Computerized Cognitive Rehabilitation

The purpose was to compare results of a cognitive rehabilitation program to standard care in patients reporting cognitive symptoms.

All subjects participated in a 30-minute telephone consultation outlining cognitive compensatory strategies prior to study group assignment. Patients were randomly assigned to intervention and control groups. The intervention was a computerized neurocognitive program targeting visual precision, divided attention, working memory, and visual processing speed, which was provided as a CD. Patients were to use training for four 40-minute sessions per week for 15 weeks. The program had an automated measure of compliance. Study assessments were completed by patients at baseline, after 15 weeks, and 6 months later.

• N = 242 in ITT analysis   
• AGE: Range 23-74 years, median 53
• MALES: 5%  
• FEMALES: 95%
• KEY DISEASE CHARACTERISTICS: Solid tumors; had completed definitive treatment within a mean of 27 months reporting quite a bit of changes or greater in concentration or memory on the EORTC QLC–C30 cognitive function scale. The majority had breast cancer. About 70% were on hormone therapy.

• SITE: Multisite   
• SETTING TYPE: Outpatient    
• LOCATION: Australia

PHASE OF CARE: Late effects and survivorship

Longitudinal randomized clinical trial

• FACT-COG questionnaire
• Cogstate computerized testing
• General Health Questionnaire (for anxiety and depression)
• FACT-General 
• FACT-Fatigue 
• Perceived Stress Scale

Only 86% of those in the intervention group used the program. Average total training time was 25 hours of the recommended 40 hours. Patients in the intervention group had better outcomes on the FACT-Cog compared to controls at 15 weeks on all subscales with better perceived cognitive abilities (p < 0.001), less perceived cognitive impairment (p < 0.001) with less impact on quality of life (p = 0.02), and less comments from others regarding cognitive functioning (p = 0.04). However, these differences were sustained at six months only for perceived cognitive impairment (p = 0.001) and perceived cognitive abilities (p < 0.001) but not for the other subscales. Similarly, those in the intervention group had less anxiety and depression (p = 0.02), fatigue (p = 0.03), and perceived stress (p = 0.03) at 15 months. Differences remained only for perceived stress (p = 0.01) at six months. There were no differences between groups in Cogstate measures of neuropsychological function. There was no evidence of dose response for training time and patient outcomes.

The computerized cognitive rehabilitation program tested here showed benefit in terms of patient-reported outcomes of cognitive function but no effect on objective measures of neuropsychological function. There were short-term improvements in anxiety, depression, and fatigue with the intervention that were not sustained.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Measurement validity/reliability questionable
• Intervention expensive, impractical, or training needs
• Other limitations/explanation: Single-scale scores were used for measurement of anxiety and depression outcomes. 14% of the intervention group never used the program, raising the question of overall usefulness for a variety of patients. There were varied numbers of patients lost to follow-up at various time points with different measures and it is not clear which participants and results were included in ITT analysis.

Findings suggest that computerized cognitive rehabilitation may improve patient perceptions of cognitive functioning; however, these findings were not consistent with objective measures. Actual benefit of computerized cognitive training for cancer treatment-related cognitive impairment remains unclear.