Évaluation d'un programme de Remédiation pour des patientes atteintes de CRCI (Cancer Related Cognitive Impairment) dans les suites d'un Cancer du sein PDF Download

Author: Marianne Merceur
Publisher:
ISBN:
Category :
Languages : fr
Pages : 0

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Introduction : Le terme « Cancer Related Cognitive Impairment » (CRCI) englobe l'ensemble des troubles cognitifs liés au cancer et à ses traitements (troubles attentionnels, mnésiques, exécutifs...). L'efficacité de l'activité physique et de la rééducation cognitive sur le CRCI est prouvée, mais l'efficacité d'une prise en charge mixte mêlant rééducation cognitive et activité physique adaptée n'a à notre connaissance jamais été évaluée et ses modalités exactes sont encore à définir. Nous avons souhaité conduire une étude visant à évaluer l'efficacité de la rééducation combinée sur les symptômes de CRCI de 4 patientes ayant été traitées pour un cancer du sein, prises en charge à l'hôpital Henry Gabrielle au CHU de Lyon. Matériel et Méthode : Cette étude prospective, interventionnelle et unicentrique respecte la méthodologie SCED (Single Case Experimental Design) et comporte 3 phases (pré-intervention, intervention et suivi). Quatre à 6 évaluations des critères de jugement sont réalisées à chaque phase, à une fréquence hebdomadaire. Les patientes inclues présentent des symptômes de CRCI dans les suites d'un cancer du sein. Le critère de jugement principal est le score à l'auto-questionnaire de plainte cognitive FACT-Cog (Functionnal Assessment of Cancer Therapy - Cognitive Function) et les critères de jugement secondaires sont les résultats à des auto-questionnaires de qualité de vie, de fatigue, d'anxiété/dépression et d'estime de soi, et à des évaluations neuropsychologiques. Résultats : Les 4 patientes améliorent de manière significative leur score à la FACT-Cog entre la phase de pré-intervention et la phase de suivi (en moyenne, leur gain est de 21 points). Concernant les critères de jugement secondaires, l'impact sur la qualité de vie est positif ; l'impact sur l'anxiété, la dépression, la fatigue et l'estime de soi est positif durant la phase d'intervention mais non maintenu en phase de suivi. À propos des évaluations neuropsychologiques, seuls les résultats au SDMT, test peu spécifique évaluant la vitesse de traitement de l'information, sont améliorés. Discussion : Ces résultats suggèrent que le programme de rééducation proposé, composé de rééducation cognitive et d'activité physique adaptée, améliore les symptômes de CRCI. La poursuite de cette étude permettra d'évaluer sa réplicabilité à d'autres centres. A terme, l'enjeu est d'identifier le ou les mécanismes impliqués et s'il existe des critères prédictifs d'efficacité de ce type de programme.

Author: Katherine R.P. George
Publisher:
ISBN:
Category :
Languages : en
Pages :

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Purpose: Cancer-related cognitive impairment (CRCI) has been associated with fatigue, emotional distress, reduced quality of life, and caregiver strain. A potential treatment option for those with CRCI is cognitive rehabilitation, a behavioural approach to improve cognitive skills and quality of life. There have been some studies that involve caregivers in aspects of rehabilitation. There are no studies in the literature however, that include direct retraining of survivors on lost functions and concurrent participation by their caregivers across all sessions. To fill this gap, a comprehensive 10-week cognitive rehabilitation program (CRP) was created, with aims to generalize improvement to everyday life in survivors of breast cancer. Methods: A manualized CRP was developed and piloted with breast cancer survivors (BCSs) and their training partners. The program focused on psychoeducation and direct training on communication strategies, breathing/relaxation techniques, simple and complex attention, and higher-order thinking. Outcome measures included feasibility (retention and attendance rates), acceptability (homework compliance, session and program satisfaction), and measures of cognitive functioning and quality of life. BCSs and their individual partner underwent assessments at baseline, immediately after completing the program, and approximately 10 weeks later in order to investigate maintenance effects. Results: Six BCSs (ages 44-59; ≥1 year post-chemotherapy) and their training partners enrolled and completed this study with a (100% retention rate). Rates of attendance were high for both BCSs and their training partners (94% and 92.5% respectively) with all participants indicating high levels of satisfaction with the iv program. Repeated measures analyses of variance (ANOVAs) did not reveal a significant main effect for time on measures of sustained attention, processing speed, executive function, fluency (semantic and phonemic), verbal and visuospatial learning, recall and recognition. Repeated measures ANOVA revealed a significant main effect for time on measures of attentional capacity, focused attention, motor dexterity with the non-dominant hand, confrontation naming, and overall quality of life. Additionally, analyses using adjusted reliable change indices (RCI) were conducted on individual cases. RCIs yielded no change on most measures across time.

