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New online intervention improves cognitive problems in cancer survivors

October 31st, 2016

A new study led by University of Sydney scholars and published today in the Journal of Clinical Oncology, has found that cancer survivors may be able to reduce their cognitive symptoms with use of an online program that targets attention, memory and visual skills.

Up to 70 per cent of cancer patients report cognitive symptoms following chemotherapy. These symptoms have been linked to poorer quality of life and increased depression, anxiety, and fatigue among cancer survivors.

This deterioration in cognitive function, commonly referred to as ‘chemobrain’ or ‘chemofog’, was largely unacknowledged by the medical profession until recent years.  It has now been termed ‘cancer induced cognitive impairment’ as it can occur prior to receiving chemotherapy.

The study examined 242 adult cancer patients who had completed three or more cycles of chemotherapy in the previous five-years, who self-reported cognitive symptoms indicated by changes in concentration and/or memory. Women with breast cancer made up 89 per cent of study participants.

All participants were randomly assigned to either the online neurocognitive learning program or standard care from their treating physician. The two groups were compared at baseline, immediately after the intervention (15 weeks) and at six months.

“Cancer induced cognitive impairment for cancer patients is a real problem and there is
little evidence to guide how best to treat it,” said study author Victoria J. Bray,
MD, Medical Oncologist and PhD candidate at The University of Sydney.

“We know there is a poor association between cognitive symptoms and impairment assessed on formal cognitive testing. Our study shows that survivors who used the online neurocognitive learning program had improved cognitive symptoms compared to survivors who received standard care immediately after treatment and at six months. This gives us a new option for treatment of cognitive symptoms, even though we did not find a difference in the objective cognitive testing”.

Cancer Council NSW’s Lead Supportive Care Manager, Hannah Baird, said that often the memory and day-to-day problems experienced by people following chemotherapy are dismissed as the result of dealing with the stress of coping with cancer treatment.

“For a lot of people we hear from who have been through cancer treatment, day-to-day functioning issues are very real. Many people say they have difficulty concentrating, focusing and remembering things. The cancer experience does not end on the last day of treatment – the reality is that people often have to adapt to a different way of living,” says Ms Baird.

Dr Alessandra Muntoni, Director of Research Investment at the National Breast Cancer Foundation said the outcomes are important for breast cancer survivors.

“With survival rates for breast cancer constantly increasing and more than
170,000 women and men living with the aftermath of breast cancer diagnosis and treatment[1],
research to improve their quality of life has the potential to make a
life-changing difference,” said Dr Muntoni.

While this is the largest cognitive intervention study in patients with cancer, there are still a number of other unanswered questions to be addressed in future research.

“If we could identify patients who are at risk of cognitive impairment, we could intervene earlier, and possibly achieve even better results. We would also like to explore whether there is added benefit from combining cognitive training with physical exercise,” said Dr. Bray.

The independent three year study was funded by Cancer Council NSW, with funding also from Friends of the Mater Foundation. The National Breast Cancer Foundation assisted with study recruitment and funding for Dr Janette Vardy.

[1] http://www.aihw.gov.au/cancer/breast/