Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity
Abstract
:Simple Summary
Abstract
1. Introduction
2. Objectives
- Are computerized physical activity, computerized cognitive stimulation or combined interventions efficient to improve cancer-related cognitive impairment?
- What are the risks of bias of the existing studies? Additionally, what is the level of quality of the evidence?
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- Population: Participants living with cancer (adults and children).
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- Intervention: computerized physical activity, computerized cognitive stimulation and combined intervention.
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- Comparisons: usual care, wait-list group or any other intervention other than computerized intervention.
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- Outcome: cognitive functioning.
3. Materials and Methods
3.1. Search Strategy
3.2. Selection Process
3.3. Data Extraction
3.4. Quality Assessment and Risk of Bias
4. Results
4.1. Computerized Cognitive Stimulation
4.1.1. Characteristics of Studies
- Population: Five studies included breast-cancer patients [43,46,49,51,56], six did not focus on a specific type of cancer [44,47,50,53,54,55], four included patients with brain cancer [45,48,52,57] and one studied patients with prostate cancer [58]. The intervention was mainly proposed to adults, only two studies proposed the intervention to children [45,50] and none of them concerned older patients (>70 years old). In three studies, chemotherapy treatment was an inclusion criterion [44,47,51]. In one study, intervention was proposed after hematopoietic stem cell transplantation [55], after surgery [57] or to patients on androgen deprivation therapy [58]. The intervention was proposed mostly to cancer survivors [43,44,45,46,51,53,54] and not directly during or after treatment. When stated, the time since treatment completion was between 22 weeks [49] and 6 years [51]. Most of the studies had a control group (14/16), among which 9/16 were wait-list groups.
- Cognitive evaluation: In most studies [43,44,46,47,48,49,50,51,53,54,55,56,58,64], the efficacy of the intervention was evaluated at the end of the intervention by both objective and subjective cognitive assessment, while in two studies it was evaluated only by objective cognitive assessment [52,57] Twelve studies also investigated the maintenance of the efficacy of the intervention on cognition [43,44,46,48,49,50,52,53,54,55,56,58].
4.1.2. Characteristics of Cognitive Stimulation Programs
4.1.3. Efficacy of Cognitive Stimulation Programs
4.2. Computerized Physical Activity
4.2.1. Characteristics of Studies
- Population: Two studies proposed the intervention to adults between 18 and 70 years old [59,60] while one study focused on the elderly (>70 years old) [62] and another on patients younger than 18 years old [61]. One study was proposed to patients with breast cancer [59], two studies did not focus on any specific type of cancer [60,61] and the intervention was proposed to both breast and prostate cancer patients in the last one [62]. Three studies provided treatment history, which showed that most patients were treated with chemotherapy, hormone therapy and/or radiotherapy [59,60,62]. None of them reported information on the time of completion of treatment. All studies had an active control group. Sample size: mean sample size was 66 participants (minimum: 32 [60]; maximum: 78 [61,62]).
- Cognitive evaluation: all studies assessed the efficacy of the physical activity intervention on objective cognitive functioning, and two studies also on cognitive complaints [60,62]. Only one study evaluated the cognitive effect after the post-intervention assessment with another assessment at 6 months [59].
