Videoconference CBT for Rural Breast Cancer Survivors with Cognitive Complaints

描述（由申请人提供）：与癌症化疗相关的认知功能障碍会对癌症幸存者的生活质量产生巨大影响，并且被认为是一个日益严重的生存问题。然而，与化疗相关的认知改变的病因尚不清楚，目前尚无广泛有效的治疗方法。PI正在开发一种简短的认知行为疗法（CBT；记忆和注意力适应训练；MAAT），旨在帮助癌症幸存者自我管理和应对日常记忆衰退。初步研究表明，MAAT可能会改善自我报告的日常认知失败和言语记忆表现，幸存者对它非常满意，但还需要更多的研究。拟议的研究旨在通过视频会议技术评估修订和更密集的MAAT版本（从4次增加到8次），以帮助农村乳腺癌幸存者与化疗相关的认知抱怨-个体在生存服务方面存在地理和成本障碍。MAAT将与视频会议支持疗法（ST）进行比较。因此，本研究旨在评估通过视频会议技术提供MAAT的可行性。参与者：48名接受I、II或IIIa期乳腺癌治疗的女性，她们患有化疗相关的认知疾病，在上次化疗后6个月，没有其他神经或精神病史，或未经治疗的焦虑或情绪障碍。干预。MAAT-Video （MAAT-V）将包括每周8次一小时的小组会议，由2-4名成员组成，每个人在最多6个农村外展诊所通过视频会议设备连接。临床医生可以看到多个参与者，参与者也可以从不同的位置看到彼此。ST在课程长度和时间上是相同的（8个一小时的课程），但比MAAT更被动，更缺乏教学意义。设计。乳腺癌幸存者将被随机分配到MAAT-V或st组。幸存者将在治疗前、治疗后和2个月随访三个时间点评估自我报告的认知问题对生活质量的影响、对认知问题的焦虑、功能健康以及基于电话的简短记忆神经心理测试。统计分析将包括2 × 3（基线、治疗后和随访）、重复测量与上述相关测量的方差分析和计划比较方法，以减少虚假发现的风险。化疗类型，年龄，教育程度，估计智商，疲劳和其他因素将作为可能的协变量进行评估。将使用可靠变化指数（RCI）评估结果测量的临床显著变化。满意度将以0-8的李克特评级进行评估。将对随机选择的20名参与者进行定性分析，以评估MAAT-V的实用性。的意义。研究结果将进一步了解通过视频会议提供MAAT的可行性，以改善乳腺癌幸存者的生活质量，特别是在农村，服务不足的地区。

DESCRIPTION (provided by applicant): Cognitive dysfunction associated with cancer chemotherapies can have a dramatic effect on cancer survivor quality of life and is recognized as a growing survivorship problem. However, the etiology of chemotherapy- related cognitive change is unknown, with no current broadly validated treatment. The PI is developing a brief cognitive-behavioral therapy (CBT; Memory and Attention Adaptation Training; MAAT) designed to help cancer survivors self-manage and cope with daily memory failure. Preliminary research suggests MAAT may improve self-reported daily cognitive failures and verbal memory performance, and survivors rate it with strong satisfaction, but more research is needed. The proposed research aims to evaluate a revised and more intense version of MAAT (increase from 4 to 8 visits) delivered through videoconferencing technology to aid rural breast cancer survivors with chemotherapy-related cognitive complaints-individuals with geographic and cost barriers to survivorship services. MAAT will be compared to a videoconference supportive therapy (ST). Thus, this study seeks to evaluate feasibility of MAAT delivered through videoconference technology. Participants. 48 women treated for stage I, II, or IIIa breast cancer with chemotherapy-related cognitive complaints, 6 months past last chemotherapy and who do not have other neurologic or psychiatric histories, or untreated anxiety or mood disorders will be enrolled. Intervention. MAAT-Video (MAAT-V) will consist of 8 weekly one-hour group sessions consisting of 2-4 members each linked by videoconferencing devices at up to 6 rural outreach clinics. Multiple participants can be seen by the clinician and participants can also see each other from different sites. ST is identical in length and time of sessions (8 one-hour sessions), but is more passive and less instructional than MAAT. Design. Breast cancer survivors will be randomized to either MAAT-V or ST. Survivors will be evaluated for self-reported impact of cognitive problems on quality of life, anxiety about cognitive problems, functional wellbeing, and on brief telephone-based neuropsychological tests of memory at 3 time points: pre-treatment, post-treatment and 2-month follow-up. Statistical analyses will consist of a 2 X 3 (baseline, post-treatment and follow-up), repeated measures analysis of variance with dependent measures listed above and a planned comparison approach to reduce risk of spurious findings. Type of chemotherapy, age, education, estimated IQ, fatigue, and other factors will be evaluated as possible covariates. Clinically significant change on outcome measures will be evaluated using the reliable change index (RCI). Satisfaction will be assessed with 0-8 Likert-type ratings. A qualitative analysis of 20 randomly selected participants will be completed to assess practicality of MAAT-V. Significance. Study results will advance knowledge of the feasibility of MAAT delivered through videoconference to improve breast cancer survivor quality of life, especially in rural, underserved areas. PUBLIC HEALTH RELEVANCE: The proposed study seeks to advance knowledge concerning the value and use of health information technology (HIT) to expand access of care to rural and underserved populations. Teleconference technology allows real-time interaction with clinicians across vast geographical distances. This makes possible the delivery of important treatments to cancer patients who otherwise may not be able to benefit from such care due to geographical distance.