Author: Robert Ferguson
Publisher: Oxford University Press
ISBN: 0197521592
Category : Medical
Languages : en
Pages : 176

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Cancer-related cognitive impairment (CRCI) may affect nearly half of all cancer survivors and can persist for years after completing cancer treatment. Memory and Attention Adaptation Training (MAAT) is a cognitive-behavioral therapy offering evidence-based, nonpharmacological treatment of this common survivorship condition. Organized into a session-by-session Clinician Manual and related Survivor Workbook, MAAT is conducted in eight treatment visits and has been demonstrated effective when delivered through telehealth technology, so survivors can readily fit MAAT into their busy lives. The MAAT Clinician Manual provides a clearly written summary of the scientific literature on CRCI and detailed guidance for each visit, including an agenda outline, in-depth discussion, and accompanying fidelity checklist in the appendix. Designed to be used in conjunction with the Survivor Workbook, the Clinician Manual also includes the full text of the workbook in a separate appendix, giving clinicians convenient one-volume access to the complete material.

Author: Robert Ferguson
Publisher: Oxford University Press
ISBN: 0197521541
Category : Medical
Languages : en
Pages : 115

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Book Description
Cancer-related cognitive impairment (CRCI) may affect nearly half of all cancer survivors and can persist for years after completing cancer treatment. Memory and Attention Adaptation Training (MAAT) is a cognitive-behavioral therapy offering evidence-based, nonpharmacological treatment of this common survivorship condition. Organized into a session-by-session Clinician Manual and related Survivor Workbook, MAAT is conducted in 8 treatment visits and has been demonstrated effective when delivered through telehealth technology, so survivors can readily fit MAAT into their busy lives. The Survivor Workbook starts with a brief overview of what is understood about CRCI, common problems, and how MAAT helps. The introduction is followed by the 8 visits summarized in concise chapters that allow for easy review after the therapy visit. Thus, survivors with memory problems have a reliable source to turn to so that content of visits is not forgotten. Each visit consists of homework exercises with easy to follow forms.

