Von Ah, D., Carpenter, J.S., Saykin, A., Monahan, P., Wu, J., Yu, M., . . . Unverzagt, F. (2012). Advanced cognitive training for breast cancer survivors: A randomized controlled trial. Breast Cancer Research and Treatment, 135, 799–809.

To evaluate the efficacy of memory and speed of processing training for improving cognitive function in breast cancer survivors

Patients were randomly assigned to one of three groups: training in speed of processing, memory training, or a wait list control group. The intervention included 10 one-hour sessions of memory and speed of processing training delivered in small groups of three to five patients over six to eight weeks. Specific intervention strategies were adapted from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trials. Follow-up was done at two months.

• A total of 82 patients participated in the study.
• Participants' mean age was 56.6 years (SD = 8.5 years).
• The sample was 100% female.
• All patients were diagnosed with breast cancer and had received surgery and chemotherapy. The mean time since treatment was 5.5 years.

• Single site
• Outpatient setting
• United States

Patients were in the late effects and survivorship phases of care.

Single-blind, three-group randomized controlled trial

• Rey Auditory Verbal Learning Test
• Rivermead Behavioral Paragraph Recall test
• Useful Field of View for speed of processing
• Functional Assessment of Cancer Therapy–Cognitive (FACT–Cog)
• Squire Subjective Memory Questionnaire
• Center for Epidemiological Studies Depression Scale
• Spielberger State–Trait Anxiety Inventory
• FACT–Fatigue
• Quality of Life Cancer Survivors
• Short Form-36

The memory training group demonstrated better immediate (d = 0.59, p = 0.036) and delayed memory performance (d = 0.70, p = 0.013) at the two-month follow-up compared to the control group. Those trained in speed of processing improved immediate memory post-intervention (d = 0.75) and at the two-month follow-up (d = 0.82) (p < 0.01). The memory and speed of processing training groups had significant improvement in perceived cognitive functioning on questionnaires. Compared to controls, speed of processing training was associated with lower symptom distress. Memory training also had a positive effect on anxiety at the two-month follow-up (p = 0.017)

Memory and speed of processing training had significant positive effects on objectively measured and perceived cognitive function among female breast cancer survivors.

• The sample was small at less than 100.
• A lack of blinding and no appropriate attentional control condition introduced a risk of bias.
• The findings not generalizable because of the highly specific sample group. The findings may not be applicable to other groups of patients or at other time points in the cancer trajectory.
• The training needs to be delivered by individuals educated in the process.

Cognitive training as provided here had a significant and at least a moderate positive effect on cognitive function in breast cancer survivors. Cognitive deficits with cancer treatment have substantial negative impacts on quality of life and functioning. Cognitive training is a promising intervention to address these problems.