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Yan X, Wei S, Liu Q. Effect of cognitive training on patients with breast cancer reporting cognitive changes: a systematic review and meta-analysis. BMJ Open 2023; 13:e058088. [PMID: 36592995 PMCID: PMC9809226 DOI: 10.1136/bmjopen-2021-058088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Cognitive training is a non-drug intervention to improve the cognitive function of participants by training them in different cognitive domains. We investigated the effectiveness of cognitive training for patients with breast cancer reporting cognitive changes. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Cochrane Library, WOS, CINAHL, CNKI, VIP, SinoMed, Wanfang, Grey literature and trial registries were searched (from inception to 1 October 1, 2022). ELIGIBILITY CRITERIA Inclusion of randomized controlled trials (RCTs) assessing the effects of cognitive training on breast cancer patients reporting cognitive changes The primary outcome was subjective cognitive function. Secondary outcomes were objective cognitive functioning (eg, executive functioning and attention) and psychological outcomes(eg, anxiety, depression, and fatigue). DATA EXTRACTION AND SYNTHESIS Two reviewers worked independently to screen the literature, extract data, and assess the methodological quality and risk bias of the included studies. Results are reported as standardizedstandardised mean differences (SMDs) with 95% confidence intervals(CI). Grades of Recommendation, Assessment, Development, and Evaluation(GRADE) were used to assess the quality of evidence. MAIN OUTCOMES AND MEASURES The primary outcome was subjective cognitive function. Secondary outcomes were objective cognitive functioning (eg, executive functioning and attention) and psychological outcomes(eg, anxiety, depression and fatigue). RESULTS A total of 9 RCTs involving 666 patients with breast cancer were included. The frequency of cognitive training varied and the duration was mostly focused on 5-12 weeks. It can be delivered to patients in an individual or group mode, both online and face to face. Meta-analysis revealed that cognitive training aimed at adaptive training in cognitive field has statistically significant effects on improving subjective cognitive function (SMD=0.30, 95% CI (0.08 to 0.51), moderate certainty). Some objective cognitive functions such as processing speed (SMD=0.28, 95% CI (0.02 to 0.54), low certainty), verbal memory (SMD=0.32, 95% CI (0.05 to 0.58), moderate certainty), working memory (SMD=0.39, 95% CI (0.17 to 0.61), moderate certainty) and episodic memory (SMD=0.40, 95% CI (0.11 to 0.69), moderate certainty) were significantly improved after the intervention. In addition, we did not find statistically significant changes in attention, short-term memory, execution function, depression, anxiety and fatigue in patients with breast cancer after the intervention. Subgroup analyses revealed that based on the delivery of individual sessions, the use of web-based cognitive training software may be more beneficial in improving the outcome of the intervention. CONCLUSION Evidence of low to moderate certainty suggests that cognitive training may improve subjective cognition, processing speed, verbal memory, working memory and episodic memory in patients with breast cancer reporting cognitive changes. But it did not improve patients' attention, short-term memory, executive function, depression, anxiety and fatigue. PROSPERO REGISTRATION NUMBER CRD42021264316.
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Affiliation(s)
- Xue Yan
- Lanzhou University School of Nursing, Lanzhou, Gansu, China
| | - Siqi Wei
- Lanzhou University School of Nursing, Lanzhou, Gansu, China
| | - Qianqian Liu
- Lanzhou University School of Nursing, Lanzhou, Gansu, China
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Guran E, Hu J, Wefel JS, Chung C, Cata JP. Perioperative considerations in patients with chemotherapy-induced cognitive impairment: a narrative review. Br J Anaesth 2022; 129:909-922. [PMID: 36270848 DOI: 10.1016/j.bja.2022.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/01/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Abstract
Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.
