November 2, 2016
M.D. Alert
Will Boggs MD

A cognitive rehabilitation program available on the Internet improves self-reported cognitive symptoms after chemotherapy in cancer survivors, researchers report.

“The program is an option for cancer survivors who have cognitive symptoms that they believe are cancer or cancer-treatment related,” Dr. Janette L. Vardy from Sydney Medical School, University of Sydney, Australia, told Reuters Health by email. “Our participants had all received adjuvant chemotherapy 6-60 months previously.”

“Up to 70% of cancer survivors report cognitive symptoms after a cancer diagnosis and/or cancer treatment,” she explained. “For many the symptoms improve over the first six months after treatment has ended, but a subgroup of cancer survivors experience ongoing symptoms that can greatly impact their daily life and cause them high levels of distress.”

Dr. Vardy’s team evaluated the efficacy of a Web-based cognitive rehabilitation program called Insight versus standard care in a randomized trial of 242 cancer survivors self-reporting cognitive symptoms after completion of curative chemotherapy for a primary solid malignancy.

After the 15-week intervention, patients assigned to the Insight program reported significantly better perceived cognitive abilities and significantly less impact on their quality of life from perceived cognitive impairment, as well as fewer comments from others suggesting that they had cognitive impairment, compared with those assigned to standard care.

The differences in perceived cognitive abilities and quality-of-life impact persisted six months later, the researchers report in the Journal of Clinical Oncology, online October 28.

At the end of the intervention, patients using Insight reported significantly lower levels of anxiety/depression, fatigue, and perceived stress, and their global quality-of-life was significantly better six months later.

The two groups did not differ significantly in objective neuropsychological function as assessed by Cogstate.

“It is important to note that there is only a weak association between cognitive symptoms and cognitive impairment measured by neuropsychological tests,” Dr. Vardy said. “We do not yet have robust evidence to guide how to treat the objective cognitive impairment found in ~30% of survivors. Patients with ongoing cognitive problems should be assessed by a neuropsychologist.”

Among patients assigned to the Insight intervention, 14% never started it, and only 27% completed the program in the recommended 15-week timeframe. The average total training time was 25.08 hours of a recommended 40 hours, but there was no evidence of a dose response in the outcome measures.

“Regardless of the lack of association generally seen between the cognitive symptoms and the neuropsychological test results, patients are distressed by the symptoms,” Dr. Vardy concluded. “The Insight program is a relatively low-risk and low-cost intervention that may alleviate survivors’ cognitive symptoms and their distress.”