Feasibility of using remotely-delivered metacognitive strategy training to address cancer-related cognitive impairment in breast cancer

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7. Project Summary/Abstract The long-term goal of this project is to help improve recovery from cancer-related cognitive impairment (CRCI) following treatment for breast cancer. There are two primary factors impacting recovery that must be addressed to achieve this long-term goal: (1) breast cancer survivors have inadequate access to rehabilitation services to address CRCI; and (2) there is relatively little evidence supporting effective interventions that address CRCI in breast cancer survivors. The overall hypothesis of this proposal is that an activity-based metacognitive-strategy training intervention, the Cognitive Orientation to daily Occupational Performance (CO- OP) approach, can feasibly be administered remotely to improve activity performance, subjective and objective cognition, and quality of life in breast cancer survivors with CRCI. The specific aims of this study are: (1) to assess the feasibility of delivering CO-OP remotely to breast cancer survivors who self-report CRCI; and (2) to assess the effect of CO-OP on activity performance, subjective and objective cognition, and quality of life in a sample of breast cancer survivors who self-report CRCI. Both specific aims of this study will be completed through a single-blind, exploratory, randomized controlled trial. Breast cancer patients who received chemotherapy within the past three years will be identified. These women will be asked to complete a prescreening survey to evaluate eligibility and identify if they have CRCI. Those with self-reported CRCI who provide written consent will undergo a baseline assessment battery. After completing the baseline assessment battery, participants (n=44) will be randomized to one of two groups: (1) a 12 session CO-OP intervention; or (2) a 12 session attention control group. Following the completion of the intervention, participants will complete the same assessment battery that was completed at baseline. The purpose of this R03 is to obtain estimates of effect and precision of response on the outcome measures. Treatment outcomes will be analyzed under the intention to treat model. Independent samples t-test and chi square test will be used to evaluate whether randomization was successful. Descriptive statistics, reported with 95% confidence intervals, will be used to evaluate the feasibility data. Pre-to-post change in each of the outcome measures will be calculated for both groups. Cohen’s d effect size reported with precision around the estimate, 95% confidence intervals, will be used to evaluate the within and between group effects of the interventions on the primary and secondary outcome measures. Finally, a correlation matrix using Pearson correlation coefficients will be developed to evaluate the relationships between the outcome measures. The expected outcomes of this study will be: (1) data to support the feasibility of remotely administering CO-OP to this population; and (2) data to estimate effect sizes of CO-OP compared to the attention control group. This proposal is consistent with the research priority of the National Center for Medical Rehabilitation Research (NCMRR) to identify, prevent, and treat key secondary conditions associated with disabilities, e.g., cancer.