Feasibility and Acceptability of a Computerized Working Memory Training in Breast Cancer Survivors

Abstract

Abstract Feasibility and Acceptability of Computerized Working Memory Training in Breast Cancer Survivors Purpose: To evaluate the feasibility and acceptability of an in-home, computerized, working memory training program for breast cancer survivors. Design: A randomized wait-list control trial. Setting: Breast oncology clinic at a comprehensive cancer center. Sample: Female breast cancer survivors (n=15), aged 43-64, who self-reported persistent cognitive deficits and were 18 months to five years post primary oncologic treatment(s). Methods: Eligible participants completed baseline measures and then were randomized to a wait list control (n=7) or immediate intervention group (n=8). The intervention was a computerized working memory training protocol for six weeks (5 days a week and up to 35 minutes a day) and included a weekly coach phone call to review training progress. Baseline (T1) and post measures (T2) included five PROMIS® short form measures (depression, anxiety, fatigue, applied cognition general concerns, and applied cognition executive function), Functional Assessment of Cancer Therapy Cognition Version 3 measure, and seven neuropsychological tests (Rey Auditory Verbal Learning Test; Wechsler Adult Intelligence Scale IV Symbol Search and Coding and Letter Number Sequencing; Trails A and Trails B tests; and Delis-Kaplan Executive Function Color Block test). Wait list control participants were offered the working memory computerized training program after completing T2 measures. An acceptability survey was completed by all participants who participated in the training program. Main Research Variables: Feasibility measures: recruitment, attrition, number of weekly coach phone calls achieved, and reasons individuals declined to participate in the study. Acceptability measures: adherence to the training schedule (five days a week, for six weeks), number of participants who completed >24 training blocks in six weeks, participant satisfaction, ease of use, comprehensibility of training directions, and recommendation to other breast cancer survivors experiencing cognitive deficits. Trends in difference scores (posttest scores adjusted by baseline scores) were analyzed for neuropsychological tests, PROMIS® short form measures, FACT-Cog measure, and working memory training index score. Findings: Twenty-seven eligible survivors were referred to the study,15 were enrolled (56% recruitment rate), and two wait list control participants (87% retention rate) withdrew at T2. Thirteen participants completed T1 measures, T2 measures, and computerized working memory training (at least 24/30 training sessions). All weekly coach calls were achieved. The acceptability measures were rated positively with high values. The difference scores were analyzed using the Mann- Whitney U test. Statistically significant results included two PROMIS® measures: applied cognition general concerns U (nII= 8, nWLC=5) =5.0, Z = -2.196, pexact=.030; applied cognition executive function U (nII= 8, nWLC=5) = 4.0, Z = -2.34, pexact=.019; and three FACT Cog subscales: Perceived Cognitive Impairments U (nII =8, nWLC= 5) = 5.0, Z = - 2.02, pexact= .030, Impact of Perceived Cognitive Impairments on Quality of Life U(nII = 8, nWLC=5)) = 4.5, Z = -2.291 , pexact= .022, and Perceived Cognitive Abilities U(nII = 8, nWLC = 5) = 3.5 , Z = -2.422 , pexact= .011. The results demonstrate that the immediate intervention group reported a greater decrease in cognitive impairment symptoms compared to the wait list control group for these measures. Conclusions: The in-home computerized working memory intervention was feasible, acceptable, and safe. There was a trend in some of the difference scores demonstrating improvements in cognitive performance for the immediate intervention group after the working memory training. Implications: This study aimed to address the gap in evidence-based treatments available for breast cancer survivors who report persistent cognitive deficits. This research extended a working memory intervention with demonstrated efficacy in other populations to breast cancer survivors and tested a scalable, practical, intervention. The findings support the need for a larger randomized control study to evaluate efficacy of this intervention.