Abstract
Objectives
Adjuvant chemotherapy for breast cancer is undeniably effective in increasing survival rates but many breast cancer survivors (BCS) exhibit side effects including nausea, fatigue, stress, and neurocognitive deficits, known as “chemobrain.” This pilot study explored how neurotherapy, or EEG biofeedback, a non-pharmacological approach, improved neurocognitive, behavioral, and neurophysiological deficits associated with BCS who underwent chemotherapy.
Methods
Subjects underwent 18 sessions of EEG biofeedback training, in which audio and visual feedback occurred with successful shifting of EEG patterns.
Results
Quantitative EEG and assessment tests demonstrated neurophysiological, cognitive, and behavioral deficits in all nine subjects prior to training. EEG biofeedback resulted in significant improvements in neurophysiological, neurocognitive, and psychological functions in all nine subjects after training.
Conclusions
We propose that this intervention and related forms of EEG biofeedback have the potential to significantly alleviate common side effects of chemotherapy in BCS and therefore merits additional research attention.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: The authors have no conflicts of interest and no funding sources to report.
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Informed consent: Informed consent was obtained from all subjects.
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Compliance with ethical standards: All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
References
1. Ono, M, Ogilvie, JM, Wilson, JS, Green, HJ, Chambers, SK, Ownsworth, T, et al.. A meta-analysis of cognitive impairment and decline associated with adjuvant chemotherapy in women with breast cancer. Front Oncol 2015;5:59. https://doi.org/10.3389/fonc.2015.00059.Search in Google Scholar
2. Argyriou, AA, Assimakopoulos, K, Iconomou, G, Giannakopoulou, F, Kalofonos, HP. Either called “chemobrain” or “chemofog” the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manag 2011;41:126–39. https://doi.org/10.1016/j.jpainsymman.2010.04.021.Search in Google Scholar
3. Bender, CM, Sereika, SM, Berga, SL, Vogel, VG, Brufsky, AM, Paraska, KK, et al.. Cognitive impairment associated with adjuvant therapy in breast cancer. Psycho Oncol 2006;15:422–30. https://doi.org/10.1002/pon.964.Search in Google Scholar
4. Ercoli, LM, Castellon, SA, Hunter, AM, Kwan, L, Kahn-Mills, BA, Cernin, PA, et al.. Assessment of the feasibility of a rehabilitation intervention program for breast cancer survivors with cognitive complaints. Brain Imaging Behav 2013;7:543–53. https://doi.org/10.1007/s11682-013-9237-0.Search in Google Scholar
5. Raffa, RB. Is a picture worth a thousand (forgotten) words? Neuroimaging evidence for the cognitive deficits in ‘chemo-fog’/‘chemo-brain’. J Clin Pharm Therapeut 2010;35:1–9. https://doi.org/10.1111/j.1365-2710.2009.01044.x.Search in Google Scholar
6. Schagen, SB, van Dam, FS, Muller, MJ, Boogerd, W, Lindeboom, J, Bruning, PF. Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 1999;85:640–50. https://doi.org/10.1002/(sici)1097-0142(19990201)85:3<640::aid-cncr14>3.0.co;2-g.10.1002/(SICI)1097-0142(19990201)85:3<640::AID-CNCR14>3.0.CO;2-GSearch in Google Scholar
7. Shilling, V, Jenkins, V, Morris, R, Deutsch, G, Bloomfield, D. The effects of adjuvant chemotherapy on cognition in women with breast cancer-preliminary results of an observational longitudinal study. Breast 2005;14:142–50. https://doi.org/10.1016/j.breast.2004.10.004.Search in Google Scholar