4.2.2. Characteristics of Programs
4.2.3. Efficacy of Programs
5. Discussion
6. Implication for Practice
7. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
References
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Intervention | N of Randomized Studies/N of Pilot Studies | Strength of Evidence | Risk of Bias | Directness | Consistency | Precision |
---|---|---|---|---|---|---|
Computerized cognitive stimulation | 10/6 | Low | High | Direct | Inconsistent | Imprecise |
Computerized physical activity | 3/1 | Low | High | Direct | Unknown | Imprecise |
Publication | Study Design and Assessment | Participants | Intervention | Supervision | Outcomes and Tools | Results | Conclusion |
---|---|---|---|---|---|---|---|
Becker et al., 2017 [49] | Pilot study Pre-intervention Post-intervention Two-weeks after intervention | Breast cancer survivors N = 20 | 3–4 times/week of 45-min cognitive training (home-based) + 6 90-min group classes supervised by a nurse (BrainHQ) 6 weeks of the program | Home-based cognitive training without supervision On-site group intervention supervised by a nurse | Efficacy: cognition (CVLT; COWAT; SDMT; PROMIS; MMQ) and quality of life (FACT-G) | Efficacy: no significant results | Program feasible but no significant cognitive improvement |
Bellens et al., 2020 [43] | Pilot RCTBefore intervention Cognitive assessment every 4 weeks For other measures: after 3 and 6 months | Breast cancer survivors early intervention group: n = 23 Delayed intervention group: n = 23 | 3×/week of 60-min video-game over 6 months (Aquasnap) | Home-based intervention with 3 monthly meetings with the principal investigator. Contacts by email or telephone of study team if problems | Primary outcome: MyCQ (cognitive tests) Secondary outcomes: Anxiety (HADS), self-reflectiveness (BCIS), cognitive complaints (CFQ), quality of sleep (PSQI) | Primary outcome: non-significant change in overall MyCQ score between groups for baseline to 3 months. Secondary outcomes: Significant improvement in CFQ scores (p = 0.029) | Improvement of cognitive complaints |
Bray et al., 2017 [44] | RCT T1: before intervention T2: after intervention T3: 6 months later | Cancer survivors Intervention group: n = 121 Control group: n = 121 | 40-min sessions/week 15 weeks intervention (Insight) or standard care | Home-based intervention without supervision or support | Primary outcome: FACT-COG PCI (cognitive complaints) Secondary outcome: cognitive tests (Cog-State), anxiety/depression (General Health Questionnaire); QoL (FACT-G); fatigue (FACT-F) and stress (Perceived Stress scale) | Primary outcome: Difference between the groups on the FACT-COG PCI was statistically significant, with less PCI in the intervention group at T2 (p < 0.001) sustained at T3 (p < 0.001) Secondary outcomes: No significant difference between groups in cognitive tests at T2 and T3 but significant improvement at T2 on anxiety/depression, fatigue and stress. | Improvement of cognitive complaints |
Conklin et al., 2015 [45] | RCT pre-intervention post-intervention | Survivors of childhood acute lymphoblastic leukaemia (ALL) or brain tumour (BT) Intervention group: n = 34 Waitlist group: n = 34 | 25 training 30–45 min sessions (Cogmed)+ weekly telephone-based coaching over 5 to 9 weeks | Home-based intervention with weekly coaching telephone calls | Primary outcome: spatial span backwards (WISC-IV) Secondary outcome: Other cognitive tests (WISC-IV, CPT-II, WJ-III) and parent-reported measures (CPRS-3, BRIEF) | Primary outcome: Greater improvement of spatial span backward in the intervention group than the control group (p = 0.002) Secondary outcomes: Greater improvement of intervention vs. control group in WM, attention and processing speed (p = 0.01). Improvement in reported-attention and executive dysfunctions (p < 0.01) | Intervention feasible and efficacious for childhood cancer survivors |
Damholdt et al., 2016 [46] | RCT pre-intervention post-intervention 5-month follow-up | Breast cancer survivors Intervention group: n = 94 Waitlist group: n = 63 | 30 training 30 min-session over 6 weeks (HappyNeuron Pro) with phone support | Home-based intervention with telephone and email support in case of difficulties. 2 phone calls: one at the beginning of the program and one at the end. | Primary outcome: PASAT (attention and working memory) Secondary outcomes: Cognitive complaints (CFQ), verbal learning (RAVLT), WM (WAIS-IV), EF (Multilingual aphasia examination; D-KEFS, Cognitive estimation task) | Primary outcome: no significant time x group interaction for PASAT Secondary outcomes: post-intervention and 5-month follow-up significant increase in verbal learning (p = 0.043) and digit span backwards (p = 0.040) for the intervention group compared to a waiting list | Improvements in verbal learning and working memory including at 5-month follow-up |
