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.

Keywords: cancer; chemotherapy; cognitive impairment; cognitive rehabilitation; supportive care.

Figure 1

CONSORT flow diagram. CR, cognitive rehabilitation.

Figure 2

Forest plot of effect sizes and 95% CIs for computer‐assisted cognitive rehabilitation compared with the 2 active control groups. CES‐D, Center for Epidemiologic Studies Depression Scale; CR, cognitive rehabilitation; ES, effect size; FACT‐An, Functional Assessment of Cancer Therapy–Anemia; FACT‐G, Functional Assessment of Cancer Therapy–General; PCA, perceived cognitive abilities; PCI, perceived cognitive impairments; STAI‐Trait, Spielberger State‐Trait Anxiety Inventory; WAIS, Wechsler Adult Intelligence Scale.