8. Simó, M, Rifà-Ros, X, Rodriguez-Fornells, A, Bruna, J. Chemobrain: a systematic review of structural and functional neuroimaging studies. Neurosci Biobehav Rev 2013;37:1311–21. https://doi.org/10.1016/j.neubiorev.2013.04.015.Search in Google Scholar
9. van Dam, FS, Schagen, SB, Muller, MJ, Boogerd, W, vd Wall, E, Droogleever Fortuyn, ME, et al.. Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 1998;90:210–8. https://doi.org/10.1093/jnci/90.3.210.Search in Google Scholar
10. Silverman, DHS, Dy, CJ, Castellon, SA, Lai, J, Pio, BS, Abraham, L, et al.. Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5–10 years after chemotherapy. Breast Cancer Res Treat 2007;103:303–11. https://doi.org/10.1007/s10549-006-9380-z.Search in Google Scholar
11. Evens, K, Eschiti, VS. Cognitive effects of cancer treatment: “chemo brain” explained. Clin J Oncol Nurs 2009;13:661–6. https://doi.org/10.1188/09.cjon.661-666.Search in Google Scholar
12. Alvarez, J, Meyer, FL, Granoff, DL, Lundy, A. The effect of EEG biofeedback on reducing postcancer cognitive impairment. Integr Cancer Ther 2013;12:475–87. https://doi.org/10.1177/1534735413477192.Search in Google Scholar PubMed
13. Liu, L, Mills, PJ, Rissling, M, Fiorentino, L, Natarajan, L, Dimsdale, JE, et al.. Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy. Brain Behav Immun 2012;26:706–13. https://doi.org/10.1016/j.bbi.2012.02.001.Search in Google Scholar PubMed PubMed Central
14. Pinto, AC, de Azambuja, E. Improving quality of life after breast cancer: dealing with symptoms. Maturitas 2011;70:343–8. https://doi.org/10.1016/j.maturitas.2011.09.008.Search in Google Scholar PubMed
15. Luctkar-Flude, M, Groll, D. A systematic review of the safety and effect of neurofeedback on fatigue and cognition. Integr Cancer Ther 2015;14:318–40. https://doi.org/10.1177/1534735415572886.Search in Google Scholar PubMed
16. Monastra, VJ, Lynn, S, Linden, M, Lubar, JF, Gruzelier, J, LaVaque, TJ. Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 2005;30:95–114. https://doi.org/10.1007/s10484-005-4305-x.Search in Google Scholar PubMed
17. Egner, T, Gruzelier, JH. EEG biofeedback of low beta band components: frequency-specific effects on variables of attention and event-related brain potentials. Clin Neurophysiol 2004;115:131–9. https://doi.org/10.1016/s1388-2457(03)00353-5.Search in Google Scholar PubMed
18. Kober, SE, Schweiger, D, Witte, M, Reichert, JL, Grieshofer, P, Neuper, C, et al.. Specific effects of EEG based neurofeedback training on memory functions in post-stroke victims. J NeuroEng Rehabil 2015;12:107. https://doi.org/10.1186/s12984-015-0105-6.Search in Google Scholar PubMed PubMed Central
19. Scott, WC, Kaiser, D, Othmer, S, Sideroff, SI. Effects of an EEG biofeedback protocol on a mixed substance abusing population. Am J Drug Alcohol Abuse 2005;31:455–69. https://doi.org/10.1081/ada-200056807.Search in Google Scholar PubMed
20. Arns, M, de Ridder, S, Strehl, U, Breteler, M, Coenen, A. Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 2009;40:180–9. https://doi.org/10.1177/155005940904000311.Search in Google Scholar PubMed
21. Sterman, MB. Physiological origins and functional correlates of EEG rhythmic activities: implications for self-regulation. Biofeedback Self Regul 1996;21:3–33. https://doi.org/10.1007/bf02214147.Search in Google Scholar PubMed
22. Jasper, HH. The ten-twenty electrode system of the international federation. Electroencephalogr Clin Neurophysiol 1958;10:371–5.Search in Google Scholar
