Group cognitive rehabilitation via telehealth for brain cancer

This study will investigate the impact of the LaTCH (La Trobe – Caulfield Hospital) memory program on the wellbeing of adult brain cancer survivors through a randomised control trial, hybrid implementation, design. This method allows for the primary aim of determining the effectiveness of the LaTCH intervention, with a concurrent secondary aim of gathering information to better understand the context for future implementation of the intervention. Intervention - The LaTCH Program The LaTCH program provides psychoeducation, practical advice, and strategies for coping with the memory and thinking difficulties encountered in everyday life following cancer diagnosis and treatment. The program incorporates didactic presentations, interactive group activities (e.g. brainstorming), and short video presentations (e.g. vignettes of memory difficulties and memory strategies). It consists of 6 x 2-hour, weekly interactive group sessions covering the following topics: Session 1 Describing common memory problems and frustrations. Memory stores (working memory, recently acquired memories and remote memories) are described and participants give examples of some aspects of memory. Prospective memory and forgetting are explained. Memory processes (registration, retention, retrieval) are described and ideas about enhancing these are discussed with input from the group. Ways of dealing with memory problems are described. Session 2 Cognition and cancer - Description of the causes of normal memory/ cognitive lapses due to cancer; cancer treatment; and associated factors, and older age (if relevant to group). Explanation of the cumulative effect of these causes. Active learning techniques, incorporating explanation, illustration, and demonstration. Session 3 Remembering Tasks - discuss different types of Prospective Memory tasks and the different solutions that are suitable for each. Using external memory aids. Session 4 Review of content covered so far. Responding to memory difficulties in conversation. Active learning techniques, incorporating explanation, illustration, and demonstration. Approaches to learning to use new technology. Session 5 Remembering non-verbal information. Losing belongings. Concentration, organisation, and routines. Unwinding and staying calm. Navigating to new places. Session 6 Keeping Your Brain Healthy - factors shown to affect cognitive function; diet, exercise, health checks, depression/anxiety, sleep. Review personal memory goals. Booster Revision of keys points from each session. Review personal memory goals. LaTCH has been shown to improve cognitive strategy knowledge/use, well-being and self-reported memory ability in samples of healthy ageing Australians (ACTRN12620000979954), in those with mild cognitive impairment (trial not registered), and in cancer survivors (trial not registered). However, it has not yet been used exclusively with survivors of brain cancer. A recent pilot trial of this face-to-face group for cancer survivors (N=10; 60% brain cancer) at Olivia Newton John centre, Austin Health (HREC/46115/2018), provided preliminary evidence of efficacy, with large effect sizes found in relation to pre-post changes in goals, perceived cognition, memory strategy use, memory contentment, and emotional well-being. Recruitment of a sufficient number of brain cancer patients from a single site was challenging, and a telehealth model will enable nationwide recruitment and reduce access barriers, especially in the context of the current pandemic. Of note, the LaTCH program has recently been successfully adapted for telehealth delivery in patients with mild cognitive impairment (MCI) (Mullaly & Rand, 2021). The LaTCH program intervention will be conducted online via zoom with between 10-12 groups of participants (approximately 4-5 participants per group, totalling 50 participants overall). The intervention sessions for each group will occur over a 6-week period and may run concurrently or consecutively, depending on facilitator schedules and participant recruitment rates. A reminder email will be sent to each participant several days in advance of each session. Participant attendance at each session will be recorded by the facilitator. If a participant does not attend a session, they will be contacted by email by the researchers to enquire if they wish to remain in the program or withdraw. If a participant elects to withdraw, they will asked to complete a brief online ‘Withdrawal of Consent’ form, nominating their reason for withdrawing. Block randomisation of participant groups will occur once 8-10 participants have been recruited. Wherein 4-5 participants will be randomly allocated to either the intervention or waitlist. One to two weeks prior to participation, a member of the research team will make contact with each participant in a given group to administer the pre-assessment (baseline) measures. The intervention groups will meet weekly via zoom for six weeks to participate in the 2-hour sessions of LaTCH. The LaTCH facilitators will be either trained members of the research team or, to enhance future implementation likelihood, relevant health professionals will be trained as facilitators (i.e., interested brain cancer coordinators). At the end of the first LaTCH session, participants will generate personal functional memory goals with the assistance of the LaTCH facilitator. This was evidenced in the 2019 LaTCH pilot to be the most effective timepoint for goal generation because participants have acquired an understanding of the content and focus of LaTCH. Following the conclusion of the six sessions, the outcome measures will be re-administered to both the waitlist and intervention groups (utilising the same format as the pre-intervention). Intervention-group participants will return six weeks after the completion of the LaTCH program for a 90-minute booster session. Following the conclusion of the booster session, the outcome measures will be re-administered to both the waitlist and intervention groups (utilising the same format as the pre-intervention). Participants in the intervention group will also complete the post-intervention semi-structured interview with a member of the research team. Inclusion of this third outcome measures testing point allows for both the assessment of the longitudinal maintenance of LaTCH and any further implementation information that participants could provide following utilisation of LaTCH in their everyday lives. This also provides the ability for the research team to monitor participants’ change in cognition over time. The waitlist groups will be offered the intervention after their respective intervention group have completed the intervention (6-week LaTCH program and 6-week post-booster session). Inclusion of 4-5 paired intervention/waitlist control groups will allow us to determine if the LaTCH program contributes to any improvements in subjective cognitive ability and well-being.