A randomised controlled trial evaluating two cognitive rehabilitation approaches for cancer survivors with perceived cognitive impairment

Janette L Vardy; Gregory R Pond; Melanie L Bell; Corrinne Renton; Ann Dixon; Haryana M Dhillon

doi:10.1007/s11764-022-01261-5

A randomised controlled trial evaluating two cognitive rehabilitation approaches for cancer survivors with perceived cognitive impairment

J Cancer Surviv. 2023 Dec;17(6):1583-1595. doi: 10.1007/s11764-022-01261-5. Epub 2022 Oct 15.

Authors

Janette L Vardy^{1

2

3}, Gregory R Pond⁴, Melanie L Bell⁵, Corrinne Renton⁶, Ann Dixon⁶, Haryana M Dhillon⁶

Affiliations

¹ Faculty of Medicine and Health, University of Sydney, Sydney, Australia. janette.vardy@sydney.edu.au.
² Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia. janette.vardy@sydney.edu.au.
³ Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia. janette.vardy@sydney.edu.au.
⁴ McMaster University, Hamilton, ON, Canada.
⁵ Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
⁶ Centre for Medical Psychology & Evidence-Based Decision-Making, University of Sydney, Sydney, Australia.

Abstract

Purpose: Up to 70% of survivors report cognitive symptoms after chemotherapy. We compared two cognitive rehabilitation programs to a control group in cancer survivors.

Methods: Study population were adult cancer survivors with cognitive symptoms 6-60 months after adjuvant chemotherapy. Participants randomised to: Attention Process Training (APT), Compensatory Strategy Training (CST), or control group. Active interventions comprised 6-week, 2-h/week small group sessions.

Assessments: pre- and post-intervention, 6- and 12-months later. Primary outcome was change in cognitive symptoms (FACT-COG-PCI subscale) between baseline and post-intervention. Secondary endpoints included objective neuropsychological performance, Functional Impact Assessment (FIA), patient-reported outcome measures, and associations. Analyses were on an intention-to-treat basis. Analysis of covariance mixed models were used for continuous outcomes.

Results: Sixty-five participants were randomised (APT n = 21; CST n = 24; controls n = 20): 94% breast cancer, median age 54. Median time since chemotherapy 20.7 months. FACT-COG-PCI, clinical neuropsychological T-scores, and FIA improved in all groups over time, but no significant differences between arms. On mean neuropsychological T-scores 19/65 (29%) were impaired at baseline; post-intervention impairment controls 31.3%, CST 16.7%, APT 20.0%. On FIA at baseline, nine were impaired; this decreased to three post-intervention (one/group). FACT-COG-PCI was weakly associated with neuropsychological tests (rho = 0.24, p = 0.051) at baseline, and had no association with FIA. Neuropsychological total mean T-score was moderately positively associated with FIA (rho = 0.37, p = 0.003).

Conclusion: There were no significant differences between intervention groups and controls using linear mixed models adjusted for baseline scores.

Implications for cancer survivors: Cognitive symptoms and neuropsychological test scores improve over time.

Keywords: Cancer-related cognitive impairment; Cognitive rehabilitation; Cognitive symptoms; Randomised control trial.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Breast Neoplasms* / psychology
Cancer Survivors* / psychology
Cognitive Dysfunction* / etiology
Cognitive Training
Female
Humans
Middle Aged
Neuropsychological Tests
Percutaneous Coronary Intervention*