Wu, L.M., Amidi, A., Tanenbaum, M.L., Winkel, G., Gordon, W.A., Hall, S.J., . . . Diefenbach, M.A. (2018). Computerized cognitive training in prostate cancer patients on androgen deprivation therapy: A pilot study. Supportive Care in Cancer, 26, 1917–1926.

The purpose of this pilot study is to examine the feasibility, acceptability, and preliminary efficacy of a home-based computerized cognitive training program compared to usual care in patients with breast cancer on androgen deprivation therapy (ADT).

BrainHQ, one hour per day, five days per week for eight weeks or 40 hours total

• N = 60    
• AGE: 66.6 years (SD = 8.5)
• MALES: 60 (100%)  
• FEMALES: 0 (0%)
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Patients with prostate cancer who had received three or more months of ADT 
• OTHER KEY SAMPLE CHARACTERISTICS: 55 (91.7%) were White, well-educated (16.5, SD = 2.8 years) with 24 (40%) annual household income of $110,000 or greater and on average 6.9 years (SD = 5.5) time since diagnosis, and 45.7 months (SD = 49.7) of ADT.

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: Mount Sinai Hospital, New York

PHASE OF CARE: Late effects and survivorship

This was a two-group pilot study which randomized patients with prostate cancer who had been on ADT three months or longer to BrainHQ or usual care. Patents were screened and outcomes assessed at three time points: baseline (T1), immediately after 8 week intervention (T2), and 8 weeks later (T3). Participants were asked to complete 40 hours of training over 8 weeks.

• Feasibility (%) randomized and completed study
• Acceptability: 8-item Client Satisfaction Questionnaire
• CNS Vital Signs (30-minute computer administrated neuropsychological assessment for basic-level functions (reaction time, simple attention, processing speed, and motor speed) and higher-level functions (verbal memory, visual memory, and cognitive flexibility). 
• Patient Assessment of Own Functioning Inventory: 33-item self-report scale

87 of 174 (50%) were screened and consented. 73 completed baseline and 60 met randomization criteria. Retention was 72.5% for intervention and 100% in usual care at T2 and 72.5% and 100% in usual care at T3. 
Overall, 50% randomized; however, less than 70% completed the study (10 hours or greater total of the intervention, results were greater than 70% if non-completers of the intervention were included. Participants were mostly satisfied with training (2.97, SD = 0.53 on scale of 1-4 with 4 being most positive). Most common barriers to training included difficulty finding time to train (n = 16, 52%), tiredness (39%), health problems (35%), boredom (32%), and distraction (16%). Preliminary efficacy of training was mixed: improvement noted in reaction time (p = 0.01); however, was unfavorable on verbal and visual memory. Memory was temporarily suppressed in the training group at T2 but normalized at T3. No effect of training noted on self-reported cognitive functioning, neurobehavioral functioning, nor quality of life.

This study presented tentative support for the feasibility and acceptability of BrainHQ in prostate cancer patients. Preliminary efficacy of BrainHQ was mixed with improvement in reaction times but more research is needed to fully understand efficacy of cognitive training.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Other limitations/explanation: A number of participants did not complete the minimum training requirements of ≥ 10 hours of training over the 8-week period.

Cognitive training using BrainHQ may be feasible and mostly satisfying intervention for prostate cancer survivors. Additional studies are needed to determine efficacy.