Associate Professor, Faculty of Medicine
Principal Research Fellow, Medicine
Concord Clinical School
University of Sydney
Many women who receive chemotherapy complain of memory and concentration problems. There are no proven treatments thus far to address these concerns. Cognitive impairment is recognized by breast cancer survivors as an important side-effect of treatment that impairs function and quality of life, and for which there is no known treatment. Cognitive rehabilitation programs have the potential to treat underlying impairment and/or teach survivors strategies to cope with cognitive symptoms. It is important to compare both programs to determine which, if either is more beneficial than watchful waiting.
Cognitive rehabilitation interventions have been shown to improve cognition in non-cancer populations. Dr. Vardy’s BCRF-funded study will evaluate two different cognitive rehabilitation programs to determine whether they can decrease cognitive impairment in women who self report impairment after receiving adjuvant chemotherapy for breast cancer.
Dr. Vardy will undertake a three-arm randomized controlled trial comparing two cognitive rehabilitation programs to a standard care control group in breast cancer survivors with perceived cognitive impairment after adjuvant chemotherapy. Her team will evaluate a structured neurocognitive learning program (Attention Process Training) aimed at improving cognitive deficit. They will also conduct Compensatory Strategy Training, which involves systematic teaching of strategies to help women cope with cognitive impairment. Both interventions involve small group sessions with a trained therapist and have shown benefits in non-cancer populations. Study participants will be women with breast cancer who self-report cognitive impairment six to sixty months after adjuvant chemotherapy.
Dr. Vardy’s team hopes that women who undergo a cognitive rehabilitation program will experience fewer self-reported cognitive symptoms, increased neuropsychological performance, overall better quality of life and less fatigue, anxiety and depression, and improvement in cognitive function sustained at six months post intervention.
The project, which will evaluate two different cognitive rehabilitation programs, is set up with all materials and plans in place to run the first round of cognitive rehabilitation courses in February 2014 with the intention to run courses continuously throughout 2014 until recruitment is completed. IRB approval has been obtained. Patients are recruited from the Survivorship Clinic, breast cancer follow-up clinics at participating hospitals and via self-referral in response to advertising in breast cancer specific newsletters and websites. Dr. Vardy’s team has established a free-call service for patients in this study. As of late 2013, they have 20 patients waitlisted for randomization into the study who will commence the first course in February 2014. Further, clinicians at approved sites will write to their breast cancer survivors in follow-up, inviting them to participate in the study, and Register4, an Australian register of women treated for breast cancer who are willing to be contacted about research, agreed to advertise the study through their electronic register.
Janette Vardy, MD, FRACP, PhD is a staff medical oncologist working as a clinician researcher at the Sydney Cancer Centre, and is a senior lecturer at the University of Sydney, Australia. She graduated medicine with honors from the University of Newcastle, Australia. She received the Margaret Dunn Resident of the Year award in 1999 and completed internal medicine and specialty training in Medical Oncology, obtaining a Fellowship from the Royal Australasian College of Physicians in 2002. From 2003-2006 she completed a Clinical Research Fellowship at the Princess Margaret Hospital in Toronto and a PhD in Clinical Epidemiology at the University of Toronto under the supervision of Dr Ian Tannock.
Upon returning to Australia in 2007 she received a Cancer Institute New South Wales fellowship which has enabled her to establish a research program in cancer survivorship at the Sydney Cancer Centre. Her primary area of research is in cognitive function and fatigue in cancer survivors. For this work she has received two Young Investigator Awards (ASCO, MASCC), a PhD scholarship and an ASCO Career Development Award.
More recently she has commenced work on establishing trials investigating the benefits of exercise in cancer patients. She is co-chair of the International Cognition and Cancer Task Force, and chair of the Scientific Advisory Committee for the Psycho-Oncology Co-operative Group, Australia.