Ferguson, R.J., Ahles, T.A., Saykin, A.J., McDonald, B.C., Furstenberg, C.T., Cole, B.F., & Mott, L.A. (2007). Cogntive-behavioral management of chemotherapy-related cognitive change. Psycho-Oncology, 16, 772–777.

The study was conducted to examine Memory and Attention Training (MAAT) as a possible intervention for cognitive dysfunction. MAAT consists of four cognitive-behavioral components.

1. Education on memory and attention
2. Self-awareness training
3. Self-regulation emphasizing arousal reduction through relaxation training, activity scheduling, and pacing
4. Cognitive compensatory strategies training, which consists of self-instructional training, verbal rehearsal of auditory information, schedule-making, external cueing, and outlining written material

The MAAT intervention contained

1. Workbooks with written information about chemotherapy and memory difficulty, and step-by-step guides on how to practice and apply compensatory strategies
2. Four monthly visits, lasting 30–50 minutes, that focused on knowledge of chemotherapy-associated memory problems, identification of at-risk situations where memory failures arise, and learned and rehearsed compensatory strategies relevant to participants' difficulties
3. Three interim phone calls to assist participants in applying compensatory strategies
4. Homework between phone calls to further apply the compensatory strategies.

• The number of participants was 29.
• All participants were Caucasian and female.
• All participants had breast cancer.
• The average participant age was 56.
• Participants had an average of 15.40 years of education, and their mean IQ was 112.82.
• Participants were an average of 8 years post-chemotherapy and had reported memory and attention problems.
• Telephone screenings were completed for psychiatric disorders using PRIME-MD.
• Participants who had previous central nervous system (CNS) radiation or intrathecal therapy were excluded from the study. Those who had psychiatric mental health issues or neurologic, CNS-related, or neuroehavioral risk factors were also excluded.

• Rural
• Regional academic cancer center (Dartmouth-Hitchcock Medical Center)
• Private oncology offices in Northern New England

This was a prospective, longitudinal, single-arm pilot study.

• California Verbal Learning Test-II (CVLT-II) for verbal memory
• Logical Memory I and II for memory
• Digit Symbol for graphomotor skills
• Trail Making Test (TMT), Parts A and B, for visual attention, motor speed, and cognitive flexibility
• Stroop Color-Word Interference Task for executive function
• Center for Epidemiologic Studies Depression Scale for depression
• State-Trait Anxiety Inventory for anxiety
• Quality of Life-Cancer Survivors (QOL-CS) for cancer-related quality of life
• Multiple Ability Self-Report Questionnaire (MASQ)

Participants rated the MAAT program with high levels of general satisfaction post-treatment, and reported that it was helpful with improving memory, attention, and compensatory skills.

Neuropsychological test results revealed improvement on verbal memory (p = 0.001), executive functioning (p < 0.001), and psychomotor functioning (p = 0.001). Moderate to large treatment effect sizes (0.47 to 0.67) were observed in the MASQ total score and subscales immediately post-treatment, and the visual perceptual scale (0.63) was significant at the two month follow-up. Self-report in cognitive function in participants’ daily lives improved significantly over baseline and was sustained across all follow-up periods (p = 0.001). Similar patterns of improvement were observed on MASQ subscales of attention and concentration, spatial memory, verbal memory, and language. 

MAAT is a feasible and possibly effective cognitive-behavioral, non-pharmacologic management approach to a common problem for many cancer survivors.

• The sample size was small and lacked diversity. 
• The study had no comparison control group or randomization. 
• Participants were highly educated, limiting the generalizability of study findings.
• Neuropsychiatric scores fell within normal range after conversion of the raw scores to standardized scores, despite patient complaints of cognitive issues. This may reflect the measure’s insensitivity or specificity or imply that the participants did not have mild impairments in their memory or attention.
• Measurements were not acquired before chemotherapy treatments for a true baseline measure.
• Differences in chemotherapies or other treatments for the participants were not reported.