Dos Santos et al., 2020 [47] | RCT pre-intervention post-intervention | Cancer patients The experimental group (A): N = 55 Control group B: N = 56 Control group C: N = 56 | Experimental group: computer-assisted cognitive rehabilitation (Rehacom). 9 sessions (45–60 min) over 3 months Group control B: cognitive exercises at home (booklet) 9 sessions (30–60 min) over 3 months Group control C: a phone call. 9 over 3 months | On-site intervention supervised by a neuropsychologist | Primary outcome: PCI FACT-COG Secondary outcomes: episodic memory (Grober and Buschke), attention (d2), executive functions and processing speed (Verbal fluency test, TMT), working memory and short-term memory (digit span WAIS-IV) | Primary outcome: no significant difference between groups on PCI improvement Secondary outcomes: compared to control groups significant improvement of PCI (p = 0.02), perceived cognitive abilities (p > 0.01) and working memory (p = 0.03) for group A | Improvement of cognitive complaints and working memory |
Gehring et al., 2009 [48] | RCT Pre-intervention post-intervention 6-month follow-up | Adult patients with gliomasIntervention group: n = 66 Waitlist group: n = 69 | 6 weekly 2h-sessions of attention program (C-Car) and psychoeducation | On-site intervention with the supervision of a neuropsychologist | Attention (SCWT, DS, LDST, MST, TEA), verbal memory (WLT), executive function (CST, LF, BADS) and cognitive complaints (MOS CFS, CFQ), fatigue (MFI) | Cognitive tests: significant group differences for attention (p = 0.028) and verbal memory (p = 0.015). Cognitive complaints: significant group difference overtime for CFS total score, burden, and CFQ total score (p = 0.003) and mental aspects of fatigue (p = 0.049) | Improvement of cognitive complaints, attention and verbal memory |
Hardy et al., 2013 [50] | Pilot study Pre-intervention Post-intervention 3 month follow-up | Survivors of childhood cancer Intervention group n = 13 Control group n = 7 | 5–8 weeks 25 sessions (Cogmed RM) | Home-based intervention with phone-based coaching support | Preliminary efficacy of the program (WASI, WRAML2, Conner’s rating scale, SERS) | Efficacy: significant group differences for working memory (p = 0.05) and parent-reported learning problems (p = 0.05) | Program feasible and Improvement of working memory and learning abilities |
Kesler et al., 2013 [51] | Feasibility study pre-intervention post-intervention | Breast-cancer survivors Intervention group: n = 21 Wait list: n = 20 | 48 session (20-30 min) of EF program (Lumosity) over 12 weeks | Home-based intervention without supervision and reminder | Primary outcome: WCST (flexibility) Secondary outcome: EF (letter fluency test, BRIEF), verbal memory (HVLT-R), working memory (digit span), processing speed (symbol search) and depression (CAD) | Primary outcome: significant improvement of flexibility in the intervention vs. control group (p = 0.008) Secondary outcomes: Improvement in letter fluency and symbol search (p < 0.01) | Improvement of flexibility, letter fluency and symbol search |
Maschio et al., 2015 [52] | Pilot study Pre-intervention After intervention 6-month follow-up | Brain-tumor patients Intervention group n = 16 | 1h/week 10 weeks RehabTr | On-site intervention With the supervision of a neuropsychologist | Cognitive improvement (MMS; TMT; frontal assessment battery; Raven Matrices; ROCF-Copy and recall; Clock Drawing test; Span forward and backward; 15 Rey-Osterrieth Word list, fluency test | Primary outcome: significant improvement of memory (p = 0.0017; p = 0.036) and fluency (p = 0.043) | significant improvement of memory and fluency after intervention and at 6-month follow up |
