The implementation of web-based cognitive rehabilitation in adult cancer survivors: examining participant engagement, attrition and treatment fidelity

Factors Associated With Digital Intervention Engagement and Adherence in Patients With Cancer: Systematic Review

BACKGROUND

Digital interventions offer vital support for patients with cancer through education, behavior change, and monitoring. Despite their potential, patient adherence to and engagement with these self-help interventions is challenging. Factors like user characteristics, technology, and intervention design influence adherence and engagement. Existing reviews have gaps in exploring diverse factors associated with adherence in cancer care.

OBJECTIVE

This systematic review aims to identify factors influencing adherence to and engagement with digital interventions with self-help components in cancer care. It examined sociodemographic, psychosocial, health-related, and intervention-related factors that affect patients' adherence to and engagement with these digital health solutions.

METHODS

Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted across PubMed, Embase, Cochrane Library, and PsycINFO to find studies published from January 2010 to September 2021. The studies included in this review focused on adult patients with cancer using digital interventions with self-help features. Data were extracted and synthesized using a standardized approach. Factors associated with adherence were synthesized according to their type-sociodemographic factors, psychosocial factors, health-related factors, technology-related factors, and intervention-related factors.

RESULTS

Among 9386 studies initially screened, 61 (0.6%) were eligible for analysis. These studies covered diverse eHealth intervention types, cancer types, and outcome measures. Investigating the determinants of adherence to and engagement with digital interventions was the main objective for 43% (26/61) of the included studies. Adherence and engagement were gauged using varied measures, such as dropout rates, log-ins, and self-reported measures. Results regarding factors associated with adherence and engagement were inconsistent across studies. Most sociodemographic (eg, age) and health-related factors (eg, cancer stage) yielded mixed outcomes. However, comorbidity consistently predicted lower adherence and engagement. Results regarding psychosocial factors were more stable across studies. Specifically, higher social support was associated with lower adherence and engagement. Finally, intervention-related factors like intervention type or human support showed conflicting results. Adopting an intersectional perspective revealed that specificities vary according to intervention goals and the operationalization of adherence versus engagement, with women being more adherent and engaged than men in interventions targeting distress. When focusing on adherence rather than engagement, older patients were more adherent than younger patients.

CONCLUSIONS

This review highlights the complexity of adherence to and engagement with digital interventions in cancer care. While some factors, notably comorbidities and low social support, were consistently linked to adherence and engagement, others displayed mixed associations. The review underscores the need for standardizing measures, investigating specific intervention features, and enhancing study quality to optimize digital interventions for patients with cancer. Further research is crucial to better understand and improve adherence to digital health solutions in cancer care.

TRIAL REGISTRATION

PROSPERO CRD42021281028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=281028.

Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: protocol for a randomised pilot trial

INTRODUCTION

Cancer-related cognitive impairment is common among people diagnosed with and treated for cancer. This can be a distressing and disabling side effect for impacted individuals. Interventions to mitigate cognitive dysfunction are available, but, to date, most have been trialled in samples that are largely or exclusively composed of people with solid tumours. Intervention strategies to support cognitive functioning are needed, but there is a paucity of research in this area. The main aim of this study is to test the feasibility and acceptability of methods and procedures intended for use in a definitive trial of a web-based cognitive rehabilitation programme, Responding to Cognitive Concerns (eReCog), in people who have received chemotherapy for aggressive lymphoma.

METHODS AND ANALYSIS

The proposed study is a single-site, parallel-group, pilot randomised controlled trial, with one baseline and one follow-up (or postintervention) assessment. 38 people from the target population with low perceived cognitive function based on the Cognitive Change Screen will be recruited from a specialist cancer centre between July 2023 and June 2024. After baseline assessment, participants will be randomised one-to-one to receive usual care only (a factsheet about changes in memory and thinking for people with cancer) or eReCog plus usual care. The 4-week eReCog intervention consists of four online modules offering psychoeducation on cognitive impairment associated with cancer and its treatment, skills training for improving memory, and attention and relaxation training. Study outcomes will include the feasibility of recruitment and retention at follow-up assessment (primary outcomes), as well as adherence to, usability of and intrinsic motivation to engage with eReCog, and compliance with study measures. The potential efficacy of eReCog will also be evaluated.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Peter MacCallum Cancer Centre Human Research Ethics Committee in Victoria, Australia (HREC/97384/PMCC). Study findings will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry, ACTRN12623000705684.

Internet-based cognitive rehabilitation for working cancer survivors: results of a multicenter randomized controlled trial

BACKGROUND

Cognitive problems contribute to decline in work performance. We evaluated (1) the effectiveness of basic self-management and extensive therapist-guided online cognitive rehabilitation on attainment of individually predetermined work-related goals among occupationally active cancer survivors, and (2) whether effectiveness of the programs differed for survivors with and without formal cognitive impairment.

