of cognitive complaints and its relation with chemotherapy was explicated . The remaining patients received a neutral letter that did not mention this relationship . RESULTS Patients with pre-existing knowledge about chemotherapy-associated cognitive problems reported more cognitive complaints ( M=3.04 ) than patients without this knowledge ( M=2.21 ; p<0.001 ) . The priming letter increased the reporting of cognitive complaints only for patients without a history of chemotherapy ( p<0.05 ) . All effects were independent of negative affect , age and education level . CONCLUSION Our study shows that facilitating the accessibility of concepts related to chemotherapy-associated cognitive complaints directly increases the reporting of such complaints , in particular in patients without firsth and chemotherapy experience . This increase in prevalence of cognitive complaints following a chronically or temporarily accessible ' chemo-brain ' schema has relevant implication s for clinical practice and for scientific research in this area 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
BACKGROUND Chemotherapy-related cognitive dysfunction ( CRCD ) refers to problems with memory , attention span , or concentration , experienced by patients with cancer who have had chemotherapy .
CRCD can have a significant negative effect on a patient 's quality of life .
The exact cause of CRCD is unknown but is presumed to be multifactorial .
OBJECTIVE To conduct a systematic review of the effectiveness of psychosocial interventions design ed to treat CRCD .