Oh, P.J., & Kim, J. 2016. The effects of nonpharmacologic interventions on cognitive function in patients with cancer: A meta-analysis. Oncology Nursing Forum, 43, E205–E217. 

DOI Link

Purpose

STUDY PURPOSE: To examine nonpharmacologic intervention effects on cognitive function in adult survivors of cancer, and to examine whether these effects are driven by psychological or behavioral intervention types

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: EMBASE, MEDLINE, CINAHL, Cochrane Library CENTRAL, Korean databases, Google Scholar, reference lists of screened studies
 
INCLUSION CRITERIA: Subjects aged 18 years or older with any cancer diagnosis of any stage. Nonpharmacologic interventions were classified as psychological (e.g., meditation, cognitive behavioral therapy) or behavioral (e.g., physical exercise, gentle movement) for the prevention or amelioration of cognitive deficits following chemotherapy. Randomized, controlled trials (RCTs) and non-RCTs that compared standard of care, attention, or placebo control arms were considered for inclusion. Outcomes included objective or subjective measures of cognitive function. Dates included the earliest publication date available through November 2014.
 
EXCLUSION CRITERIA: Concomitant administration of pharmacologic and nonpharmacological interventions

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 4,360 articles were initially retrieved and screened after eliminating duplicates.
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Bias Method Group Risk of Bias Scale was used to assess five sources of bias (selection, performance, attrition, detection, reporting) for a high, low, or unclear risk determination. The authors assessed intervention monitoring procedures and manual use. Meta-analysis were performed to calculate mean effect sizes (d), heterogeneity (I2) among studies, and publication bias (funnel plot, Egger’s test).

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 14 systematic reviews,11 meta-analyses
  • TOTAL PATIENTS INCLUDED IN REVIEW = 977
  • SAMPLE RANGE ACROSS STUDIES: 13–157 patients 
  • KEY SAMPLE CHARACTERISTICS: The mean age was 53.1 years. Cancer diagnoses were breast (n = 7), glioma (n = 3), mixed diagnoses (n = 3), and hematologic (n = 1). Stage not mentioned (n = 4), stage I–III (n = 7), all stages (n = 3)

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care
 
APPLICATIONS: Elder care

Results

Eleven studies used psychological interventions, and three used behavioral interventions. All studies used standard care control groups, with intervention durations of two weeks to more than one year that included an average of 16 one-hour sessions. Psychological interventions used individual-based cognitive rehabilitation (n = 10) with three using computer-based retraining programs. Outcomes included subjective cognitive function (n = 5), attention (n = 6), memory (n = 8), executive function (n = 7), verbal ability (n = 3),  and multiple domains (n = 7). Low risk bias assessments: Rrandomization (n = 5), allocation concealment (n = 3), blinded participants or personnel (n = 2), blinded personnel conducting outcome assessment (n = 4), attrition (n = 12), reporting bias (n = 14), monitoring procedures, and manual use (n = 13). Statistical heterogeneity ranged from none to moderate (I2 = 0%–68%). Significant treatment effects existed for nonpharmacologic interventions on memory (n = 8, d = 0.21, 95% confidence interval [CI] [0.04, 0.38], p = 0.02, I2 = 0%) and perceived cognitive function (n = 5, d = 0.41, 95% CI [0.2, 0.61], p < 0.001, I2 = 0%). Subgroup analysis for psychological interventions was significant for effect on perceived cognitive function (n = 3, d = 0.35, 95% CI [0.13, 0.58], p = 0.002, I2 = 0%).

Conclusions

The treatment effects of nonpharmacologic interventions significantly improved memory and perceived cognitive function. The meta-analysis indicated that psychological interventions significantly improved perceived cognitive function. No treatment effects from other interventions were observed, and no effects on cognitive performance in domains of executive function, attention, and verbal ability were observed. Most studies reviewed in this meta-analysis did not provide sufficient evidence to demonstrate improvement in cognitive performance. Further study is warranted using RCT designs to increase the sample pool to observe positive treatment effects.

Limitations

  • Limited number of studies included
  • Low sample sizes

Nursing Implications

Nonpharmacologic interventions, specifically those involving psychological interventions, have demonstrated improvements in memory and self-reported cognitive function in adult survivors of cancer.

Legacy ID

6238