Mihuta et al., 2017 [54] | Pilot study pre-intervention post-intervention 3-month follow-up | Cancer survivor Cancer intervention group: n = 13 Non-cancer intervention group: n = 21 Non cancer wait-list: n =17 | 4-week 2-h session (eRECog program) | Home-based intervention with reminder emails | Primary outcome: PCI FACT-Cog (cognitive complaints) Secondary outcome: other cognitive complaints questionnaires (BAPM, BADL, EORTC QLQ-C30, IADL), cognitive tests (WebNeuro), distress (K10), illness perception (BIPQ) and program satisfaction | Primary outcome: No significant interaction for PCI Secondary outcome: Significant improvement of cognitive complaints (BADL) and attention in the intervention group | High participant satisfaction and some improvements in subjective and objective cognitive functioning |
Mihuta et al., 2018 [53] | RCT pre-intervention post intervention 3-month follow-up | Cancer patients Intervention group: n = 40 Waitlist group:n = 36 | 30–60 min sessions/week 4 weeks (eRECog program) | Home-based intervention with emails reminder 5 days after non-completion of the session and phone call after 3 mails reminder without answer. Encouragement mail after completion of the first module | Primary outcome: PCI FACT-Cog (cognitive complaints) Secondary outcome: other cognitive complaints questionnaires (BAPM, BADL, EORTC QLQ-C30, IADL), cognitive tests (WebNeuro), distress (K10), illness perception (BIPQ), fatigue (EORTC QLQ-C30) and program satisfaction | Primary outcome: No significant interaction for PCI Secondary outcome: Significant improvement of the prospective memory IADL score in the intervention vs. control group. No significant interaction for other variables | No significant group effect on cognition |
Poppelreuter et al., 2008 [55] | RCT Pre-intervention Post intervention 6-month follow-up | Patients after HSCT Intervention group (NPT) n = 21 Intervention group (PC) n = 26 Control group n = 28 | 1 h/week 3–5 weeks Different training software | On-site intervention NPT = neuropsychological training group (max 8 participants) supervised by an occupational therapist PC = individualized computer-based training + individual coaching | Attention, memory (battery of standardized tests) and cognitive complaints questionnaires (EORTC; MFI; FEDA) | No significant results | No significant improvement |
Von Ah et al., 2012 [56] | RCT Pre-intervention Post-intervention 2-month follow-up | Breast cancer survivors Memory training group n = 29 Speed of processing intervention group n = 30 Wait-list control group n = 29 | 10 1 h sessions over 6–8 weeks (Insight program) | On-site group intervention supervised | Primary outcomes: Objective memory (AVLT; Rivermead Behaviourall Paragraph Recall Test) and speed of processing (UFOV) Secondary outcome: Perceived cognitive functioning (FACT-COG); symptoms distress (CES-D; STAI-S; FACT-F) and quality of life (QOL-CS; SF-36) | Primary outcomes: significant improvement of immediate and delayed memory (p = 0.036, p = 0.013) at the 2-month follow-up in the intervention group vs. control group. Significant improvement of processing speed after the intervention (p = 0.007) and at the 2-month follow-up (p = 0.004) Secondary outcomes: significant improvement of perceived cognition (p ≤ 0.005) | Improvement of objective and perceived cognition |
Wu et al., 2018 [58] | Pilot study Pre-intervention Post-intervention 8-weeks follow-up | Prostate cancer patients Intervention group (CCT) n = 40 Wait-list group: 20 | 1 h/day, 5 days/week for 8 weeks (BrainHQ) | Home-based intervention with e-mail reminders and weekly phone calls | Efficacy: Objective cognitive functioning (CNS Vital Signs); Self-reported cognitive functioning (PAOFI); Neurobehavioral functioning (FrSBe) | Significant improvement of reaction time in the intervention group vs. control group | Program feasible with some effects on reaction time |
Zucchella et al., 2013 [57] | RCT Pre-intervention Post-intervention | Patients with brain tumor Rehabilitation group n = 30 Wait-list group n = 32 | 4 weeks 4 1 h sessions/week (training di riabilitatione cognitive; una palestra per la mente) | On-site intervention with direct training and metacognitive training supervised by two neuropsychologist | Cognitive functioning (MMS, digit span, Corsi′s test, RAVLT, PM47, FAB, TMT, ENPA) | Significant improvement in all the neuropsychological measures in the intervention vs. control group. | Significant cognitive improvement |
Interventions | Memory | Attention | Executive Functions | Processing Speed | Subjective Cognition |
---|---|---|---|---|---|
Computerized-Cognitive Stimulation | |||||
Becker et al., 2017 [49] | |||||
