Web-Based Exercises May Ease Chemobrain

Online mental exercises showed an improvement in cognitive function for patients with cancer who were facing treatment-related cognitive impairment, according to research published in the Journal of Clinical Oncology.

Study author, Victoria J. Bray, M.D., said in a statement that these findings are the first from a randomized trial to show a benefit for patients with persistent cognitive symptoms after chemotherapy — also known as “chemobrain”— a problem that affects up 70 percent of cancer survivors. Bray is a medical oncologist and Ph.D. candidate at the University of Sidney in Australia where the study was carried out at 18 sites between 2009 and 2014.

The trial enrolled 242 patients with solid tumors: 89 percent had breast cancer, 5 percent colorectal cancer and 95 percent of the participants were women; the median age of all participants was 53 years. Eligible patients had to have completed at least three cycles of adjuvant chemotherapy in the prior six months to five years and rated their cognitive complaints (changes in concentration and/or memory) “quite a bit” or more along a cognitive function scale. Patients were evaluated at baseline, 15 weeks and six months after the intervention.

For the study, participants were evenly randomized to standard oncology care or cognitive rehabilitation using Insight (brainHQ, Posit Science) —a computerized program that employs adaptive exercises targeted at areas of cognition often impacted in patients with cancer, such as divided attention, working memory, and visual processing speed. Those assigned to the intervention arm were asked to do 40 hours of the exercises over 15-weeks, which is equivalent to four 40-minute sessions each week.

Among the program’s advantages cited by researchers is that it is home-based, relatively inexpensive and empowers participants to direct their own treatment.

To measure the tool’s effectiveness, researchers used assessments previously validated in the oncology setting. For the primary outcome of perceived cognitive impairment (PCI) after 15 weeks, participants answered the 37-item questionnaire FACT-COG. For the main secondary outcome of neuropsychological function, they completed Cogstate, a battery of seven tests that can be performed on the computer at home. That assessment takes about 18 minutes and gauges cognition in such areas as processing speed, working memory, decision making and executive function.

Researchers found that after 15 weeks, patients who did the exercises had a reduction of 7.47 in PCI compared with those in the control arm, and this difference persisted after six months, when a —6.48 reduction in PCI was observed in the intervention arm.

Perceived cognitive abilities at 15 weeks also significantly improved among those doing the web exercises and continued to be better after six months. In addition, participants' quality of life was improved six months after participants finished the program.

"Cognitive rehabilitation should be a core part of cancer survivorship care, as cognitive symptoms are very common and have a profound effect on people's lives,” Patricia Ganz, M.D., of UCLA’s Jonsson Comprehensive Cancer Center and ASCO expert in survivorship, noted in a statement. “This study points to a simple tool that may help alleviate mild cognitive problems."

Objective neuropsychological function test results were not significantly different between the two groups. However, the researchers suggested caution in interpreting this finding, as several participants had difficulty installing and re-accessing Cogstate.

Researchers were also interested to find out what, if any, effect the intervention had on participants’ levels of anxiety/depression, fatigue and stress, as all have been shown to be associated with patients’ assessments of their cognitive impairment. Each of these symptoms improved among those doing the web-based exercises.

In the intervention arm, reductions in anxiety/depression and fatigue were reported at 15 weeks, but the differences were not significant at six months. On the measure of perceived stress, however, the intervention yielded a significant reduction at both time points.

Study authors note that longer follow-up is needed to determine if the effects of the training are long-lasting. In addition, a number of unanswered questions remain for future research, including how to tailor intervention approaches to specific survivors. For example, a self-directed program such as this one may be suitable for some survivors, whereas a group-based program may work better for others. The ideal length and "dose" of cognitive training also has not yet been determined.

"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 Bray.