Author: Arielle S Radin
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Cognitive impairment during and after treatments for breast cancer, referred to as cancer-related cognitive impairment (CRCI), is one of the most common and troublesome consequences of the cancer experience. Women report experiencing difficulties with memory, multi-tasking, and keeping up with the demands of what used to be cognitively manageable tasks. Over the last several decades, both pre-clinical and clinical research have provided empirical evidence supporting an association between the cancer experience and cognitive problems; however, several gaps in the literature remain. First, the study of CRCI has primarily focused on the influence of adjuvant therapies given that women often complain of cognitive disturbances following chemotherapy, referring to the experience as "chemo-brain." However, longitudinal investigations into the onset and maintenance of CRCI have identified pre-chemotherapy cognitive impairment that cannot be explained by presumed cytotoxic effects. These pre-systemic therapy cognitive problems could potentially be driven by breast cancer surgery, the primary treatment for solid tumor cancers. Although breast cancer surgery is included in almost every conceptual model of CRCI, few studies have examined the association between different surgery types and cognitive problems over time. Second, the prevailing biological mechanistic theory linking the cancer experience with cognitive problems is increases in peripheral inflammation resulting in neuroinflammation. However, a paucity of studies have examined associations between inflammation and CRCI, even fewer have investigated this relationship longitudinally, and only one study to our knowledge that has interrogated within-subject associations. Third, most studies have examined mean levels of cognitive problems over time, which masks heterogeneity. Therefore, investigations into distinct group-based trajectories of cognitive problems over time in breast cancer survivorship are required. This approach will also enable the identification of various clinical, psychological, and biological risk factors for elevated cognitive problems throughout survivorship. Thus, this dissertation comprises three different studies of breast cancer-related cognitive impairment. Study 1, "Surgery-Chemo-Brain?" The role of surgery in cancer-related cognitive impairment in breast cancer survivors," assessed the associations between different surgery types and perceived and objective cognitive problems over time. Study 2, "The role of peripheral inflammation in cancer-related cognitive problems," assessed between- and within-subjects associations between inflammation and perceived and objective cognitive problems longitudinally. Study 3 "Trajectories of perceived and objective breast cancer-related cognitive problems," characterized group-based trajectories of perceived cognitive problems as well as identified clinical, psychological, and biological risk factors for group membership. We used rich biobehavioral data from one or both of two longitudinal observational cohort studies of breast cancer survivors, the RISE and Mind-Body Studies, to conduct these studies. Together, these studies further our understanding of clinical drivers of, biological mechanisms of, and risk factors for trajectories of CRCI.

Author: Giulia Binarelli
Publisher:
ISBN:
Category :
Languages : en
Pages : 0

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Cancer-related cognitive impairment (CRCI) is a common side effect with substantial implications for patients'daily lives, work, and treatment adherence. Many patients would benefit from interventions such as cognitiveand physical training and psychological support. However, CRCI remains relatively unrecognized byhealthcare professionals, and access to interventions in clinical practice is limited. While digital technologieshold promises for expanding intervention access, their acceptance and feasibility, particularly among olderpatients, require further investigation. Multimodal interventions offer potential solutions with enhancedefficacy. Nevertheless, their feasibility demands thorough examination. The primary aim of the Cog-Stimresearch program was to enhance our understanding of feasible and effective interventions for CRCIaccessible to a broader population. Our results demonstrated the feasibility and efficacy of a multimodaldigital intervention, combining non-simultaneous cognitive and physical training, among breast cancerpatients. Additionally, we established the feasibility of implementing a digital cognitive intervention amongelderly breast cancer patients. Notably, both studies underscored the pivotal role of expert supervision as afacilitator for successful intervention outcomes. To implement these interventions in clinical practice, keyconsiderations include patient motivation, preferences regarding intervention format (home-based/on-site,supervised/unsupervised), and the presence of significant cognitive complaints. In summary, addressing CRCInecessitates a multifaceted approach, integrating diverse interventions and patient-centered considerationsto enhance the quality of life for individuals throughout their journey after cancer.

Author: Erin O'Farrell
Publisher:
ISBN:
Category :
Languages : en
Pages :

