Focus Forward: Outcomes of a Brief Occupational Therapy Intervention for Cancer-Related Cognitive Dysfunction

PURPOSE: After completing their treatment for cancer, many survivors experience cognitive dysfunction that interferes with their performance of valued roles and activities (Player, Mackenzie, Willis, & Loh, 2014). Many individuals are referred to occupational therapy. However, there is limited evidence to specify best practices in intervention (Asher, 2011). A team of occupational therapists and researchers used stakeholder input and a logic model to translate a clinical intervention into a manualized, four-session study intervention called Focus Forward. The purpose of this study was to evaluate the feasibility, user acceptance, and preliminary impact of Focus Forward.

DESIGN AND METHOD: This observational study used a prospective, one-group pretest–posttest design. Twenty-eight women with breast cancer who reported cancer-related cognitive dysfunction (CRCD) 3–18 mo after completing chemotherapy participated in the study intervention. Focus Forward is a manualized CRCD intervention that standardized a currently practiced and deemed efficacious intervention by experienced occupational therapists.

Focus Forward included four 60- to 90-min one-to-one weekly sessions with client-centered discourse in which cancer survivors learned to develop and implement cognition management strategies, with the hypothesized result that as participants learned to manage the factors associated with cognitive performance, they would achieve greater success with everyday tasks and roles. Based on results of the Canadian Occupational Performance Measure (Law et al., 2005), outcomes were measured in the following areas—self-reported occupational performance, self-efficacy, and neurocognitive performance—and in factors related to cognitive performance such as depression, anxiety, fatigue, and stress.

RESULTS: Participants made statistically significant pre–post improvements in self-reported occupational performance, self-efficacy, and factors influencing cognitive functioning, while there were no changes in most neurocognitive metrics. Participants reported that they were very satisfied with Focus Forward, reporting an overall satisfaction score of 9.4 out of 10.

CONCLUSION: This study demonstrated the feasibility of Focus Forward, high levels of user acceptance and satisfaction, and pre–post improvements in occupational performance. Manualized intervention proved to be usable for occupational therapists with varying levels of experience with this population. Study results support the value of an occupation-oriented approach to addressing CRCD and suggest the need for further study of this approach using a randomized controlled trial. CRCD is increasingly presumed to have multifactor causes: Focus Forward explicitly addressed the multifactorial nature of CRCD. While further study is needed, findings show a multifactorial, occupation-oriented approach holds promise in addressing cognitive needs of an ever-growing population of cancer survivors.

References

Asher, A. (2011). Cognitive dysfunction among cancer survivors. American Journal of Physical Medicine and Rehabilitation, 90, S16–S26. https://doi.org/10.1097/PHM.0b013e31820be463

Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2005). The Canadian Occupational Performance Measure (4th ed.). Ottawa: CAOT Publications.

Player, L., Mackenzie, L., Willis, K., & Loh, S. Y. (2014). Women’s experiences of cognitive changes or ‘chemobrain’ following treatment for breast cancer: A role for occupational therapy. Australian Occupational Therapy Journal, 61, 230–240. https://doi.org/10.1111/1440-1630