November 1, 2016
The American Journal of Managed Care
Surabhi Dangi-Garimella, PhD

Cognitive impairment is a very common complaint among patients with cancer who have undergone chemotherapy. Now, a new study suggests that a Web-based intervention could improve a cancer survivor’s cognitive function.

Impaired cognitive function can impact a patient’s quality of life (QOL) and can result in depression, anxiety, and fatigue. In the absence of a documented correlation between neuropsychological testing results and cognitive symptoms, treatment remains a challenge. With the hope of addressing this issue, researchers in Australia have created a cognitive rehabilitation program: Insight.

The program was tested in 242 adult cancer survivors with a primary malignancy (not associated with the central nervous system) who had been treated with at least 3 cycles of adjuvant chemotherapy in the previous 6- to 60-month period. A complaint of persistent cognitive symptoms was a prerequisite for trial participation. While adjuvant endocrine treatments were permitted for patients with breast cancer, radiotherapy and targeted therapies had to be completed at least 3 months before participating in the study. Prior malignancy, diagnosis of an unstable psychiatric condition, and existing major cognitive disorder were grounds for exclusion.

Following a 30-minute phone consult, participants were randomly assigned (1:1) to a 15-week, home-based intervention or to standard care. Primary outcome for the trial was self-reported cognitive function (Functional Assessment of Cancer Therapy Cognitive Function [FACT-COG] perceived cognitive impairment [PCI] subscale), evaluated as the difference in function between the groups after completing a 15-week intervention (T2) and after 6 months (T3).

The researchers observed less PCI in the intervention group at T2 (P <.001), which was sustained at T3 (P <.001). At T2, significant difference in all the FACT-COG subscales were indicative of a successful intervention, the authors write. Further, levels of anxiety, depression, and fatigue were lower in the intervention group at T2, while stress was significantly lower at both time points.

The intervention group also gained on QOL at the 6-month mark.   “The intervention, Insight, led to improvements in cognitive symptoms compared with standard care,” the authors conclude, “indicating that this intervention is a feasible treatment.”