scholarly journals 1030 An Exploration of the Impact of Cognitive Behavioural Therapy of Insomnia (CBT-I) on Perceived Cognitive Impairment in Breast Cancer Survivors

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A391-A392
Author(s):  
N Walsh ◽  
S Garland ◽  
R Lester ◽  
J McCarthy ◽  
K Laing
Keyword(s):  
Breast Cancer ◽  
Cancer Research ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Post Treatment ◽  
Subjective Cognitive Function ◽  
The Impact ◽  
Insomnia Severity

Abstract Introduction Insomnia and cognitive impairment are prevalent and persistent symptoms in cancer survivors. Cognitive Behavior Therapy is effective for improving insomnia and comorbid symptoms in cancer survivors but there are very few empirically supported treatments that can improve cognitive impairment. This feasibility study explored the impact of CBT-I on perceived cognitive impairment in breast cancer survivors. Methods We enrolled 10 early stage breast cancer survivors with insomnia disorder and perceived cognitive impairment. Participants received 7 individual sessions of CBT-I over the course of 8 weeks and completed the Insomnia Severity Index (ISI), the Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog) questionnaires and The Hospital Anxiety and Depression Scale (HADS) at baseline and post-treatment. Paired samples t-tests were used to assess change over time. Results The sample was predominantly diagnosed with stage II breast cancer (60%). Women were an average age of 50.8 (SD 6.84) and 18.2 (SD 3.62) years of education. CBT-I significantly reduced insomnia severity [19.4 to 7.1; t(9)= 6.56, p < .001] and improved perceived cognitive impairment [t(9)= -3.55, p < .01], perceived cognitive ability [t(9)= -2.87, p < .05], quality of life [t(9)= -3.14, p < .05], and overall subjective cognitive function [t(9)= -3.67, p < .01]. Although participants began treatment with low levels of mood disturbance, CBT-I further decreased symptoms of anxiety (baseline: M= 10.10, SD= 4.34; post-treatment M= 8.20, SD= 3.91) and depression (baseline: M= 7.90, SD= 3.45; post-treatment M= 5.30, SD= 2.83), although not statistically significant. Conclusion This study suggests CBT-I may improve perceived cognitive impairment in cancer survivors, in addition to insomnia and mood. Future randomized controlled trials with larger samples and objective measurements of cognition are needed. Support Nyissa Walsh is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute (BHCRI). Dr. Sheila Garland is supported by a Scotiabank New Investigator Award from BHCRI.

scholarly journals The impact of cognitive impairment on self‐regulatory styles in breast cancer survivors

2021 ◽  
Author(s):  
Jacqueline H. Becker ◽  
Charlotte Ezratty ◽  
Nusrat Jahan ◽  
Mita Goel ◽  
Yael Tobi Harris ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cognitive Impairment ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Regulatory Styles ◽  
The Impact

scholarly journals 3367 A Mouse Model of APOE Genotype in Chemotherapy Related Cognitive Impairment

2019 ◽  
Vol 3 (s1) ◽  
pp. 1-1
Author(s):  
Tamar Demby ◽  
G. William Rebeck ◽  
Christopher Albanese ◽  
Olga C. Rodriguez ◽  
Yichien Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factor ◽  
Cognitive Impairment ◽  
Cancer Survivors ◽  
Open Field ◽  
Breast Cancer Survivors ◽  
Apoe Genotype ◽  
Post Treatment ◽  
Barnes Maze ◽  
Doxorubicin Treatment

