Information sourced from NEJM Journal Watch:
Learning to Overcome Chemotherapy-Related Cognitive Dysfunction
Randomized trial suggests Web-based cognitive rehabilitation is effective for cancer survivors.
Cognitive impairment (sometimes called “chemo-brain”) is commonly reported after chemotherapy. Behavioral interventions can improve cognitive and psychosocial function in individuals with traumatic brain injury. Can such neurocognitive rehabilitation also benefit cancer survivors? Australian investigators randomized 242 patients with self-reported cognitive difficulties after chemotherapy (median age, 52; 89% breast cancer survivors) to a computerized Web-based neurocognitive learning program (recommended training time, 4 weekly 40-minute sessions for 15 weeks; total, 40 hours) or standard care. Before randomization, all participants received a 30-minute consultation session by telephone in which cognitive-training strategies were outlined.
Among participants in the intervention group, 27% completed the learning program within the recommended 15-week timeframe (mean total training time, 25 hours). Immediately after the intervention, a validated measure of self-reported cognitive function indicated that perceived cognitive impairment had improved more with the learning program than with standard care (P<0.001). This improvement persisted 6 months later and was greater for those who trained for >25 hours. Participants in the learning program also experienced significant reductions in stress at both time points.
Performing any intervention that creates expectation of benefit might improve cognitive function. As the authors note, a better study design would have also randomized participants to a third arm consisting of a 40-hour nontherapeutic intervention. Notwithstanding its limitations, this trial may open the way to a practical intervention that can help cancer patients with chemotherapy-associated cognitive concerns.
Andrew M. Kaunitz, MD reviewing Bray VJ et al. J Clin Oncol 2016 Oct 28.
Bray VJ et al. Evaluation of a Web-based cognitive rehabilitation program in cancer survivors reporting cognitive symptoms after chemotherapy. J Clin Oncol 2016 Oct 28; [e-pub].
[Free full-text J Clin Oncol article]
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