Emerging from the HazeTM: A Multidisciplinary, Psycho-Educational, Cognitive Rehabilitation Program Under Investigation

Emerging from the HazeTM, a cognitive rehabilitation program, is a combination of didactic and experiential content focused on brain health to provide participants with a toolbox of strategies to help them cope with cancer treatment-related cognitive impairment.

Do you frequently encounter patients who report issues with short-term memory, concentration, word finding, and the ability to multitask? This phenomenon, known as cancer-/cancer treatment-related cognitive impairment (CRCI) is commonly reported by patients during and after chemotherapy as well as throughout other types of cancer therapy programs.1

Emerging from the HazeTM, a cognitive rehabilitation program, was developed by Dr. Arash Asher and colleagues at Cedars-Sinai Medical Center in an effort to address this issue. Since it’s development, it has remained a centerpiece of their survivorship program for many years. The program is a combination of didactic and experiential content focused on brain health to provide participants with a toolbox of strategies to mitigate, or cope with, CRCI. Ten weekly sessions are conducted in virtual groups via videoconferencing. Previous pilot work has demonstrated that the program is associated with positive results for improving self-reported perceived cognitive function.2-4

Thanks to an RE03 research grant from the Oncology Nursing Foundation, we are conducting an on-going, expanded pilot study to assess how this program may be delivered in a virtual format. Two groups will undergo the program via 2 separate telehealth virtual delivery formats while a third, wait-listed group will serve as a control arm. The study’s primary endpoint is to demonstrate feasibility for the 3-arm study design. The secondary endpoint will be to assess differences in perceived cognitive function between the 3 groups: 1 of which will experience the program via “real-time” group presentations, the second of which will view “pre-recorded” group presentations, while the third group will serve as wait-list control.

We currently are enrolling adults with stage I to III solid tumors, Hodgkin, or non-Hodgkin Lymphoma who are within 6 months to 5 years of completing their chemotherapy. Eligible individuals are patients who have reported issues with cognitive function. In addition, eligible individuals are permitted to continue receiving endocrine, anti-HER-2, or other stable maintenance therapies (such as anti-CD20 antibody therapy). However, individuals with history of neurological conditions involving impaired cognitive function (such as Alzheimer’s disease and related dementias) will be excluded.

Following informed consent, participants will be randomized to 1 of the 3 study groups. All participants will complete electronic study questionnaires at baseline, week 10, and week 16. Those randomized to the intervention group will attend 10 weekly sessions via videoconference. The questionnaires have been designed to evaluate self-reported cognitive function levels, loneliness, determinants of behavior change, global, physical, and mental health, and satisfaction with the intervention.

Following the final study questionnaire, participants in the wait-list control group may choose whether to attend the “real-time” or “pre-recorded” program. Study tablets will be provided to individuals who do not have access to a device and/or data plan in an effort to be as inclusive as possible for under-resourced populations. Lastly, participants will receive a small monetary payment to thank them for their time and effort.

Ninety participants will be enrolled (30 in each group). Individuals may participate from any location. All study procedures will be conducted virtually. At the time of this writing, 22 individuals have been enrolled in the first cohort of the study and we are actively recruiting for the second cohort. If you are interested in learning more about this study, or would like to refer eligible, interested individuals who may wish to participate, please contact Dr. Jamie Myers, jmyers@kumc.edu . Effective, evidence-based, disseminatable interventions for CRCI are desperately needed. Results from this pilot will be used to inform a large, multi-site, confirmatory study targeted to be conducted within the SWOG Cancer Research Network.

Acknowledgements: Funding for this grant is provided through Oncology Nursing Foundation Endowment Dollars and in part, through a generous contribution made to the Foundation from Genentech, A Member of the Roche Group.

References

1. Asher A, Myers JS. The effect of cancer treatment on cognitive function. Clinical Advances in Hematology and Oncology. 2015;13(7):441-450.

2. Asher A, Van Dyk K, Jo MY, Bailey C, Myers JS. Retrospective analyses of a multi-dimensional, psycho-education-based cognitive rehabilitation intervention for cancer-related cognitive impairment. Clin J Oncol Nurs. 2019;(accepted for publication, 1.13.19).

3. Myers JS, Cook-Wiens G, Baynes R, et al. Emerging from the Haze: A multi-center, controlled pilot study of a multi-dimensional, psycho-education-based cognitive rehabilitation intervention for breast cancer survivors delivered with telehealth conferencing. Arch Phys Med Rehabil. 2020.

4. Myers JS, Shirazipour CH, Wertheimer JC, Asher A. Feasibility Pilot Study of a Virtual Intervention for Survivors With Decreased Perceived Cognitive Function After Cancer Treatment. Oncol Nurs Forum. 2022;49(1):90-95.