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Affiliation(s)
- Ekin Guran
- Department of Anaesthesiology and Reanimation, University of Health Sciences, Ankara Oncology Training and Research Hospital, Ankara, Turkey; Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Jian Hu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Caroline Chung
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Juan P Cata
- Anaesthesiology and Surgical Oncology Research Group, Houston, TX, USA; Department of Anaesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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3
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García-Torres F, Tejero-Perea A, Gómez-Solís Á, Castillo-Mayén R, Jaén-Moreno MJ, Luque B, Gálvez-Lara M, Sánchez-Raya A, Jablonski M, Rodríguez-Alonso B, Aranda E. Effectiveness of the Unified Barlow Protocol (UP) and neuropsychological treatment in cancer survivors for cognitive impairments: study protocol for a randomized controlled trial. Trials 2022; 23:819. [PMID: 36175973 PMCID: PMC9524048 DOI: 10.1186/s13063-022-06731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Cancer survivors frequently develop cognitive impairment, which negatively affects their quality of life and emotional well-being. This study compares the effectiveness of a well-established treatment (neuropsychological treatment) with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to reduce these cognitive deficits and evaluate the effect of both treatments on anxiety-depressive symptoms and the quality of life of cancer survivors. Methods A three-arm, randomized superiority clinical trial with a pre-post and repeated follow-up measures intergroup design using a 1:1:1 allocation ratio will be performed. One hundred and twenty-three cancer survivors with mild to moderate cognitive impairment will be randomly assigned to one of the study interventions: a cognitive rehabilitation intervention group, an intervention group with UP intervention, or a control group on the waiting list. The primary outcome is to observe a significant improvement in cognitive function in both intervention groups and a significant decrease in emotional impairments in comparison with the waitlist group. Improvements in anxiety, depression, and quality of life are also expected as secondary outcomes. These results will be maintained at 6 months of follow-up. Discussion The aim of this trial is to test the efficacy of the UP intervention in reducing cognitive deficits in breast cancer survivors. The results of this trial may be useful in reducing the presence of cognitive problems in cancer survivors and improving their emotional state and quality of life. Trial registration ClinicalTrials.gov NCT05289258. Registered 12 March 2022, v01. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06731-w.
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Affiliation(s)
- Francisco García-Torres
- Department of Psychology, University of Cordoba, Cordoba, Spain. .,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.
| | - Adrián Tejero-Perea
- Department of Psychology, University of Cordoba, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | | | - Rosario Castillo-Mayén
- Department of Psychology, University of Cordoba, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Maria José Jaén-Moreno
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Department of Social Health Sciences, Radiology and Physical Medicine, University of Córdoba, Córdoba, Spain
| | - Bárbara Luque
- Department of Psychology, University of Cordoba, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Araceli Sánchez-Raya
- Department of Psychology, University of Cordoba, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Marcin Jablonski
- Collegium Medicum Jan Kochanowski, University in Kielce, Kielce, Poland
| | - Beatriz Rodríguez-Alonso
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain.,Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - Enrique Aranda
- Medical Oncology Department, Reina Sofía University Hospital, Córdoba, Spain
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Oppegaard K, Harris CS, Shin J, Paul SM, Cooper BA, Chan A, Anguera JA, Levine J, Conley Y, Hammer M, Miaskowski CA, Chan RJ, Kober KM. Cancer-related cognitive impairment is associated with perturbations in inflammatory pathways. Cytokine 2021; 148:155653. [PMID: 34388477 PMCID: PMC10792770 DOI: 10.1016/j.cyto.2021.155653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
Cancer-related cognitive impairment (CRCI) is a significant problem for patients receiving chemotherapy. While a growing amount of pre-clinical and clinical evidence suggests that inflammatory mechanisms underlie CRCI, no clinical studies have evaluated for associations between CRCI and changes in gene expression. Therefore, the purpose of this study was to evaluate for differentially expressed genes and perturbed inflammatory pathways across two independent samples of patients with cancer who did and did not report CRCI. The Attentional Function Index (AFI) was the self-report measure used to assess CRCI. AFI scores of <5 and of >7.5 indicate low versus high levels of cognitive function, respectively. Of the 185 patients in Sample 1, 49.2% had an AFI score of <5 and 50.8% had an AFI score of >7.5. Of the 158 patients in Sample 2, 50.6% had an AFI score of <5 and 49.4% had an AFI score of >7.5. Data from 182 patients in Sample 1 were analyzed using RNA-seq. Data from 158 patients in Sample 2 were analyzed using microarray. Twelve KEGG signaling pathways were significantly perturbed between the AFI groups, five of which were signaling pathways related to inflammatory mechanisms (e.g., cytokine-cytokine receptor interaction, tumor necrosis factor signaling). This study is the first to describe perturbations in inflammatory pathways associated with CRCI. Findings highlight the role of cytokines both in terms of cytokine-specific pathways, as well as pathways involved in cytokine production and cytokine activation. These findings have the potential to identify new targets for therapeutics and lead to the development of interventions to improve cognition in patients with cancer.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Carolyn S Harris
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Joosun Shin
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Steven M Paul
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
| | - Alexandre Chan
- School of Pharmacy and Pharmaceutical Sciences, University of California Irvine, 147B Bison Modular, Irvine, CA 92697, USA.
