A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON)
Laura Tack, Tessa Lefebvre, Michelle Lycke, Chistine Langenaeken, Christel Fontaine, Marleen Borms, Marianne Hanssens, Christel Knops, Kathleen Meryck, Tom Boterberg, Hans Pottel, Patricia Schofield, Philip R Debruyne, Laura Tack, Tessa Lefebvre, Michelle Lycke, Chistine Langenaeken, Christel Fontaine, Marleen Borms, Marianne Hanssens, Christel Knops, Kathleen Meryck, Tom Boterberg, Hans Pottel, Patricia Schofield, Philip R Debruyne
Abstract
Background: Cancer-related cognitive impairment (CRCI) is a prevalent source of comprised quality of life in cancer survivors. This study evaluated the efficacy of Emotional Freedom Techniques (EFT) on self-reported CRCI (sr-CRCI).
Methods: In this prospective multicentre randomised wait-list controlled study (ClinicalTrials.gov Identifier: NCT02771028), eligible cancer survivors had completed curative treatment, were 18 years or older and screened positive for sr-CRCI with ≥ 43 on the Cognitive Failures Questionnaire (CFQ). Participants were randomised to the immediate treatment group (ITG) or wait-list control (WLC) group, based on age (< or ≥ 65 years), gender, treatment (chemotherapy or not), and centre. The ITG started to apply EFT after inclusion and performed this for 16 weeks. The WLC group could only start the application of EFT after 8 weeks of waiting. Evaluations took place at baseline (T0), 8 weeks (T1) and 16 weeks (T2). The primary outcome was the proportion of patients with sr-CRCI according to the CFQ score.
Findings: Between October 2016 and March 2020, 121 patients were recruited with CFQ ≥ 43 indicating sr-CRCI. At T1, the number of patients scoring positive on the CFQ was significantly reduced in the ITG compared to the WLC group (40.8% vs. 87.3% respectively; p<0.01). For the WLC group, a reduction in CFQ scores was observed at T2, comparable to the effect of the ITG at T1. Linear mixed model analyses indicated a statistically significant reduction in the CFQ score, distress, depressive symptoms, fatigue and also an improvement in quality of life.
Interpretation: This study provides evidence for the application of EFT for sr-CRCI in cancer survivors and suggests that EFT may be useful for other symptoms in cancer survivors.
Keywords: Cancer survivorship; Cancer-related cognitive impairment; Emotional freedom techniques; Subjective cognitive complaints.
Conflict of interest statement
All authors have no conflicts of interest to declare, except for co-author dr. Christel Fontaine who received financial support for attending online ESMO 2020, ICOS 2020, SABCS 2020, EBCC 2021, ASCO 2021, MASCC 2021, ECHNO 2021.
© 2021 The Author(s).
Figures
References
- American Cancer Society . American Cancer Society; Atlanta: 2019. Cancer treatment & survivorship facts & figures 2019-2021.
- Pal S.K., Miller M.J., Agarwal N., Chang S.M., Chavez-MacGregor M., Cohen E. Clinical cancer advances 2019: annual report on progress against cancer from the american society of clinical oncology. J Clin Oncol. 2019;37(10):834–849.
- Ahles T.A., Root J.C., Ryan E.L. Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol. 2012;30(30):3675–3686.
- Janelsins M.C., Heckler C.E., Peppone L.J., Ahles T.A., Mohile S.G., Mustian K.M. Longitudinal trajectory and characterization of cancer-related cognitive impairment in a nationwide cohort study. J Clin Oncol. 2018;36(32)
- Hurria A., Somlo G., Ahles T. Renaming "chemobrain". Cancer Investig. 2007;25(6):373–377.
- Lycke M., Pottel L., Pottel H., Ketelaars L., Stellamans K., Van Eygen K. Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment. Psychooncology. 2017;26(5):632–639.
- Joly F., Heutte N., Duclos B., Noal S., Léger-Hardy I., Dauchy S. Prospective evaluation of the impact of antiangiogenic treatment on cognitive functions in metastatic renal cancer. Eur Urol Focus. 2016;2(6):642–649.
- Joly F., Castel H., Tron L., Lange M., Vardy J. Potential effect of immunotherapy agents on cognitive function in cancer patients. J Natl Cancer Inst. 2020;112(2):123–127.
- Lycke M., Lefebvre T., Pottel L., Pottel H., Ketelaars L., Stellamans K. Subjective, but not objective, cognitive complaints impact long-term quality of life in cancer patients. J Psychosoc Oncol. 2019;37(4):427–440.
- Moore H.C. An overview of chemotherapy-related cognitive dysfunction, or 'chemobrain'. Oncol (Williston Park) 2014;28(9):797–804.