OBJECTIVES/SPECIFIC AIMS: Chemotherapy-related cognitive impairment (CRCI) affects 15-35% of breast cancer survivors and constitutes a significant challenge for survivor quality of life. Among older breast cancer survivors who received chemotherapy treatment, carriers of at least one ɛ4 allele of the APOE gene, which encodes apolipoprotein E, are at higher risk for developing CRCI than non-carriers. APOE4 is well characterized as the strongest genetic risk factor for Alzheimer’s disease, but how it contributes to CRCI is not yet understood, and no animal models of APOE genotype and CRCI have yet been established. To better understand how APOE4 acts as a risk factor for CRCI, we used APOE targeted replacement (TR) mice to develop a model of its effects on cognition following treatment with doxorubicin, a chemotherapy drug commonly used in breast cancer treatment. METHODS/STUDY POPULATION: Twelve-to-thirteen month old APOE3 and APOE4 targeted replacement mice expressing human APOE3 or human APOE4 under control of the endogenous murine promoter were treated with 10 mg/kg doxorubicin or equivolume saline given via two IP injections spaced one week apart. One week post-treatment, mice were tested using Open Field and Elevated Zero apparatuses to assess baseline locomotive activity and anxiety and exploratory behaviors. Five weeks post-treatment, mice were assessed using the Barnes Maze over four days of training trials and one 72 hour memory probe. RESULTS/ANTICIPATED RESULTS: We found no differences in Open Field and Elevated Zero behavior, indicating limited influence of doxorubicin treatment on locomotive and anxiety behaviors in both genotypes. During Barnes Maze training, APOE4 mice treated with doxorubicin showed increased latency compared to untreated APOE4 mice as well as treated and untreated APOE3 mice, indicating deficiencies in spatial learning. In APOE3 mice, no differences in performance were seen between doxorubicin-treated and untreated mice (n = 15-16/group, p <.0001). DISCUSSION/SIGNIFICANCE OF IMPACT: These results indicate that APOE4 targeted replacement mice have specific cognitive vulnerabilities to doxorubicin treatment that can be reliably detected using the Barnes Maze assessment. Future directions include experiments to determine how other chemotherapy drugs or drug combinations impact cognition of APOE4 mice. Ultimately this model may be used to assess preventive measures or therapies for CRCI in the vulnerable APOE4 carrier population with the ability to validate cognitive impacts of these interventions.

1031 Exploring the Impact of Cognitive Behavioral Therapy for Insomnia (CBT-I) on Daytime Productivity in Survivors of Breast Cancer

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A392-A392
Author(s):  
J Kieley ◽  
N Walsh ◽  
J McCarthy ◽  
E Powell ◽  
S N Garland
Keyword(s):  
Breast Cancer ◽  
Cancer Research ◽  
Cognitive Behavioral Therapy ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Behavioral Therapy ◽  
Work Productivity ◽  
Cognitive Behavioral ◽  
Activity Impairment ◽  
The Impact

Abstract Introduction Post-treatment insomnia disorder and fatigue symptoms can impair work and daytime productivity in breast cancer survivors. Cognitive Behavioral Therapy for Insomnia (CBT-I) significantly improves insomnia and daytime fatigue. This feasibility study examined whether improving insomnia and fatigue using CBT-I is associated with improved work and activity productivity in breast cancer survivors. Methods 10 survivors of early stage breast cancer participated in 7 weekly individual CBT-I sessions. The primary outcome was the Work Productivity and Activity Impairment Questionnaire-General Health (WPAIQ-GH) questionnaire. Secondary outcomes were the Insomnia Severity Index (ISI) and the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). Assessments were conducted at baseline and post-treatment. Paired samples t-tests examined the impact of CBT-I on productivity and fatigue. Linear regression assessed whether change in fatigue was associated with change in productivity. Results Participants had a mean age of 50.8 (range 42-63) and the majority were diagnosed with stage II (60%) cancer. There was a significant reduction in fatigue [t(9)= 2.43, p =.04] and activity impairment due to insomnia [t(9)= 3.105, p &lt;.05] following treatment. Insomnia affected 52% of work productivity at baseline with a non-significant decrease to 15% following treatment [t(3)= 2.25 p= .110]. Reductions in fatigue were significantly associated with reductions in activity impairment [F(1,8)= 7.25, p =.03], accounting for 47.5% of the variability. Conclusion Treating insomnia with CBT-I significantly improved daytime productivity, activity impairment, and fatigue. Controlled research with larger sample sizes is warranted to confirm these preliminary results. Support Nyissa Walsh is a trainee in the Cancer Research Training Program of the Beatrice Hunter Cancer Research Institute (BHCRI). Dr. Sheila Garland is supported by a Scotiabank New Investigator Award from BHCRI.