METHODS

In a 3-arm randomized controlled trial (NCT03900806), 279 non-central nervous system cancer survivors with cognitive complaints were assigned to the basic program (n = 93), the extensive program (n = 93), or a waiting-list control group (n = 93). Participants completed measurements pre-randomization (T0), 12 weeks post-randomization upon program completion (T1), and 26 weeks post-randomization (T2). Mixed-effects modeling was used to compare intervention groups with the control group on goal attainment, and on self-perceived cognitive problems, work ability, and health-related quality of life.

RESULTS

Participants in the extensive program achieved their predetermined goals better than those in the control group, at short- and long-term follow-up (effect size [ES] = .49; P < .001; ES = .34; P = .014). They also had fewer recovery needs after work (ES = -.21; P = .011), more vitality (ES = .20; P = .018), and better physical role functioning (ES = .0.43 P = .015) than controls. At long-term follow-up, this finding persisted for physical role functioning (ES = .42; P = .034). The basic program elicited a small positive nonsignificant short-term (not long-term) effect on goal attainment for those with adequate adherence (ES = .28, P = .053). Effectiveness of the programs did not differ for patients with or without cognitive impairment.

CONCLUSIONS

Internet-based therapist-guided extensive cognitive rehabilitation improves work-related goal attainment. Considering the prevalence of cognitive problems in survivors, it is desirable to implement this program.

Web-based psychoeducational interventions for managing cognitive impairment-a systematic review

Objective

Web-based rehabilitation, a branch of telerehabilitation, is carried out over the internet, unrestricted by time or place. Even though web-based interventions have been reported as feasible and effective in cases of mood disorders, for example, such evidence on the effectiveness of web-based cognitive rehabilitation remains unclear. This systematic review summarizes current knowledge on web-based psychoeducational programs aiming to manage cognitive deficits in patients with diseases that affect cognition.

Methods

Using the Ovid database and the Web of Science, we systematically searched the Cochrane Database of Systematic Reviews, Medline, and PsycINFO to identify eligible studies. The review protocol (CRD42021257315) was pre-registered with the PROSPERO International Prospective Register of Systematic Reviews. The search was performed 10/13/2022. Two reviewers independently screened titles, abstracts, and full-texts, and extracted data for the selected studies. Two independent reviewers assessed the methodological quality.

Results

The search retrieved 6,487 articles. Four studies with different patient groups (stroke, traumatic brain injury, brain tumor, and cancer) met the inclusion criteria of this systematic review. The studies examined systematic cognition-focused psychoeducational rehabilitation programs in which the patient worked independently. Three studies found positive effects on subjective cognitive functions, executive functions, and self-reported memory. No effects were found on objective cognitive functions. However, the studies had methodological weaknesses (non-randomized designs, small sample sizes, vaguely described interventions). Overall, adherence and patient satisfaction were good/excellent.

Conclusion

Web-based cognitive intervention programs are a new approach to rehabilitation and patient education. The evidence, although scarce, shows that web-based interventions are feasible and support subjective cognitive functioning. However, the literature to date is extremely limited and the quality of the studies is weak. More research with high-quality study designs is needed.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=257315, identifier: CRD42021257315.

Internet-based cognitive rehabilitation for WORking Cancer survivors (i-WORC): study protocol of a randomized controlled trial

Background

Cognitive problems are common in non-central nervous system cancer survivors. These problems are perceived as an important contributor to decline in work performance and work ability. Various interventions for cognitive problems have been proposed, but effectiveness regarding work-related outcomes has not yet been established. Effective treatment options to alleviate the adverse influence of cognitive problems on work performance are needed for working cancer survivors. In this paper, we will describe the design of a randomized, controlled, multicenter trial that evaluates the (cost-)effectiveness of an Internet-based cognitive rehabilitation program for occupationally active cancer survivors confronted with cognitive problems.

Methods/ design

A three-armed randomized controlled trial will be conducted, including two intervention groups (i.e., basic and extensive cognitive rehabilitation program) and one waitlist control group. In total, 261 cancer survivors (18–65 years) who have returned to work and who experience cognitive problems will be recruited. Patients with and without cognitive impairment as established in a neuropsychological assessment will be eligible; stratification will take place based on the presence of this cognitive impairment. The extensive intervention arm will contain a comprehensive training program (including psycho-education, fatigue management, and cognitive strategy training) with individual guidance (blended intervention). The basic intervention arm will contain a brief cognitive training program (including psycho-education and fatigue management) without individual guidance. The primary outcome will be accomplishment of an individually defined work-related treatment goal. Secondary outcomes include, among others, subjective cognitive functioning, work functioning, and quality of life. Primary and secondary outcomes will be measured at baseline (T0) and at 12 weeks (T1) and 26 weeks (T2) post-randomization.

Discussion

About 40–50% of the cancer patients worldwide are of working age at time of diagnosis. Many of the occupationally active cancer survivors experience cognitive problems. Both from an individual and a societal perspective, it is important to sustain cancer survivors’ employability. An effective treatment to alleviate the impact of cognitive decline and to improve work ability might help cancer survivors to sustain employability.

Trial registration

ClinicalTrials.gov NCT03900806. Registered on 03 April 2019 (current status: ongoing).