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Advances in cancer treatment have led to increasing numbers of survivors left to struggle with the long-term adverse effects of disease and treatment. Many possible effects have been described including anxiety, depression, as well as physical side effects and consequences of cancer treatment. One particular adverse effect that is frequently reported but often overlooked in clinical practice is disturbances of cognitive functioning. Cancer-related cognitive impairment (CRCI) is a growing area of research with important clinical implications for current patients and survivors. Despite a huge increase in this research endeavour in the last 20 years, many important questions remain unanswered due, in large part, to methodological limitations of many of the studies. The overall goal of this dissertation is to critically examine previous CRCI research from a methodological perspective. It will explore limitations and confounds in this research and provide suggestions for improving future work. This dissertation is comprised of three manuscripts, a critical literature review and two original papers, addressing specific research questions. The first original paper addresses the disparity between the results of objective (performance-based) and subjective (self-report) measures of cognition that is typically observed in samples of cancer patients, using multilevel modeling to explore the hypothesis that this is due to failure to address measures of change over time. Despite negative findings, the methodological approach taken to this research question provided greater evidence for this subjective-objective disparity as well as methodological suggestions for future studies. The second original paper explores the sensitivity and validity of a computerized cognitive test for measuring CRCI to determine if it might be an appropriate alternative to traditional, resource-intensive neuropsychological testing. This study found that, although the computerized measure of cognitive functioning was not sensitive enough to detect changes at the individual level or within specific domains, it was sensitive to changes in cognitive functioning at the group level suggesting its usefulness as a screening tool in research settings. By addressing methodological limitations of research to date and, specifically, the two issues identified above, this dissertation aims to a) make recommendations to help improve the quality of future research, b) validate the cognitive complaints of cancer patients, and c) improve access to cognitive assessments leading to increased detection and treatment of cognitive side effects and improvement in quality of life of cancer survivors.

Author: Alice Medalia
Publisher: Oxford University Press
ISBN: 0199395225
Category : Psychology
Languages : en
Pages : 233

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"Cognitive Remediation to Improve Functional Outcomes provides mental health practitioners with the background knowledge, hands-on methods, and tools they need to provide CR to patients in a way that maximizes the transfer of cognitive gains to everyday functioning"--

Author: Amanda Lucas
Publisher:
ISBN:
Category :
Languages : en
Pages : 86

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Chemotherapy, radiation therapy, and targeted biological therapies are cancer treatments that can increase survivorship in patients with breast cancer, yet the associated cognitive side effects of therapy can significantly reduce quality of life (QOL). Cognitive Impairment has been identified by oncology nurses and patient's as one of the most difficult symptoms to manage. However, methods to detect cognitive impairment are inconsistent in the literature. The purpose of this study was to examine the effect of cancer treatment on cognitive impairment in women with breast cancer using self-reported instruments. A descriptive, correlational pilot study was used to compare healthy women of similar age and those women who receive surgery, radiation, and chemotherapy for breast cancer at six months or less of endocrine therapy. This study evaluated three-self reported tools on cognition (attention, memory, and executive function) in conjunction with self-reported tools on symptom burden, QOL, anxiety, and depression. Results showed a significant difference between groups in attention and executive function but not in memory. Women with breast cancer reported significantly more symptoms and demonstrated more anxiety and depression than the healthy women. The findings of this study corresponded with findings from previous studies. However, a larger scale study with a larger sample size needs to be completed to validate these findings.

Author: Frédéric Coppola
Publisher:
ISBN:
Category :
Languages : fr
Pages : 106

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Introduction : Les déficits cognitifs, notamment en mémoire de travail, sont fréquents chez les patients bipolaires en période inter critique, et sont responsables d'un handicap fonctionnel. Notre étude prospective avait pour objectif d'évaluer l'impact du programme de remédiation cognitive COGMED sur le fonctionnement global de patients bipolaires euthymiques avec plaintes mnésiques. Méthode : L'ensemble des patients ont suivi le programme COGMED, comprenant 25 sessions d'exercices (durée de 5 semaines), à caractère ludique, et ciblant la mémoire de travail. Cette remédiation étaient effectuée au domicile, sur support informatique via un accès internet. Une évaluation clinique et neuropsychologique étaient réalisées à l'inclusion, et dans un délai de l mois (+/- 15 jours) après la fin de la thérapie. Le fonctionnement global du patient fut évalué par l'échelle FAST (Functioning Assessment Short Test). Résultats : 20 patients ont été inclus, souffrant en majorité d'un trouble bipolaire de type l, avec symptomatologie dépressive résiduelle. Leur handicap fonctionnel était d'intensité modéré, et leur profil cognitif dans la moyenne de la population générale. Une amélioration significative du fonctionnement global a été retrouvé (p