Cognitive Training - Group

Cognitive Training - Group

PEP Topic 
Fatigue
Description 

Cognitive training is any intervention aimed at improving, maintaining, or restoring mental function through the repeated and structured practice of tasks which pose an inherent problem or mental challenge. Group cognitive training is provided to individuals in a group setting.

Effectiveness Not Established

Research Evidence Summaries

Cherrier, M.M., Anderson, K., David, D., Higano, C.S., Gray, H., Church, A., & Willis, S.L. (2013). A randomized trial of cognitive rehabilitation in cancer survivors. Life Sciences, 93, 617–622.

doi: 10.1016/j.lfs.2013.08.011
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Study Purpose:

Test the effects of a group cognitive rehabilitation program on memory and attention in cancer survivors

Intervention Characteristics/Basic Study Process:

Patients randomly were assigned to the treatment or a wait-list control group. The intervention consisted of hourly trainings that incorporated didactic teaching methods, focusing primarily on memory aids and skills, as well as mindfulness meditation. A portion of each session was dedicated to reviewing and practicing skills.  The intervention was offered weekly over seven consecutive weeks, delivered in a group format. Homework was assigned to the participants with the expectation that they practice the intervention independently at home. Objective measures were evaluated twice at baseline (in an attempt to eliminate potential practice effects) and one month after completion of the intervention. Subjective measures were evaluated at baseline and one month after completion of the intervention. Control group participants underwent subsequent testing seven to eight weeks after their initial evaluation.

Sample Characteristics:

  • N = 28    
  • MEAN AGE: 58.9 years (SD = 2.4 years)
  • MALES: 7%, FEMALES: 93%
  • KEY DISEASE CHARACTERISTICS: All subjects had completed cancer therapy at least six months ago and had concerns about their cognitive functioning.

Setting:

  • SITE: Single site  
  • SETTING TYPE: Outpatient    
  • LOCATION: Fred Hutchison Cancer Research Center, Seattle, WA

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Late effects and survivorship
  • APPLICATIONS: Late effects and survivorship

Study Design:

Randomized clinical trial

Measurement Instruments/Methods:

  • Functional Assessment of Cancer Therapy-Cognition (FACT-Cog)
  • Rey Auditory Verbal Learning Test
  • Stroop Color and Word Test
  • Wechsler Adult Intelligence Scale (WAIS)-Digit Symbol Subtest
  • WAIS-Digit Span Subtest
  • Patient Health Questionnaire-9 (PHQ-9)
  • Beck Anxiety Inventory (BAI)
  • Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue)

Results:

Patients who received the cognitive rehabilitation intervention had improvements in perceived cognitive function (p < 0.01), perceived cognitive abilities (p < 0.01), and cognitive quality of life (p < 0.01) as measured by the FACT-Cog and in one measure of attention, digit span backward (p < 0.01). In contrast, differences were not found between the treatment and control groups in other objective measures of cognition. No significant differences between groups over time were found for anxiety, depression, or fatigue.

Conclusions:

Findings from this study suggest that cognitive rehabilitation may improve attention and perceived cognitive functioning, but not memory, in patients with cancer. The fact that significant differences were not found in anxiety, depression, or fatigue suggests that they were not related to the any improved cognitive functioning.

Limitations:

  • Small sample (< 30)
  • Risk of bias (no appropriate attentional control condition)
  • Intervention expensive, impractical, or training needs
  • Subject withdrawals ≥ 10%
  • Feasibility may be an issue. In addition, the results may be influenced by subject withdrawal prior to the completion of the intervention as well as variability in the number of sessions attended (may indicate that the “treatment” is too burdensome).

Nursing Implications:

Although this study found improvements in perceived cognitive function and one objective measure of attention, it was underpowered and patient compliance was inconsistent. Further research with larger sample sizes is warranted to determine effectiveness. In addition, longer follow-up is required to determine the sustainability of any improvements in cognitive functioning.


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