Cognitive rehabilitation program to improve cognition of cancer patients treated with chemotherapy: A 3‐arm randomized trial

Abstract

BACKGROUND: There is no treatment for cancer-related cognitive impairment, an important adverse effect that negatively impacts quality of life (QOL). We conducted a 3-arm randomized controlled trial to evaluate the impact of computer-assisted cognitive rehabilitation (CR) on cognition, QOL, anxiety, and depression among cancer patients treated with chemotherapy. METHODS: Patients who reported cognitive complaints during or after completing chemotherapy were randomly assigned to 1 of 3 12-week CR programs: computer-assisted CR with a neuropsychologist (experimental group A), home cognitive self-exercises (active control group B), or phone follow-up (active control group C). Subjective cognition was assessed by the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog), objective cognition was assessed by neuropsychological tests, QOL was assessed by the FACT-General, and depression and anxiety were assessed by psychological tests. The primary endpoint was the proportion of patients with a 7-point improvement in the FACT-Cog perceived cognitive impairment (PCI) score. RESULTS: Among the 167 enrolled patients (median age, 51 years), group A had the highest proportion of patients with a 7-point PCI improvement (75%), followed by groups B (59%) and C (57%), but the difference was not statistically significant (P = .13). Compared with groups B and C, the mean difference in PCI score was significantly higher in group A (P = .02), with better perceived cognitive abilities (P < .01) and a significant improvement in working memory (P = .03). Group A reported higher QOL related to cognition (FACT-Cog QOL) (P = .01) and improvement in depression symptoms (P = .03). CONCLUSIONS: These results suggest a benefit of a computer-based CR program in the management of cancer-related cognitive impairment and complaints.

Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity

“…After the full-text assessment, 20 studies were finally included in this review. Among the included studies, sixteen evaluated computerized cognitive stimulations [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and four evaluated a computerized physical activity program [59][60][61][62]. Thirteen studies were randomized-control studies [44][45][46][47][48]51,[54][55][56][57][61][62][63] and seven pilot studies (reporting also efficacy of the intervention) [43,49,50,52,53,58,60].…”

“…Among the included studies, sixteen evaluated computerized cognitive stimulations [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] and four evaluated a computerized physical activity program [59][60][61][62]. Thirteen studies were randomized-control studies [44][45][46][47][48]51,[54][55][56][57][61][62][63] and seven pilot studies (reporting also efficacy of the intervention) [43,49,50,52,53,58,60]. Most studies have been judged to have an overall high level of risk of bias, three studies arose some concerns regarding the risk of bias [44,48,59] and only one study resulted in having a low risk of bias [46] (Figures 2 and 3).…”

“…Design: Among the sixteen computerized cognitive stimulation studies [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], ten were randomized controlled studies [44][45][46][47][48]51,53,[55][56][57], and six were feasibility/pilot studies [43,49,50,52,54,58].…”

Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol

“…While the beneficial effects of both cognitive stimulation and physical activity have been proved [ 2 , 23 , 24 , 25 , 26 ], many barriers limit the setup of such interventions in supportive care units in hospitals. Web-based interventions have been used to reduce some of these barriers, including the cost of interventions, while increasing convenience for patients, also reaching patients who are normally isolated and cannot benefit from these interventions [ 67 ] and have resulted as efficient in the improvement of CRCI [ 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Nevertheless, little is known about patients’ preferences in terms of length of the program, length, and frequency of the sessions.…”

“…E-Health approaches represent one solution to overcome these barriers because it allows home-based and remotely supervised interventions. The potential of such approaches has already been shown in multiple domains of mental health [39][40][41][42] and also for the improvement of quality of life [43] and CRCI in cancer patients [44][45][46][47][48][49][50]. Furthermore, e-Health interventions have been shown to improve patients' engagement [51] and to promote physical activity [52].…”