scholarly journals The Relationship Between Insomnia and Cognitive Impairment in Breast Cancer Survivors

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Kevin T Liou ◽  
Tim A Ahles ◽  
Sheila N Garland ◽  
Q Susan Li ◽  
Ting Bao ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cognitive Impairment ◽  
Cancer Survivors ◽  
Aromatase Inhibitor ◽  
Breast Cancer Survivors ◽  
Postmenopausal Breast Cancer ◽  
Inhibitor Therapy ◽  
Cancer Center ◽  
Aromatase Inhibitor Therapy ◽  
Insomnia Severity

Abstract Background Cancer-related cognitive impairment is an emerging public health burden. Growing research suggests that sleep disturbances contribute to poor cognition. Our study aimed to evaluate the association between insomnia and cognitive impairment in breast cancer survivors. Methods We analyzed cross-sectional data from a cohort study of postmenopausal women with stage 0–III hormone receptor-positive breast cancer on aromatase inhibitor therapy. The study was conducted between November 2011 and April 2015 at an academic cancer center (Philadelphia, PA). Insomnia was assessed with the Insomnia Severity Index. Perceived cognitive impairment was assessed with the cognitive subscale of the Breast Cancer Prevention Trial Symptom Checklist. We used linear regression to evaluate the association between insomnia and perceived cognitive impairment. Results Among 1072 patients, 556 (51.9%) reported insomnia and 847 (79.0%) were bothered by cognitive symptoms (forgetfulness, difficulty concentrating, distractibility). Greater perceived cognitive impairment was reported by patients with mild insomnia (regression coefficient [β] = 0.35, 95% confidence interval [CI] = 0.23 to 0.46, P &lt; .001), moderate insomnia (β = 0.51, 95% CI = 0.36 to 0.65, P &lt; .001), and severe insomnia (β = 0.94, 95% CI = 0.67 to 1.21, P &lt; .001), compared with those without insomnia. Greater perceived cognitive impairment was also associated with patients younger than 55 years (β = 0.30, 95% CI = 0.15 to 0.45, P &lt; .001), taxane-based chemotherapy (β = 0.11, 95% CI = 0.004 to 0.22, P = .04), anxiety (β = 0.47, 95% CI = 0.30 to 0.64, P &lt; .001), and depression (β = 0.65, 95% CI = 0.35 to 0.94, P &lt; .001). Conclusions Among postmenopausal breast cancer survivors receiving aromatase inhibitor therapy, insomnia and cognitive impairment are prevalent and characterized by a graded association, in which severity of perceived cognitive impairment increases as insomnia severity increases. Our findings warrant further research to determine whether addressing sleep is a strategy to improve management of cancer-related cognitive impairment.

scholarly journals Older Breast Cancer Survivors’ Cognitive Response to Qigong/Tai Chi Easy: An Exploratory Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 691-692
Author(s):  
Dara James ◽  
Linda Larkey ◽  
SeungYong Han
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Tai Chi ◽  
Treatment Compliance ◽  
Exploratory Analysis

