A University of Sydney study has shown “brain training” games targeting attention, memory and visual skills reduced chemotherapy-induced neurological problems in cancer patients — commonly referred to as “chemobrain” or “chemofog.”
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 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, and who self-reported cognitive symptoms, indicated by changes in concentration as well as memory. Of those who participated in the study, 89 per cent were women with breast cancer.
Study participants were randomly assigned to either the online program or standard care from their doctor. The two groups were compared at baseline, immediately after the intervention 15 weeks in, and at six months.
Participants were assessed on both self-reported cognitive function and objective neuropsychological function.
The self-reporting used the Functional Assessment of Cancer Therapy Cognitive Function questionnaire, made up of perceived cognitive impairments (PCI), perceived cognitive abilities, impact of PCI on quality of life, and comments from others on cognitive function.
The objective neuropsychological function was assessed by Cogstate — an 18-minute computerised battery — made up of seven tests evaluating processing speed, decision making, working memory, executive function, continuous performance, matching, and new learning.
Compared to participants who received standard care, those assigned to the online program had less cognitive symptoms immediately following the intervention and at six months. The participants using the online program group also had significantly lower levels of anxiety, depression and fatigue than the standard care group immediately after treatment, but not at six months.
There was no difference in quality of life between the groups immediately following the intervention, but the online program group had better quality of life at six months.
There was no difference on objective neuropsychological function between the comparison groups immediately following the intervention, or at six months.
The brain training program used in the study, “Insight from Posit Science“, uses adaptive exercises targeting processing systems aimed at improving cognition through speed and accuracy of information processing.
“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 lead, Dr Victoria Bray, a 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 who 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”.
Dr Alessandra Muntoni, Director of Research Investment from 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, 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.
Until then, Cancer Council NSW has a number of resources currently available to cancer survivors experiencing cognitive problems after treatment.
Cancer Council NSW’s webinar Chemo-brain — ‘Clearing the fog’– “What can I do to start thinking more clearly?” addresses the psychological challenges that are faced following chemotherapy cancer treatment, and offers information, strategies and resources to assist local cancer patients to work towards a better memory and functioning in their daily lives.
Tips on how to manage cognitive problems after cancer treatment can also be found on the Cancer Council NSW website.
This 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.