Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial.

OBJECTIVE: To evaluate the efficacy of a brief cognitive-behavioral therapy (CBT) that is being developed for management of cognitive dysfunction following chemotherapy among breast cancer survivors. Memory and Attention Adaptation Training (MAAT) is a brief CBT designed to improve the quality of life and function among cancer survivors with post-chemotherapy cognitive complaints. METHODS: An initial, two-group (MAAT versus waitlist, no treatment control), randomized clinical trial (RCT) was conducted. Forty stage I and II female breast cancer survivors (mean age = 50; SD = 6.4) were randomized to conditions and assessed at baseline, post-treatment (8 weeks) and 2-month follow-up assessment points on measures of: (1) self-reported daily cognitive failures; (2) quality of life; and (3) neuropsychological performance. Participants were also assessed for satisfaction with MAAT. RESULTS: With education and IQ as covariates, MAAT participants made significant improvements relative to controls on the spiritual well-being subscale of the quality of life measure and on verbal memory, but statistical significance was not achieved on self-report of daily cognitive complaints. However, moderate-to-large effect sizes were observed on these outcomes. Participants gave MAAT high satisfaction ratings. CONCLUSIONS: Although this initial RCT is a small study, MAAT participants appear to improve on one measure of quality of life and verbal memory performance relative to no treatment controls and rate MAAT with high satisfaction. These data are encouraging and support the continued development and evaluation of MAAT efficacy.

Accidental and non-accidental ingestion of methadone and buprenorphine in childhood: a single center experience, 1999-2009.

OBJECTIVE: To assess the effect of recent availability (due to more home use) of methadone and buprenophine has had on the accidental and non-accidental misuse by children. METHODS: A retrospective review of all pediatric (< 18 years old) admissions for methadone or buprenorphine ingestion at Eastern Maine Medical Center (EMMC) from September 1, 1999 to August 31, 2009 was performed. Data recorded included age, sex, accidental or non-accidental ingestion, source of drug, ward or pediatric intensive care unit (PICU) admission, treatment given and length of hospital stay. Relation to pediatric emergency department (ED) visits, general pediatric ward admissions and patients on opioid maintenance treatment in the area was also assessed. RESULTS: There were 22 children (12 female) admitted for methadone (10, 46%) or buprenorphine (12, 54%) ingestion, with ingestions tripling in the later five year period compared with the earlier five years. The trend was statistically significant, unrelated to pediatric ED visits or ward admissions but statistically related to number of patients on opioid maintenance treatment in the region. Of the 22 children with ingestion, six (27%) were adolescents (mean age 15.2 years) and ingestion was intentional (three suicide, three recreational) and 16 were infants or toddlers (mean age 21.6 months) whose ingestions were accidental. The drug source was family and friend (18, 82%) or unknown (four, 18%). There were six patients admitted to the ward and 16 patients (74%) admitted to the PICU. Two patients had observation only, seven had anticipatory intravenous (IV) line placement, nine patients were given IV line and naloxone (bolus + IV infusion), and four patients required endotracheal intubation, IV placement and naloxone. There were no fatalities and mean hospital stay was one to seven days, mean 2.3 days. All families were referred to family services. CONCLUSIONS: Accidental and non-accidental ingestion of methadone and buprenorphine by children is increasing in proportion to increased clinical use and availability. Health providers should be aware of this increased risk and be able to provide appropriate treatment and family support.