Damholdt, M.F., Mehlsen, M., O'Toole, M.S., Andreasen, R. ., Pedersen, A.D., & Zachariae, R. (2016). Web-based cognitive training for breast cancer survivors with cognitive complaints—A randomized controlled trial. Psycho-Oncology, 25, 1293–1300. 

To investigate the use of a web-based cognitive training intervention for subjective and objective cognitive complaints in breast cancer survivors

HAPPYneuron Pro^© (Scientific Brain Training, Villeurbanne Cedex, France) is a customized 12-task training program of 6 cognitive domains (attention, processing speed, learning, memory, working memory, problem solving) involving 10 levels of difficulty. The program required a minimum commitment of 30 minutes a day for 5 days a week for 6 weeks.

• N = 157   
• MEAN AGE = 54.77 years (SD = 8.62)
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable
• KEY DISEASE CHARACTERISTICS: Breast cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Recruited from existing cohort of 682 breast cancer survivors with subjective cognitive complaints and Internet access

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Aarhus University Hospital, Denmark

PHASE OF CARE: Late effects and survivorship

Randomized, waitlist controlled, pretest–post-test design

• Paced Auditory Serial Addition Test (PASAT)-primary outcome working memory 
• Cognitive Failures Questionnaire (CFQ)-secondary outcome perceived cognitive function
• Neuropsychologic battery for other cognitive outcomes: Rey Auditory Verbal Learning Test (RAVLT) (verbal memory and learning), Digit Span Forward and Backward (working memory), letter fluency test
• 20 Question Test, and cognitive estimation task (CET) (executive function)
• Wechsler Adult Intelligence Scale (WAIS) (premorbid intelligence estimate)
• Beck Depression Inventory (depression)
• Whiteley-7 subscale from Common Mental Disorders Questionnaire (somatization, illness worrying, and conviction)
• SCL-ANX4 from Symptoms Checklist-92 of the Common Mental Disorders–Screening Questionnaire (anxiety)
• Likert-type scale rating of self-reported benefit from the intervention

Web-based cognitive training did not improve function for the PASAT-measured domain of working memory or the CFQ-measured secondary outcome of perceived cognitive function. Improvement was demonstrated for cognitive function on two other neuropsychologic measures for verbal learning (RAVLT) (F [2, 272.1] = 3.2, p = 0.043) and working memory (digit span backward) (F [2, 272.6] = 3.3, p = 0.04).

Primary and secondary outcomes were not achieved, but web-based cognitive training was associated with improvement onone test of verbal learning and one test of working memory. Further study with instruments validated for phone administration may be warranted.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Measurement validity/reliability questionable
• Not all measures were validated for phone administration.
• No webcam access to assure no cheating by participants

The web-based cognitive training intervention was well received by participants and not burdensome to administer in terms of costs. Small improvements were noted for some cognitive measures in the intervention group, and further study may be warranted.