Poppelreuter, M., Weis, J., & Bartsch, H.H. (2009). Effects of specific neuropyschological training programs for breast cancer patients after adjuvant chemotherapy. Journal of Psychosocial Oncology, 27(2), 274–296.

The study was conducted to evaluate the need of patients with breast cancer for neuropsychological rehabilitation after adjuvant chemotherapy. It also sought to determine the effectiveness of differentiated training programs after completion of treatment.

Participants were randomly assigned to one of two intervention groups. Control participants were selected from the “time-out” phase of the study when no training was being offered.

Both intervention groups took part in four one-hour training sessions per week during their inpatient stay. Participants were randomized to one of the following outpatient interventions.

1. Neuropsychiatric Training Group (NPT). A maximum of eight participants met with a specialized occupational therapist to work on improving attention and memory through situations specifically designed to reflect the demands of everyday life. They received practice in compensational strategies and specific techniques to improve their performance in these everyday situations, and reflected on their personal experiences.
2. Computer-based training (PC). Participants received individualized computer-based training with continuous therapeutic supervision. The software addressed specific attention and memory dimensions in eight modules. Following the PC training, participants also received individualized coaching according to their specific impairments.

Measures were completed upon admission to the rehabilitation unit (T1), at the end of in-patient rehabilitation (T2), and six months later on an outpatient basis (T3). 

• The number of participants was 90.
• All participants were female.
• All participants had breast cancer, with an average of 9.01 months since diagnosis and 2.06 months since the conclusion of chemotherapy.
• There were 33 participants in the NPT intervention group, 32 in the PC intervention group, and 25 in the control group.
• The average participant age was 49.19 ± 7.71 years.
• 16.7% of participants had a university degree, with only 3.1% not professionally trained.
• Participants were predominately receving chemotherapy with anthracyclines; most had postoperative localized radiation therapy and adjuvant antihormonal therapy.
• Individuals were exclused from the study if they were older than 64 years; had psychiatric mental health disorders or other cancer, psychiatric, or neurologic problems; or were currently using psychoactive medications.

The study took place at the Tumor Biology Center Rehabilitation Unit in Freiburg, Germany.

The study utilized a randomized, controlled trial.

• Questionnaire of Self-Perceived Deficits in Attention (FEDA) for attention
• Test Battery for Attentional Performance (TAP) for attention
• Digit Span for attention
• Wechsler Memory Scale-Revised for memory
• Rivermead Behavoral Memory Test (RBMT) Immediate and Delayed Story Recall for memory
• Learning and Memory Test (LGT-3) for memory
• Multidimensional Fatigue Inventory (MFI) for mental fatigue, activity, and motivation
• Hospital Anxiety and Depression Scale (HADS) for anxiety and depression
• European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - 30 (EORTC QLQ-30) for global and functional quality of life. The EORTC QLQ-30 uses six subscales (global, physical, role, cognitive, emotional, social functioning). Scores range from 0–100, with higher scores indicating higher quality of life.

No intervention effects were noted in this study. Significant improvement was noted in 11 of 16 neuropsychiatric parameters for all three groups between T1 and T2. Forty participants (44.4%) maintained at least one cognitive deficit at five months; 19 (21.1%) maintained two or more deficits at T3.

Both intervention groups received similar amounts of training sessions. Eighty-four participants (87.5%) had at least one impaired neuropsychological parameter and 54 (56.2%) had two or more at baseline.

No significant differences in cognitive ability between treatment groups were reported.

• The study lacked a clear description of the PC intervention.
• The use of an inpatient setting and the timing of interventions may have affected the outcome.
• The study did not address practice effects with repeated testing over time.