Rehab Program Improves Some Outcomes in Survivors With Cognitive Deficits

A cognitive rehabilitation program known as Insight resulted in improvements in cognitive symptoms compared to standard care in adult cancer survivors, according to a randomized trial.

“Up to 70% of patients with cancer report cognitive symptoms after chemotherapy,” wrote study authors led by Janette L. Vardy, MD, of the Concord Cancer Centre in Concord, Australia. “The cause remains poorly understood, and there are no proven treatments.”

Cognitive rehabilitation programs have been shown to improve function in patients with traumatic brain injury, but their evaluation in cancer survivors has been limited. The new study randomized 242 adult cancer survivors (excluding central nervous system cancers) who had received at least 3 cycles of adjuvant chemotherapy in the previous 6 to 60 months to either standard care or the Insight cognitive rehabilitation program. The program is computer-based and is used at home.

The intervention was assessed using the Functional Assessment of Cancer Therapy Cognitive Function (FACT-COG) perceived cognitive impairment (PCI) subscale. The results were published online ahead of print in the Journal of Clinical Oncology.

The median age of participants was 53 years, and 95% were female; the most common malignancy was breast cancer (89%), followed by colorectal cancer (5%). The primary outcome of FACT-COG PCI was significantly less in the intervention group following the intervention (P < .001), and this was sustained after 6 months (P = .001).

Perceived cognitive abilities were better with the intervention both immediately following it (P < .001) and after 6 months (P < .001). Those receiving the intervention reported less impact on quality of life due to PCI at both those time points, and fewer comments from others suggesting they had cognitive impairment after the intervention but not 6 months later.

The secondary outcome of neuropsychological function was no different between the two groups, though the authors cautioned that these results were missing data. There were significantly lower levels of anxiety/depression in the intervention group following the intervention (P = .02), though the difference was not significant 6 months later (P = .06); the same was true of fatigue. Global quality of life was the same immediately following the intervention, but better in the intervention group 6 months later.

“To date, there has been a large unmet need for effective treatment options for cancer survivors experiencing cognitive symptoms after chemotherapy treatment,” the authors wrote. The Insight program has the advantages of being relatively inexpensive and home based, allowing survivors to direct their own therapy. “The program has the potential to provide a new treatment option for patients with cancer with cognitive symptoms, where previously none existed.”