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Background: Chemotherapy-related cognitive impairment (CRCI) is a condition experienced by many survivors of breast cancer. At present, there are a limited number of rehabilitation programs tailored to improve the cognitive performance of these survivors. Purpose: This systematic review aims to evaluate the existing evidence-based cognitive rehabilitation programs designed for survivors of breast cancer with CRCI. Methods: Electronic databases, including PubMed and CINAHL Plus, were used to identify the relevant articles. The search was restricted to studies published in the English language from inception to March 2020. The methodological quality of the studies included here was examined using the Quality Criteria for Rating Studies of Cognitive Rehabilitation. Results: The search strategy identified 1557 studies, 10 of which met the inclusion criteria. The studies included randomized controlled trial (n = 6), quasi-randomized controlled trial (n = 1), and single-arm trial (n = 3). Discussion and Limitations: Seven of the 10 studies were considered high-quality cognitive rehabilitation research. Cognitive training (n = 4), compensatory strategies (n = 5), and a combination of cognitive training and compensatory strategies (n = 1) were shown to improve executive function, working and verbal memory, processing speed, and attention. Conclusion: Cognitive rehabilitation programs demonstrated positive outcomes for survivors of breast cancer with cognitive impairment.However, because of methodological concerns and the diversity in the programs' parameters and outcome measures, an explicit recommendation could not be established. The findings may guide future research, policies, and practices related to cognitive rehabilitation programs for survivors of breast cancer.

Objective Chemotherapy-related cognitive impairment (CRCI) is a well-known phenomenon among breast cancer survivors. Cognitive impairment among breast cancer survivors can significantly affect their quality of life and ability to function independently. However, there is a lack of specific and focused cognitive intervention to improve their cognitive performances. This study aimed to develop a tailored cognitive intervention framework module by adapting the attention and memory interventions from the Cognitive Rehabilitation Manual of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) and incorporating them with the relevant exercises for cognitive rehabilitation for Malaysian breast cancer survivors with CRCI based on the consensus agreement of the expert panel. Methods and analysis The Delphi consensus technique was conducted online to review and evaluate the framework module. A panel of experts, including rehabilitation medicine physicians, occupational therapists, and clinical psychologists in Malaysia, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items. Results A total of 33 practitioners completed the three Delphi rounds. 72.7% of the expert panel have been practising in their relevant clinical fields for more than six years (M = 10.67, SD = 5.68). In Round 1, 23% of the experts suggested that the framework module for attention training required further improvements, specifically in the language (M = 1.97, SD = 0.75) and instructions (M = 2.03, SD = 0.71) provided. In Round 2, 15% of the experts recommended additional changes in the instruction (M = 2.15, SD = 0.67) for attention training. Amendments made to the framework module in line with the recommendations provided by the experts resulted in a higher level of consensus, as 94% to 100% of the experts in Round 3 concluded the framework module was suitable and comprehensive for our breast cancer survivors. Following the key results, the objectives were practical, and the proposed approaches, strategies, and techniques for attention and memory training were feasible. The clarity of the instructions, procedures, verbatim transcripts, and timeframe further enhanced the efficacy and utility of the framework module. Conclusions This study found out that the cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfully developed and feasible to be implemented using Delphi technique.

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