BrainHQ

Each year in the United States, approximately 242,476 women are diagnosed with breast cancer, the most common cancer among women. Mortality rates are decreasing significantly, and there are more survivors. Many cancer survivors have numerous challenges including those that are physical, psychological, social, and spiritual that may negatively impact quality of life. Some cancer survivors report having problems with cognition (thinking, memory, learning, concentration, and attention) that can affect them during and after treatment. Interventions are needed to help breast cancer survivors improve their cognition and overall quality of life.

BrainHQ is an intervention designed to improve cognitive functioning and quality of life among breast cancer survivors who report having cognitive deficits. The intervention consists of speed of processing training that aims to improve both speed of processing (the speed the brain can process information or notice and react to stimuli) and memory. The program is delivered online through ten 1-hour training sessions that occur over a 6- to 8-week period. A cognitive training coach helps participants gain access to the program website, provides assistance, and monitors participants' progress and performance.

Participants access the program website and engage in various training exercises that employ and measure the participant's information-processing ability. Each exercise includes a series of tasks (e.g., time-order judgment, discrimination, spatial-match, forward-span, instruction following, narrative memory) that become progressively more difficult by systematically reducing the stimulus duration on the screen. The exercises automatically adjust to user performance to maintain an 85% correct rate.

-- Approximately 1.5 hours for implementers to become familiar with the BrainHQ program delivery materials
-- Approximately 15 minutes per participant for implementers to help participants gain access to the program website, provide assistance, and monitor participants' progress and performance
 

BrainHQ targets cancer survivors aged 18 and older who report having cognitive deficits.

This intervention is intended to be implemented in clinical and home settings.
 

Required resources to implement the program include the following:
--BrainHQ website

For costs associated with this program, please contact the developer, Cate Stasio. (See products page on the EBCCP Website for developer contact information.)

A randomized controlled trial compared the intervention (speed of processing training) and a comparison condition (memory training) with a wait-list control condition among female breast cancer survivors who reported having concerns about their cognitive functioning (e.g., poor memory, mental slowness). Other eligibility criteria included reporting that cognitive concerns negatively impacted self-esteem and/or interfered with daily life; reporting being interested in and seeking treatment to address cognitive concerns; and being post-menopausal, 40 years of age or older, at least 1-year post-treatment (which included chemotherapy for primary non-metastatic breast cancer), disease free, and able to understand, speak, read, and write English. Participants were excluded if they had substantial cognitive impairment; history of stroke, encephalitis, traumatic brain injury, brain surgery, dementia, Alzheimer's disease, or Parkinson's disease; history of cranial radiation therapy or intrathecal therapy; current active major depression or substance abuse; history of bipolar disorder, psychosis, schizophrenia, or learning disability; history of or current other cancer except for basal cell skin cancer; history of other cognitive training; or uncorrected vision problems (worse than 20/70).

Participants were randomized to the speed of processing training group (n=30), the memory training group (n=29), or the wait-list control group (n=29). Each intervention consisted of ten 1-hour training sessions done in small groups of three to five breast cancer survivors over 6 to 8 weeks and delivered by separate trained and certified interventionists. Memory training sessions involved teaching participants strategies for remembering word lists, sequences, and text material by learning how to apply principles of meaningfulness, organization, visualization, and association. Wait-list control participants received neither intervention during the study but subsequently received instructions on how to complete the BrainHQ program.

Participants had an average age of 56.5 years, 89% were Caucasian, and 62% were married. Most (89%) had stage II or lower breast cancer, they had an average of 5.5 years since treatment, all had received surgery and chemotherapy, 74% had received radiation therapy, and 46% were receiving adjuvant endocrine therapy. At baseline, all participants were similar in age, race, education, cancer severity, cancer treatment, current mental health symptoms, fatigue, and cognitive abilities (immediate and delayed memory and processing speed).

The main outcomes: immediate memory, delayed memory, and speed of processing were assessed at baseline, post-intervention (immediately after the end of the intervention), and 2-month follow-up. Immediate memory and delayed memory were measured by composite scores from equally weighted average scores from the Rey Auditory Verbal Learning Test (AVLT), a 15-item list learning task. Delayed memory was calculated from the long-term delay score from the Rey AVLT and long-term delay score from the Rivermead Behavioral Paragraph Recall Test. Speed of processing was measured with the Useful Field of View (UFOV), a computer-administered and -scored test of visual attention. During the test, participants identify and localize information, with 75% accuracy, under varying levels of cognitive demand. The results from three subtests measuring divided attention and two levels of selective attention were used to determine a composite score for speed of processing. For all three main outcomes, researchers calculated the percentage of participants that had reliable improvement, defined as a magnitude of improvement greater than 1 standard error of measurement.

Secondary outcomes were perceived cognitive functioning, symptom distress, and quality of life. Perceived cognitive functioning was measured with the 48-item Functional Assessment of Cancer Therapy-Cognitive (FACT-Cog) and 18-item Squire Subjective Memory Questionnaire (SSMQ). Symptom distress was measured with the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), the 20-item Spielberger State-Trait Anxiety Inventory-State Subscale (STAI-S), and the 13-item Functional Assessment of Cancer Therapy-Fatigue (FACT-F). Quality of life was assessed with the 41-item Quality of Life-Cancer Survivors (QO-CS), the 66-item Quality of Life Index: Cancer Version, and the 36-item Short-Form Health Survey (SF-36).

• The percentage of participants demonstrating reliable improvement in immediate memory was greater in the speed of processing training group than the control group at post-test (p=.007) and 2-month follow-up (p=.004). The percentage of participants demonstrating reliable improvement in immediate memory was greater in the memory training group than the control group at 2-month follow-up (p=.036).

• Compared with the control group, both the speed of processing training group (p=.010) and memory training group (p=.013) had a greater percentage of participants demonstrate reliable improvement in delayed memory at 2-month follow-up.

• The percentage of participants demonstrating reliable improvement in speed of processing was greater in the speed of processing training group than the control group at post-test (p=.040) and 2-month follow-up (p=.016).

Additional Findings

• Compared with control group participants, speed of processing training group participants had higher perceived cognitive functioning on the FACT-Cog at post-test (p=.042); better mental health outcomes on the SF-36 (Mental) at post-test (p=.010) and 2-month follow-up (p=.031), lower symptom distress on the CES-D at post-test (p=.031) and 2-month follow-up (p=.002), lower symptom distress on the FACT-F at post-test (p=.008) and 2-month follow-up (p=.005), and lower symptom distress on the STAI-S at 2-month follow-up (p=.006).
• Compared with control group participants, memory training group participants had higher perceived cognitive functioning on the FACT-Cog at post-test (p=.036) and 2-month follow-up (p=.021), higher perceived cognitive functioning on the SSMQ at post-test (p=.012) and 2-month follow-up (p=.003), and lower symptom distress on the STAI-S at 2-month follow-up (p=.017).