- Danhauer S.C., Legault C., Bandos H., Kidwell K., Costantino J., Vaughan L. Positive and negative affect, depression, and cognitive processes in the cognition in the study of tamoxifen and raloxifene (Co-STAR) trial. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn. 2013;20(5):532–552.
- National Comprehensive Cancer Network. Distress during cancer care 2020 [cited 2020 14th November] [Available from: .
- Lycke M., Lefebvre T., Pottel L., Pottel H., Ketelaars L., Stellamans K. The distress thermometer predicts subjective, but not objective, cognitive complaints six months after treatment initiation in cancer patients. J Psychosoc Oncol. 2017;35(6):741–757.
- Dhillon H.M., Tannock I.F., Pond G.R., Renton C., Rourke S.B., Vardy J.L. Perceived cognitive impairment in people with colorectal cancer who do and do not receive chemotherapy. J Cancer Surviv. 2018;12(2):178–185.
- Pullens M.J., De Vries J., Van Warmerdam L.J., Van De Wal M.A., Roukema J.A. Chemotherapy and cognitive complaints in women with breast cancer. Psychooncology. 2013;22(8):1783–1789.
- Janelsins M.C., Heckler C.E., Peppone L.J., Kamen C., Mustian K.M., Mohile S.G. Cognitive complaints in survivors of breast cancer after chemotherapy compared with age-matched controls: an analysis from a nationwide, multicenter, prospective longitudinal study. J Clin Oncol. 2017;35(5):506–514.
- Ganz P.A., Kwan L., Castellon S.A., Oppenheim A., Bower J.E., Silverman D.H. Cognitive complaints after breast cancer treatments: examining the relationship with neuropsychological test performance. J Natl Cancer Inst. 2013;105(11):791–801.
- Seliktar N., Polek C., Brooks A., Hardie T. Cognition in breast cancer survivors: hormones versus depression. Psychooncology. 2015;24(4):402–407.
- Vardy J.L., Dhillon H.M., Pond G.R., Rourke S.B., Bekele T., Renton C. Cognitive function in patients with colorectal cancer who do and do not receive chemotherapy: a prospective, longitudinal, controlled study. J Clin Oncol. 2015;33(34):4085–4092.
- Vardy J.L., Stouten-Kemperman M.M., Pond G., Booth C.M., Rourke S.B., Dhillon H.M. A mechanistic cohort study evaluating cognitive impairment in women treated for breast cancer. Brain Imaging Behav. 2019;13(1):15–26.
- Schilder C.M., Seynaeve C., Linn S.C., Boogerd W., Beex L.V., Gundy C.M. Self-reported cognitive functioning in postmenopausal breast cancer patients before and during endocrine treatment: findings from the neuropsychological TEAM side-study. Psychooncology. 2012;21(5):479–487.
- Li J., Yu L., Long Z., Li Y., Cao F. Perceived cognitive impairment in Chinese patients with breast cancer and its relationship with post-traumatic stress disorder symptoms and fatigue. Psychooncology. 2015;24(6):676–682.
- Bray V.J., Dhillon H.M., Bell M.L., Kabourakis M., Fiero M.H., Yip D. Evaluation of a web-based cognitive rehabilitation program in cancer survivors reporting cognitive symptoms after chemotherapy. J Clin Oncol. 2017;35(2):217–225.
- King S., Green H.J. Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial. Front Oncol. 2015;5:72.
- Ercoli L.M., Petersen L., Hunter A.M., Castellon S.A., Kwan L., Kahn-Mills B.A. Cognitive rehabilitation group intervention for breast cancer survivors: results of a randomized clinical trial. Psychooncology. 2015;24(11):1360–1367.
- Bach D., Groesbeck G., Stapleton P., Sims R., Blickheuser K., Church D. Clinical EFT (Emotional Freedom Techniques) improves multiple physiological markers of health. J Evid Based Integr Med. 2019;24 2515690x18823691.
- Church D., Feinstein D. The manual stimulation of acupuncture points in the treatment of post-traumatic stress disorder: a review of clinical emotional freedom techniques. Med Acupunct. 2017;29(4):194–205.
- Sebastian B., Nelms J. The effectiveness of emotional freedom techniques in the treatment of posttraumatic stress disorder: a meta-analysis. Explore (NY) 2017;13(1):16–25.
- Chatwin H., Stapleton P., Porter B., Devine S., Sheldon T. The effectiveness of cognitive behavioral therapy and emotional freedom techniques in reducing depression and anxiety among adults: a pilot study. Integr Med (Encinitas) 2016;15(2):27–34.
- Clond M. Emotional freedom techniques for anxiety: a systematic review with meta-analysis. J Nerv Ment Dis. 2016;204(5):388–395.
- Nelms J.A., Castel L. A systematic review and meta-analysis of randomized and nonrandomized trials of clinical emotional freedom techniques (EFT) for the treatment of depression. Explor (NY) 2016;12(6):416–426.
