We now know that as many as 70% of patients treated with chemotherapy experience cognitive impairment, and that cognitive impairment is associated with increased anxiety, depression, fatigue, and reduced quality of life. While much is known about its incidence and effects, much less is known about how this condition, sometimes referred to as “chemobrain,” can be treated.
Researchers at 18 sites in Australia evaluated a web-based cognitive rehabilitation program called Insight and compared it with standard care in cancer survivors self-reporting cognitive symptoms. Insight is a computerized neurocognitive learning program, based on the neuroplasticity model, which uses adaptive exercises targeting processing systems aimed at improving cognition through speed and accuracy of information processing.
Before random assignment, all 242 participants participated in a 30-minute structured telephone consultation outlining cognitive compensatory strategies. Standardized scripts were developed outlining cognitive training strategies in 4 areas: general cognition, memory, concentration, and multitasking. Participants were randomly assigned to the 15-week, web-based intervention, completed at home, or to standard care.
The primary outcome of difference in self-reported cognitive function (measured using the Functional Assessment of Cancer Therapy Cognitive Function perceived cognitive impairment [PCI] tool) was significant, with less PCI in the intervention group upon completion of the Insight program. This difference was sustained at the 6-month follow-up period. There were significantly lower levels of anxiety, depression, and fatigue in the intervention group upon completion of the Insight program. The intervention group also reported a better quality of life at the 6-month follow-up.
This study may be one of the first large randomized controlled trials investigating interventions for chemotherapy-induced cognitive impairment. The Insight web-based program led to improvements in cognitive symptoms compared with standard care, and may be an effective and cost-effective treatment. The study findings are available here.