23. Finley, WW, Smith, HA, Etherton, MD. Reduction of seizures and normalization of the EEG in a severe epileptic following sensorimotor biofeedback training: preliminary study. Biol Psychol 1975;2:189–203. https://doi.org/10.1016/0301-0511(75)90019-8.Search in Google Scholar PubMed
24. Fuchs, T, Birbaumer, N, Lutzenberger, W, Gruzelier, JH, Kaiser, J. Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. Appl Psychophysiol Biofeedback 2003;28:1–12. https://doi.org/10.1023/a:1022353731579.10.1023/A:1022353731579Search in Google Scholar PubMed
25. Lantz, DL, Sterman, MB. Neuropsychological assessment of subjects with uncontrolled epilepsy: effects of EEG feedback training. Epilepsia 1988;29:163–71. https://doi.org/10.1111/j.1528-1157.1988.tb04414.x.Search in Google Scholar PubMed
26. Lofthouse, N, Arnold, LE, Hersch, S, Hurt, E, DeBeus, R. A review of neurofeedback treatment for pediatric ADHD. J Atten Disord 2012;16:351–72. https://doi.org/10.1177/1087054711427530.Search in Google Scholar PubMed
27. May, G, Benson, R, Balon, R, Boutros, N. Neurofeedback and traumatic brain injury: a literature review. Ann Clin Psychiatr 2013;25:289–96.Search in Google Scholar
28. Maurizio, S, Liechti, MD, Heinrich, H, Jäncke, L, Steinhausen, H-C, Walitza, S, et al.. Comparing tomographic EEG neurofeedback and EMG biofeedback in children with attention-deficit/hyperactivity disorder. Biol Psychol 2014;95:31–44. https://doi.org/10.1016/j.biopsycho.2013.10.008.Search in Google Scholar PubMed
29. Tan, G, Thornby, J, Hammond, DC, Strehl, U, Canady, B, Arnemann, K, et al.. Meta-analysis of EEG biofeedback in treating epilepsy. Clin EEG Neurosci 2009;40:173–9. https://doi.org/10.1177/155005940904000310.Search in Google Scholar PubMed
30. Walker, JE. Power spectral frequency and coherence abnormalities in patients with intractable epilepsy and their usefulness in long-term remediation of seizures using neurofeedback. Clin EEG Neurosci 2008;39:203–5. https://doi.org/10.1177/155005940803900410.Search in Google Scholar PubMed
31. Ghaziri, J, Tucholka, A, Larue, V, Blanchette-Sylvestre, M, Reyburn, G, Gilbert, G, et al.. Neurofeedback training induces changes in white and gray matter. Clin EEG Neurosci 2013;44:265–72. https://doi.org/10.1177/1550059413476031.Search in Google Scholar PubMed
32. Cherrier, MM, Anderson, K, David, D, Higano, CS, Gray, H, Church, A, et al.. A randomized trial of cognitive rehabilitation in cancer survivors. Life Sci 2013;93:617–22. https://doi.org/10.1016/j.lfs.2013.08.011.Search in Google Scholar PubMed PubMed Central
33. Ferguson, RJ, Ahles, TA, Saykin, AJ, McDonald, BC, Furstenberg, CT, Cole, BF, et al.. Cognitive-behavioral management of chemotherapy-related cognitive change. Psycho Oncol 2007;16:772–7. https://doi.org/10.1002/pon.1133.Search in Google Scholar PubMed PubMed Central
34. Ferguson, RJ, McDonald, BC, Rocque, MA, Furstenberg, CT, Horrigan, S, Ahles, TA, et al.. Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial: CBT for chemotherapy-related cognitive change. Psycho Oncol 2012;21:176–86. https://doi.org/10.1002/pon.1878.Search in Google Scholar PubMed PubMed Central
35. Kesler, S, Hadi Hosseini, SM, Heckler, C, Janelsins, M, Palesh, O, Mustian, K, et al.. Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clin Breast Cancer 2013;13:299–306. https://doi.org/10.1016/j.clbc.2013.02.004.Search in Google Scholar PubMed PubMed Central
