Cancer Related Cognitive Changes (CRCC) can significantly affect a person’s ability to participate in meaningful activity and impact their quality of life. As a consequence people with CRCC often report increased anxiety that can impact engagement in social and family roles, including employment. Memory and attention problems that can follow chemotherapy and other cancer treatments are increasingly being reported as cancer survivorship and late effects of treatment emerge.
Occupational Therapists play a key role in assessing and treating CRCC through the comprehensive, holistic assessment of patients, optimising rehab potential and providing specialist interventions through realistic goal setting to encourage independence and enhance quality of life.
There are multiple factors that will influence the extent of cognitive rehab offered to people experiencing CRCC – often within an acute ward environment there are many environmental factors influencing cognition and other medical factors such as infection markers and disease process. An important aspect of completing cognitive rehabilitation with people experiencing CRCC is to firstly rule out medical reasons for cognitive changes i.e. brain mets or any other organic changes that would be highlighted through CT/MRI scanning. I have also found the rehab potential for CRCC varies depending on cancer type/stage/ treatment plan. Cognitive rehab approaches that work well with patients who have completed their treatment may need to be altered for patients still undergoing treatment.
Other contributing factors to CRCC include fatigue, low mood, stress, anxiety. Addressing these factors is often what is important in then identifying triggers for CRCC. Evidence shows that within CRCC these tend to be mild changes, not progressive, therefore compensatory techniques can be taught to cope with these changes (Ferguson et al, 2016).
My experience with CRCC has been further enhanced through taking part in the steering group for a Transforming Care After Treatment (TCAT) project run by Clinical Psychologist Natalie Rooney. The aim of the project was to determine how to best provide input for cancer patients experiencing CRCC; a group format was piloted and rolled out over the funded 3 year period. The evaluation report and resources can be found using the link at the end of this blog.
It has been interesting working alongside clinical psychology within this patient group and seeing the similarities of our approaches. I’ve found a Cognitive Behavioural Therapy approach works well to facilitate meaningful goal setting. As an Occupational Therapist, being dual-trained we are able to assess cognition, at times using standardised assessments alongside assessment of function. My experience with in-patients has involved use of standardised assessments such as Addenbrooke’s Cognitive Examination-III, assessment of function and cognitive rehab approaches including facilitation of memory strategies. I have found that people often feel reassured when the condition is explained clearly and normalising some of the symptoms often helps someone’s mood/anxiety levels which in turn can improve cognition. Often highlighting that not all memory/attention difficulties will be avoidable for anyone, whether they have a cancer diagnosis or not.
The aim of cognitive rehab for cancer related cognitive changes is to develop compensatory strategies to cope with the “controllable factors” that can affect memory e.g. stress/attention deficit to improve symptoms of memory difficulties impacting daily life.
Cognitive changes are often multi-factorial – as described previously factors affecting cognition include fatigue, low mood, stress and anxiety which impact executive function therefore it is important to review the person experiencing CRCC holistically. Realistic goal setting and identifying the person’s concerns and what matters to them is essential – this then allows for any triggers/external stressors that aren’t related to cognitive changes to be addressed. Involving the carer/relative/friend who knows the person best is also helpful and occupational therapists play a key role in advising them on how they can best support the person experiencing CRCC.
The information leaflet produced via the TCAT project and the video clips developed are a useful signposting resource for healthcare professionals working with people experiencing CRCC. The results of the pilot study evidence that there is a need for CRCC to be addressed and a group format can be a sustainable way of providing this intervention. In working with third sector agencies it is hoped that a similar format could be used in supporting people with CRCC.
Further information and resources can be found here:
CRCC TCAT project video: https://www.youtube.com/watch?v=StaGjnvj0ig
Self-management leaflet: https://www.woscan.scot.nhs.uk/wp-content/uploads/CRCC-Info-Leaflet.pdf
Self-management videos: https://www.youtube.com/playlist?list=PLmuRxztsS0NwaXZ132kWemjESZ9pq25v4
Ferguson, R.J., Sigmon, S.T., Pritchard, A.J., Labrie S.L., Goetze, R.E., Fink, C.M., Garrett, A., 2016. A Randomized Trial of Videoconference-Delivered Cognitive Behavioural Therapy for Survivors of Breast Cancer with Self-Reported Cognitive Dysfunction. Cancer. June, vol 122, no. 11, pp.1782-91.
By Jennifer Cameron, Specialist Occupational Therapist
Jennifer works within the Beatson West of Scotland Cancer Centre where she has focused on acute oncology for the past 8 years. She also has experience of working within the neuro-cognitive assessment clinic in HIV and infectious diseases.