| | - Joaquin A Anguera
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Jon Levine
- School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA; School of Dentistry, University of California, 513 Parnassus Ave, MSB, San Francisco, CA 94117, USA.
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
| | - Marilyn Hammer
- Dana-Farber Cancer Institute, 450 Brookline Avenue, LW523, Boston, MA 02215, USA.
| | - Christine A Miaskowski
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA; School of Medicine, University of California, 675 Nelson Rising Lane, San Francisco, CA 94158, USA.
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park SA5042, Australia.
| | - Kord M Kober
- School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, USA.
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Cui H, Shi X, Song X, Zhang W. Changes and Influencing Factors of Cognitive Impairment in Patients with Breast Cancer. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:7278853. [PMID: 34745299 PMCID: PMC8568554 DOI: 10.1155/2021/7278853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the changes in cognitive function and its influencing factors in patients with breast cancer after chemotherapy, to provide a scientific basis for further cognitive correction therapy. METHODS In this study, general information on age, marital status, and chemotherapy regimen was collected from 172 breast cancer chemotherapy patients. 172 patients with breast cancer undergoing chemotherapy were investigated by convenience sampling method, and the subjects were tested one-on-one using the Chinese version of the MATRICS Consensus Cognitive Battery (MCCB) computer system. RESULTS The mean value of standardized t-value of cognitive function and its abnormal dimensions in breast cancer patients undergoing chemotherapy were MCCB total cognition (66.3%, 36.99 ± 13.06, abnormal), working memory (73.3%, 36.84 ± 10.25), attention and alertness (70.3%, 37.20 ± 12.50), social cognition (65.1%, 39.54 ± 10.17), and visual memory (61.6%, 42.19 ± 9.38). A comparison of cognitive function among breast cancer chemotherapy patients with different demographic characteristics showed that differences in place of residence, educational level, monthly income, timing of chemotherapy, chemotherapy regimen, and chemotherapy times may be associated with abnormal cognitive function. Further multiple linear regression analysis was performed and the results showed that there was a linear regression between literacy, number of chemotherapy sessions, monthly personal income, and cognitive function. CONCLUSION Cognitive impairment is common in patients with breast cancer after chemotherapy. Nurses should pay attention to the cognitive function changes and intervention of patients with breast cancer after chemotherapy, to prevent the changes of cognitive function and promote the rehabilitation of patients.
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Affiliation(s)
- Huixia Cui
- College of Nursing, Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Xusheng Shi
- Department of Intensive Care Medicine, Liaocheng People's Hospital, Liaocheng, Shandong 252000, China
| | - Xiaoxiu Song
- College of Nursing, Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Wenlu Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning 121001, China
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Voelbel GT, Lindsey HM, Mercuri G, Bushnik T, Rath J. The effects of neuroplasticity-based auditory information processing remediation in adults with chronic traumatic brain injury. NeuroRehabilitation 2021; 49:267-278. [PMID: 34420987 DOI: 10.3233/nre-218025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Adults with chronic traumatic brain injury (TBI) may experience long-term deficits in multiple cognitive domains. Higher-order functions, such as verbal memory, are impacted by deficits in the ability to acquire verbal information. OBJECTIVE This study investigated the effects of a neuroplasticity-based computerized cognitive remediation program for auditory information processing in adults with a chronic TBI. METHODS Forty-eight adults with TBI were randomly assigned to an intervention or control group. Both groups underwent a neuropsychological assessment at baseline and post-training. The Intervention group received 40 one-hour cognitive training sessions with the Brain Fitness Program. RESULTS The intervention group improved in performance on measures of the Woodcock-Johnson-III Understanding Directions subtest and Trail Making Test Part-A. They also reported improvement on the cognitive domain of the Cognitive Self-Report Questionnaire. CONCLUSIONS The present study demonstrated that a neuroplasticity-based computerized cognitive remediation program may improve objective and subjective cognitive function in adults with TBI several years post-injury.