36. King, S, Green, HJ. Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial. Front Oncol 2015;5:72. https://doi.org/10.3389/fonc.2015.00072.Search in Google Scholar PubMed PubMed Central
37. Shura, RD, Rowland, JA, Miskey, HM. Auditory consonant trigrams: a psychometric update. Arch Clin Neuropsychol 2016;31:47–57. https://doi.org/10.1093/arclin/acv083.Search in Google Scholar PubMed
38. Wagner, S, Helmreich, I, Dahmen, N, Lieb, K, Tadić, A. Reliability of three alternate forms of the trail making tests a and B. Arch Clin Neuropsychol 2011;26:314–21. https://doi.org/10.1093/arclin/acr024.Search in Google Scholar PubMed
39. Siegrist, M. Test-retest reliability of different versions of the stroop test. J Psychol 1997;131:299–306. https://doi.org/10.1080/00223989709603516.Search in Google Scholar
40. MacLeod, CM. Half a century of research on the stroop effect: an integrative review. Psychol Bull 1991;109:163. https://doi.org/10.1037/0033-2909.109.2.163.Search in Google Scholar PubMed
41. de Paula, JJ, Malloy-Diniz, LF, Romano-Silva, MA. Reliability of working memory assessment in neurocognitive disorders: a study of the digit span and corsi block-tapping tasks. Braz J Psychiatry 2016;38:262–3. https://doi.org/10.1590/1516-4446-2015-1879.Search in Google Scholar PubMed PubMed Central
42. Rosvold, HE, Mirsky, AF, Sarason, I, Bransome, EDJr, Beck, LH. A continuous performance test of brain damage. J Consult Psychol 1956;20:343. https://doi.org/10.1037/h0043220.Search in Google Scholar PubMed
43. Shaked, D, Faulkner, LM, Tolle, K, Wendell, CR, Waldstein, SR, Spencer, RJ. Reliability and validity of the Conners’ continuous performance test. Appl Neuropsychol: Adultspan 2020;27:478–87. https://doi.org/10.1080/23279095.2019.1570199.Search in Google Scholar PubMed
44. Meachen, SJ, Hanks, RA, Millis, SR, Rapport, LJ. The reliability and validity of the brief symptom inventory − 18 in persons with traumatic brain injury. Arch Phys Med Rehabil 2008;89:958–65. https://doi.org/10.1016/j.apmr.2007.12.028.Search in Google Scholar PubMed
45. Sahin, NH, Uğurtaş, S. The validity, reliability and factor structure of the brief symptom inventory (BSI). Turk Psikiyatri Derg = Turk J Psychiatry 2002;13:125–35.Search in Google Scholar
46. Schwartz, JM. Brain lock: free yourself from obsessive-compulsive behavior. HarperCollins ancer 2016;85:640–50.Search in Google Scholar
47. Katrin Kuelz, A, Riemann, D, Halsband, U, Vielhaber, K, Unterrainer, J, Kordon, A, et al.. Neuropsychological impairment in obsessive-compulsive disorder-improvement over the course of cognitive behavioral treatment. J Clin Exp Neuropsychol 2006;28:1273–87. https://doi.org/10.1080/13803390500507246.Search in Google Scholar PubMed
48. Moritz, S, Birkner, C, Kloss, M, Jahn, H, Hand, I, Haasen, C, et al.. Executive functioning in obsessive-compulsive disorder, unipolar depression, and schizophrenia. Arch Clin Neuropsychol 2002;17:477–83. https://doi.org/10.1016/s0887-6177(01)00130-5.Search in Google Scholar
49. Moritz, S, Kuelz, AK, Jacobsen, D, Kloss, M, Fricke, S. Severity of subjective cognitive impairment in patients with obsessive-compulsive disorder and depression. J Anxiety Disord 2006;20:427–43. https://doi.org/10.1016/j.janxdis.2005.04.001.Search in Google Scholar PubMed
50. Shin, NY, Lee, TY, Kim, E, Kwon, JS. Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychol Med 2014;44:1121–30. https://doi.org/10.1017/s0033291713001803.Search in Google Scholar
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