Abstract Increasing rates of breast cancer coupled with improvements in treatment means the number of breast cancer survivors (BCSs) is growing. BCSs frequently report persistent cognitive deficits (i.e., “cancer-related cognitive impairment”) that impacts QOL and treatment compliance. Older (≥65 years old) BCSs are more likely to experience cognitive decline and impairment, partly due to the biological process of senescence. In the context of a larger RCT of BCSs (ages 45-75; stages 0-III), we evaluated cognitive function/performance effects on among the older participants (ages 65-75) of 8-weeks Qigong/Tai Chi Easy (QG/TCE) compared to education control (EdC). Cognitive function was measured using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-COG), including: perceived cognitive impairment (PCI), and perceptions of effects of cognitive function on quality of life (PCQOL). Cognitive performance was measured using the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III): Digit Span (DS) and Letter-Number Sequencing (LNS). A multilevel model with random intercept was used to examine GroupXTime interactions: The majority of participants (N= 32) (M age= 69.7) were white (84%). Changes in WAIS-III DS, LNS and FACT-COG PCI were not statistically significant, but effect sizes were small to medium. The interaction between group and time was significant for FACT-COG PCQOL (p= 0.033) with a medium effect size, 0.14. Findings from this exploratory analysis of the larger study suggests that older BCSs’ participation in QG/TCE may improve perceptions of effects of cognitive function on quality of life. Such improvements may increase cognitive-related self-efficacy, overall QOL and treatment compliance among older BCSs.

scholarly journals Cross-Sectional Characterization of Local Brain Network Connectivity Pre and Post Breast Cancer Treatment and Distinct Association With Subjective Cognitive and Psychological Function

2021 ◽  
Vol 12 ◽  
Author(s):  
Shelli R. Kesler ◽  
Tien Tang ◽  
Ashley M. Henneghan ◽  
Michelle Wright ◽  
M. Waleed Gaber ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Psychological Distress ◽  
Cognitive Function ◽  
Treatment Group ◽  
Breast Cancer Survivors ◽  
Brain Network ◽  
Post Treatment ◽  
Newly Diagnosed ◽  
Subjective Cognitive Function ◽  
Local Brain

Objective: We aimed to characterize local brain network connectivity in long-term breast cancer survivors compared to newly diagnosed patients.Methods: Functional magnetic resonance imaging (fMRI) and subjective cognitive and psychological function data were obtained from a group of 76 newly diagnosed, pre-treatment female patients with breast cancer (mean age 57 ± 7 years) and a separate group of 80, post-treatment, female breast cancer survivors (mean age 58 ± 8; mean time since treatment 44 ± 43 months). The network-based statistic (NBS) was used to compare connectivity of local brain edges between groups. Hubs were defined as nodes with connectivity indices one standard deviation or more above network mean and were further classified as provincial (higher intra-subnetwork connectivity) or connector (higher inter-subnetwork connectivity) using the participation coefficient. We determined the hub status of nodes encompassing significantly different edges and correlated the centralities of edges with behavioral measures.Results: The post-treatment group demonstrated significantly lower subjective cognitive function (W = 3,856, p = 0.004) but there were no group differences in psychological distress (W = 2,866, p = 0.627). NBS indicated significantly altered connectivity (p &lt; 0.042, corrected) in the post-treatment group compared to the pre-treatment group largely in temporal, frontal-temporal and temporal-parietal areas. The majority of the regions projecting these connections (78%) met criteria for hub status and significantly less of these hubs were connectors in the post-treatment group (z = 1.85, p = 0.031). Subjective cognitive function and psychological distress were correlated with largely non-overlapping edges in the post-treatment group (p &lt; 0.05).Conclusion: Widespread functional network alterations are evident in long-term survivors of breast cancer compared to newly diagnosed patients. We also demonstrated that there are both overlapping and unique brain network signatures for subjective cognitive function vs. psychological distress.

scholarly journals Randomized Exercise Trial of Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors

2015 ◽  
Vol 33 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
Melinda L. Irwin ◽  
Brenda Cartmel ◽  
Cary P. Gross ◽  
Elizabeth Ercolano ◽  
Fangyong Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Strength Training ◽  
Aerobic Exercise ◽  
Usual Care ◽  
Repeated Measures ◽  
Joint Pain ◽  
Breast Cancer Survivors ◽  
Pain Scores ◽  
The Impact

Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

Sign in / Sign up

Export Citation Format

Share Document