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Affiliation(s)
- Gerald T Voelbel
- Department of Occupational Therapy, New York University, New York, NY, USA.,Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Hannah M Lindsey
- Department of Psychology, New York University, New York, NY, USA.,Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - Giulia Mercuri
- Department of Psychology, New York University, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Tamara Bushnik
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
| | - Joseph Rath
- Department of Rehabilitation Medicine, Rusk Rehabilitation at NYU Langone Health, New York, NY, USA
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Computerized programs for cancer survivors with cognitive problems: a systematic review. J Cancer Surviv 2019; 13:911-920. [PMID: 31587187 DOI: 10.1007/s11764-019-00807-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/06/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to review and identify characteristics and lessons learned from studies on computerized cognitive interventions for cancer survivors (CSs) with cognitive dysfunction, exploring the content and results of interventions. METHODS Studies were collected from the CINAHL, Web of Science, PubMed, and PsycINFO databases. RESULTS Seven articles that met the inclusion criteria were included. Reviewed studies measured objective cognitive function, subjective cognitive function, and psychological aspects. Computerized interventions for CSs with cognitive decline were effective for executive function, memory, working memory, and speed of thought in the domain of objective cognitive function. Some subjective cognitive functions also showed significant improvement. CONCLUSIONS Computerized cognitive interventions have a positive impact on objective, subjective, and psychological aspects of cognitive problems. Further research needs to include more men as well as different cancer types. Programs also should include more than one target domain. Future researchers need to develop mobile applications that can effectively use computerized cognitive interventions. IMPLICATIONS FOR CANCER SURVIVORS Results of this study should help provide optimal approaches to develop and apply effective computerized-cognitive-intervention programs. Health care providers need to be involved in these types of interventions and methods to encourage CSs to proactively practice cognitive-function training need to be developed.
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Abstract
Impaired neurocognitive function is an increasingly recognized morbidity in patients who have cancer. Cancer treatments, psychosocial stressors, and the malignancy itself can alter brain function. The mechanisms by which this occurs are under active investigation. Although there is a growing appreciation of its prevalence and causes, there remain limited therapeutic options for the treatment of neurocognitive dysfunction in this population. A persistent scientific and clinical effort to understand its mechanisms and impact is critical to the care of oncology patients.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA.
| | - Jeffrey S Wefel
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, 1400 Holcombe Boulevard, Unit 0431, Houston, TX 77030, USA
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Speed of processing training in middle-aged and older breast cancer survivors (SOAR): results of a randomized controlled pilot. Breast Cancer Res Treat 2017; 168:259-267. [PMID: 29128897 PMCID: PMC5823754 DOI: 10.1007/s10549-017-4564-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 10/29/2022]
Abstract
PURPOSE Cognitive changes are common among breast cancer survivors. There is limited evidence to guide management of cognitive changes. This randomized controlled pilot evaluated the preliminary efficacy of a speed of processing (SOP) training among middle-aged and older breast cancer survivors. METHODS Sixty breast cancer survivors with self-reported cognitive changes were recruited to the SOAR study. Participants were randomized to either a home-based SOP training (n = 30) or no-contact control group (n = 30). Primary outcomes were SOP (Useful Field of View Test®), and executive function (NIH Toolbox Cognition Battery). Neuropsychological assessments were completed at baseline, 6 weeks, and 6 months post study entry. Data were analyzed using repeated measures t tests, analysis of covariance, and sensitivity analyses. RESULTS SOP training resulted in improvement in objective measures of SOP and executive function. Immediate (6 week) posttest and 6-month follow-up demonstrated large SOP training effects over time. Large representation of African American women (51.2%) and 96% retention in the SOAR study add to study strengths. CONCLUSION Home-based SOP training shows promise for remediating cognitive changes following breast cancer treatment, particularly improved SOP, and executive function.
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