- Church D. Clinical EFT as an evidence-based practice for the treatment of psychological and physiological conditions. Psychology. 2013;4(8):645–654. doi: 10.4236/psych.2013.48092.
- Church D., Yount G., Brooks A.J. The effect of emotional freedom techniques on stress biochemistry: a randomized controlled trial. J Nerv Ment Dis. 2012;200(10):891–896.
- Feinstein D. Acupoint stimulation in treating psychological disorders: evidence of efficacy. Rev Gen Psychol. 2012;16(4):364–380.
- Church D., De Asis M.A., Brooks A.J. Brief group intervention using emotional freedom techniques for depression in college students: a randomized controlled trial. Depress Res Treat. 2012;2012
- Gilomen S.A., Lee C.W. The efficacy of acupoint stimulation in the treatment of psychological distress: a meta-analysis. J Behav Ther Exp Psychiatry. 2015;48:140–148.
- Church D., Stapleton P., Yang A., Gallo F. Is tapping on acupuncture points an active ingredient in emotional freedom techniques? a systematic review and meta-analysis of comparative studies. J Nerv Ment Dis. 2018;206(10):783–793.
- Swingle P.G., Pulos L., Swingle M.K. Neurophysiological indicators of EFT treatment of posttraumatic stress. Subtle Energies Energy Med. 2004;15(1):75–86.
- Feinstein D. Rapid treatment of ptsd: why psychological exposure with acupoint tapping may be effective. Psychotherapy. 2010;47(3):385–402.
- Lane J. The neurochemistry of counterconditioning: acupressure desensitization in psychotherapy. Energy Psychol. 2009;1(1):31–44.
- Church D., Yount G., Rachlin K., Fox L., Nelms J. Epigenetic effects of PTSD remediation in veterans using clinical emotional freedom techniques: a randomized controlled pilot study. Am J Health Promot. 2018;32(1):112–122.
- Church D., Nelms J., editors. Psychological change in a population with frozen shoulder: A randomized controlled dismantling study of clinical EFT (emotional freedom techniques) Archives of Scientific Psychology; 2015.
- Church D., Nelms J. Pain, range of motion, and psychological symptoms in a population with frozen shoulder: a randomized controlled dismantling study of clinical EFT (emotional freedom techniques) Arch Sci Psychol. 2016;4(1):38–48.
- Maharaj M.E. Differential gene expression after emotional freedom techniques (EFT) treatment: a novel pilot protocol for salivary mRNA assessment. Energy Psychol Theory Res Treat. 2016;8(1):17–32.
- Craig G. Elite Books; 2011. The EFT manual.
- Broadbent D.E., Cooper P.F., FitzGerald P., Parkes K.R. The cognitive failures questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982;21(Pt 1):1–16.
- Ponds R., Van Boxtel M., Jolles J. De cognitive failure questionnaire als maat voor subjectief cognitief functioneren. Tijdschr voor Neuropsychol. 2006;2:37–45.
- Osoba D., Rodrigues G., Myles J., Zee B., Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–144.
- Lange M., Joly F., Vardy J., Ahles T., Dubois M., Tron L. Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol. 2019;30(12):1925–1940.
- Ganz P.A., Van Dyk K. Cognitive impairment in patients with breast cancer: understanding the impact of chemotherapy and endocrine therapy. J Clin Oncol. 2020;38(17):1871–1874.
- Boath E., Stewart A., Carryer A., Walton I., Hill L. Can emotional freedom techniques (EFT) be effective in the treatment of emotional conditions? Results of a service evaluation in Sandwell. Eur J Integr Med. 2014;6(5):614.
- Horowitz T.S., Suls J., Treviño M. A call for a neuroscience approach to cancer-related cognitive impairment. Trends Neurosci. 2018;41(8):493–496.
- Bray V.J., Dhillon H.M., Vardy J.L. Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment. J Cancer Surviv. 2018;12(4):537–559.
- Loh K.P., Janelsins M.C., Mohile S.G., Holmes H.M., Hsu T., Inouye S.K. Chemotherapy-related cognitive impairment in older patients with cancer. J Geriatr Oncol. 2016;7(4):270–280.
- Church D., Hawk C., Brooks A.J., Toukolehto O., Wren M., Dinter I. Psychological trauma symptom improvement in veterans using emotional freedom techniques: a randomized controlled trial. J Nerv Ment Dis. 2013;201(2):153–160.
- Church D., Feinstein D., Palmer-Hoffman J., Stein P.K., Tranguch A. Empirically supported psychological treatments: the challenge of evaluating clinical innovations. J Nerv Ment Dis. 2014;202(10):699–709.
- Feinstein D. Energy psychology interactive: rapid interventions for lasting change: Innersource; 2004.
Source: PubMed