Bellens et al., 2020 [43] | ✓ | ||||
Bray et al., 2017 [44] | ✓ | ||||
Conklin et al., 2015 [45] | ✓ | ✓ | ✓ | ✓ | |
Damholdt et al., 2016 [46] | ✓ | ||||
Dos Santos et al., 2020 [47] | ✓ | ✓ | |||
Gehring et al., 2009 [48] | ✓ | ✓ | ✓ | ||
Hardy et al., 2013 [50] | ✓ | NA | NA | NA | |
Kesler et al., 2013 [51] | ✓ | ✓ | |||
Maschio et al., 2015 [52] | ✓ | NA | |||
Mihuta et al., 2017 [54] | ✓ | ||||
Mihuta et al., 2018 [53] | |||||
Poppelreuter et al., 2008 [55] | |||||
Von Ah et al., 2012 [56] | ✓ | NA | NA | ✓ | ✓ |
Wu et al., 2018 [58] | |||||
Zucchella et al., 2013 [57] | ✓ | ✓ | NA | ||
Computerized-Physical Activity | |||||
Galliano-Castillo et al.,2017 [63] | NA | NA | NA | ||
Gehring et al., 2020 [60] | ✓ | ✓ | ✓ | ✓ | ✓ |
Howell et al., 2018 [61] | NA | NA | NA | NA | |
Miki et al., 2014 [62] | NA | NA | ✓ | NA | NA |
NA = not assessed |
Publication | Study Design/Assessment | Participants | Intervention | Supervision | Outcomes/Tools | Results | Conclusion |
---|---|---|---|---|---|---|---|
Galliano-Castillo et al., 2017 [59] | RCT Pre-intervention Post-intervention 6-month follow-up | Breast cancer survivors Intervention group: n = 39 Control group: n = 37 | 3 sessions/week (90 min) over 8-week internet-based tailored exercise program | Home-based intervention with individual supervision through instant messages, video-conference sessions and phone calls | 6-min walk test (functional capacity) and ACT + TMT (cognitive tests) | Functional capacity: significant improvement in the intervention vs. control group for the 2 follow-up assessments (p = 0.001) Cognitive function: significant improvement on 1/5 of the ACT score in the intervention vs. control group for the 2 follow-up assessments (p < 0.05). No effect on TMT scores | Some improvement in functional performance and cognition |
Gehring et al., 2020 [60] | RCT Baseline Post-intervention | Stable patients with grades II/III glioma Exercise group: n = 21 Control group: n = 11 | 6-month intervention with 3 aerobic sessions/week (20–45 min) | Home-based remotely coached intervention | Attention (SCWT-int; LDST; WAIS-R digit span; test of everyday attention), memory (VVLT; WMS-III verbal paired associates); executive function (CST-Shift; GIT letter fluency, GIT category fluency); cognitive complaints (CFS cognitive functioning scale; CFQ); fatigue, sleep, mood and QoL (MFI; PSQI; POMS; QLQ-BN20; SF-36) | Better post-intervention scores of the exercise group: attention, processing speed, verbal memory, executive function and cognitive complaints | Improvement in several domains of cognition and cognitive complaints |
Howell et al., 2018 [61] | RCT Pre-intervention Post-intervention | Adolescent cancer survivors Intervention group, n = 53 Control group, n = 25 | 24 weeks web-delivered physical activity intervention | Home-based intervention without supervision | Physical activity (wGT3X-BT, ACTi Graph); fitness; general intelligence (vocabulary and visual-spatial construction WASI) and flexibility (Delis-Kaplan Executive Function System); quality of life (PedsQL) | No statistical difference between groups for mean change in weekly MVPA. No significant improvement in intervention vs. control group for cognitive scores | No significant difference between groups on cognition |
Miki et al., 2014 [62] | Feasibility study pre-intervention post-intervention | Breast and prostate elderly cancer patients Intervention group: n = 38 Control group: n = 40 | 4-week 1/week on-site intervention (5min) with a bicycle ergometer | On-site intervention supervised by a therapist | FAB (executive function), BI+IADL (activities of daily living), FACT-G (QoL) | Significant effect of group, time and time x group for FAB score | Feasible intervention to improve cognition |
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Binarelli, G.; Joly, F.; Tron, L.; Lefevre Arbogast, S.; Lange, M. Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity. Cancers 2021, 13, 5161. https://doi.org/10.3390/cancers13205161
Binarelli G, Joly F, Tron L, Lefevre Arbogast S, Lange M. Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity. Cancers. 2021; 13(20):5161. https://doi.org/10.3390/cancers13205161
Chicago/Turabian StyleBinarelli, Giulia, Florence Joly, Laure Tron, Sophie Lefevre Arbogast, and Marie Lange. 2021. "Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity" Cancers 13, no. 20: 5161. https://doi.org/10.3390/cancers13205161