Introduction
cognitive symptoms, cognitive impairment, traumatic brain injury, non-cancer, cancer, fatigue, anxiety, neurocognitive learning, cognitive deficits, depression, cognitive deficit
CANCER, SOLID TUMOUR, SIDE EFFECT
Cancer-related cognitive impairment (CRCI) is reported to be the side effect impacting most on survivor’s daily functioning and quality of life (QOL) [As assessed by neuropsychological tests, CRCI affects ~ 30% of cancer survivors, with incidence dependent on treatment regimen, time since treatment, method of assessment, and criteria used to define cognitive impairment [Multiple studies have reported poor associations between objective cognitive impairment after chemotherapy and survivors’ self-report of their cognitive function [Despite how common CRCI is, its impact on everyday functioning is poorly understood. Most cancer survivors reporting cognitive symptoms do not undergo neuropsychological testing, and standard neuropsychological tests assess cognitive function outside everyday contexts; consequently scores may not reflect the practical difficulties cancer survivors describe [The aetiology of cognitive impairment in cancer patients following chemotherapy is likely multifactorial but remains poorly understood [Cognitive rehabilitation refers to behaviourally oriented interventions designed to improve performance in cognitive and functional domains. The goals are to enhance a person’s capacity to process and interpret information to improve their functional ability [Retraining of a specific cognitive function(s).Teaching compensatory techniques to help adaptation to deficits.Holistic methods addressing social, emotional, and functional issues related to impairment [The NIH Consensus Development Panel in 1999 found evidence for efficacy of cognitive interventions focusing on attention, memory and executive skills for individuals after traumatic brain injury [A systematic review of 19 cognitive rehabilitation studies evaluated 13 intervention programs, either computer-based training or compensatory strategy training in 1124 cancer survivors. All studies reported improvement on at least one self-reported or objective cognitive measure, with 87% of studies (13/15) with control groups, finding improvement in objective measures, particularly memory, executive function, and processing speed [Although cognitive rehabilitation programs are routinely used in other clinical populations with acquired cognitive impairment, they are not routinely offered to cancer survivors with CRCI, and the type of rehabilitation program to provide the most benefit is not known. Our aim was to evaluate two cognitive rehabilitation programs used in non-cancer populations against standard-of-care control in solid tumour survivors self-reporting cognitive impairment after chemotherapy. The cognitive rehabilitation programs were (1) a structured neurocognitive learning program (attention process training [APT]), aimed at improving underlying cognitive deficit; and, (2) psychoeducation and systematic teaching of strategies to compensate for the functional impact of cognitive deficits (compensatory strategy training [CST]). Our a priori hypotheses were that participants randomised to cognitive rehabilitation would: (1) report less impairment; (2) have improved objective neuropsychological performance, better QOL, and less fatigue, anxiety and depression; and (3) have improvement in cognitive symptoms sustained up to 12 months post-intervention.