Discussion
fatigue, anxiety/depression, breast cancer, cancer, tumour
CANCER, RECRUITMENT, TUMOUR, BREAST CANCER
An improvement was seen in the mean cognitive symptom scores in all groups over time, but no significant differences found between the intervention groups compared with controls for cognitive symptoms, mean total Our findings are consistent with other studies employing similar interventions. Dos Santos [Similarly, our previous RCT comparing a computer training program to standard-of-care in 242 survivors found improvement in cognitive symptoms, anxiety/depression, stress, and fatigue, and improved QOL sustained 6 months later, but no significant difference in neuropsychological test results [Determining whether cognitive rehabilitation interventions are generalisable to everyday activities could provide important information but few studies have included functional tests performed under ‘real world’ conditions [Two other small pilot studies that included functional tests found no difference for intervention or time effects but both were underpowered [The qualitative findings from our study suggest differential impacts from the treatment approaches, and tailoring interventions to the specific priorities of individuals should be considered in future research. Our experience with two RCT for CRCI suggests online home-based programs with timing flexible to suit participant’s lifestyles, and may be more feasible for cancer survivors. There is a clear need to understand the components of interventions most impactful for participants, to enable shorter and/or greater tailoring to support stepped care in CRCI. Other suggestions for future research include a comparison between online computer-based training and face-to-face group sessions such as used here to compare efficacy, and development of functional tests more suitable for repeat testing to better determine impact of CRCI on everyday activities and any improvement after cognitive rehabilitation programs.Strengths of our study include the use of two active interventions and a control group, to determine whether improvement was due to the intervention, practice effect, and/or improvement over time. There were limitations to our study, particularly the smaller than planned sample size due to recruitment difficulties compounded by the COVID-19 pandemic, which meant we were only able to detect larger than planned differences for comparing either active treatment group with the control group. COVID-19 restrictions also necessitated a change in follow-up assessments to online, omission of the FIA, and two participants having their sessions run as individual rather than group sessions. Time between baseline assessment and the intervention was longer than planned waiting for sufficient numbers to run the groups. Staff and participants were not blinded to allocation. Focus groups and interviews were limited to the first two groups and may not reflect the experience of later groups. Most participants were breast cancer survivors so results may not be generalisable to other tumour types or to men.