Cancer-related fatigue and postcancer cognitive impairment or “chemobrain” are distressing symptoms that may persist for months or years following completion of cancer treatment. Cancer survivors with unmet needs often turn to Complementary and Alternative Medicine (CAM) therapies. Neurofeedback is a mind-body technique that utilizes real-time biofeedback of EEG activity to train individuals in self-regulation with results similar to meditation (Brandmeyer & Delorme, 2013). Self-regulation is related to neuroplasticity, the capacity of the brain to develop new neural pathways in response to stimuli, and neural efficiency, a decrease in the amount of energy dedicated to performing a given task (Cannon, 2015). Neurofeedback is non-invasive, drug-free and reported to help with a variety of symptoms including pain, fatigue, depression, anxiety, sleep problems and cognitive decline. Thus, neurofeedback may be an effective CAM option for cancer survivors experiencing persistent symptoms such as post-cancer cognitive impairment and cancer-related fatigue. The purpose of this study was to determine the feasibility of a randomized controlled trial investigating the effect of neurofeedback on post-cancer cognitive impairment and cancer-related fatigue in a sample of breast cancer survivors.
A few studies have examined the effect of neurofeedback on persistent symptoms in cancer survivors. Results of an integrative review suggest neurofeedback could be effective to manage cancer pain (Prinsloo et al., 2014). A systematic review provides preliminary evidence of use neurofeedback to manage fatigue and cognitive impairment (Luctkar-Flude & Groll, 2015). One study in this review demonstrated the feasibility of neurofeedback in a sample of breast cancer survivors who showed significant improvements in cognition, fatigue, psychological symptoms and sleep (Alvarez et al., 2013). A randomized controlled trial conducted in the U.S. demonstrated improvement in chemotherapy-induced peripheral neuropathy symptoms following neurofeedback therapy (Prinsloo et al., 2017). Interviews with a sample of neurofeedback providers and some of their clients who were cancer survivors revealed a number of benefits of neurofeedback including two powerful themes “transforming lives” and “regaining control” which depict the positive impact on quality of life of cancer survivors (Luctkar-Flude et al., 2018). Thus, there is a need to determine which neurofeedback systems and protocols are safe and most effective for different populations of cancer survivors with persistent symptoms.
Methods:
Breast cancer survivors were recruited for this pilot wait-list controlled study. Participants received 20 NeurOptimalTM sessions over a ten-week period. Primary study outcomes were cognitive impairment measured by an objective neurocognitive assessment, CNS Vital Signs, and a standardized patient-reported measure, the FACT-Cognition Scale. Secondary outcomes included fatigue as measured by the FACIT-Fatigue. Participants were also invited to participate in a semi-structured interview exploring their experience with neurofeedback and its impact on their quality of life.
Results:
Twenty women met inclusion criteria, 16 enrolled and completed the neurofeedback protocol; 12 completed all five study surveys, and 4 did not complete the follow-up survey. Mean scores for the Total FACT-CoG increased significantly [F(1.346, 18.845) = 6.192, p = .006] over the treatment period as compared to the wait-list period, with a medium effect size (partial eta squared = .307). Mean scores for the FACIT-Fatigue increased significantly F(2, 28) = 10.953, p = .000] with a medium effect size (partial eta squared = .439). Results of the CNS Neurocognition Index demonstrated no significant differences between pre and post-neurofeedback scores increased non-significantly [F(1.021, 10.213) = .554, p = .477]. Qualitative feedback indicated that neurofeedback had a positive effect on post-cancer cognitive impairment, cancer-related fatigue and quality of life.
Conclusion:
The 20-session neurofeedback protocol tested in this study was feasible to implement and acceptable to cancer survivors. Statistically significant improvements in perceived cognition and fatigue levels support the need for further trials of neurofeedback in cancer survivors. Results of this pilot study have identified challenges to patient recruitment that will inform development of an RCT protocol.