Many cancer survivors take back their lives after cancer treatments by rebuilding their emotional and physical strength. However, memory problems, poor attention span, anxiety, depression, and fatigue often plague patients who've undergone chemotherapy. Now, researchers at the University of Sydney in Australia have found online mental exercises alleviate some of the effects of “chemo brain” and may improve cognitive symptoms for cancer survivors.
"To the best of our knowledge, this is the largest cognitive intervention study that has shown a benefit for patients who are reporting persistent cognitive symptoms following chemotherapy," said study author Dr. Victoria J. Bray, Medical Oncologist, and PhD candidate, in a statement.
Cognitive impairments, especially memory and concentration problems, are common among cancer survivors. In fact, up to 70 percent report their cognitive function is not as good as it was prior to their cancer diagnosis, according to the researchers. Currently, there are no proven treatments to assist with cancer-induced cognitive decline.
The exact cause of mental fogginess, known as chemo brain, before, during, and after cancer treatment, isn't known. The mental changes patients notice can last a short time, or they might go on for years. Chemo brain affects daily life functioning for many people with cancer.
In the study, published in the Journal of Clinical Oncology, Bray and her colleagues recruited about 240 adult cancer survivors in Australia who completed chemotherapy in the prior 6-60 months and reported persistent cognitive problems to evaluate whether online brain exercises could help patients cope with chemo brain. Approximately 95 percent of participants were women; 89 percent had breast cancer and 5 percent had colorectal cancer. At the beginning of the study, participants received a personalized 30-minute telephone consult that provided tips and strategies for coping with cognitive problems in daily life.
Then, the researchers randomly assigned participants to the web-based cognitive rehabilitation program Insight, a computerized learning program that uses exercises targeting processing symptoms to improve cognition, or standard oncology care. The recommended training time was four 40-minute sessions/week for 15 weeks, for a total of 40 hours.
The main outcome was self-reported cognitive function assessed by the Functional Assessment of Cancer Therapy Cognitive Function version 3 (FACT-COG) questionnaire. It evaluates perceived cognitive impairments, perceived cognitive abilities, and the impact of perceived cognitive impairment on quality of life. Separate measures were used to evaluate objective neuropsychological function, anxiety/depression, fatigue, and stress.
Upon completing the program, self-reported cognitive function improved compared to the standard care group, both at the end of the 15-week program and six months later. Participants reported less perceived cognitive impairment, better cognitive abilities, and lower levels of anxiety, depression, fatigue, and stress. Their quality of life was improved six months following the program.
However, the objective neuropsychological function test results did not differ between the two groups. The researcher team suspects the neuropsychological test battery used to assess the participants in the study may not have been sensitive enough to pick up on differences in cognitive functioning.
They also caution longer follow-up is needed to determine if the effects of the training are long-lasting. It’s undetermined whether delivering cognitive rehabilitation is better via a self-directed program like Insight for some, or whether a group-based program may work better for others. Moreover, the researchers do not know what the ideal duration and length of cognitive training should be.
They do believe if they could identify patients who are at risk of cognitive impairment, they 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.
A similar 2015 study provides evidence mental training exercises may help clear the mental fogginess most patients experience. A group of psychologists taught breast cancer patients strategies designed to boost memory and sustain attention. Patients were required to do homework and frequently practice specific mental exercises to improve cognitive function. After completing the five-week rehabilitation program, the participants showed a noticeable improvement in self-reported cognitive complaints, and performed better on memory function in neurocognitive tests compared to control groups.
These studies suggest brain training exercises could be a simple way to alleviate at least some of the debilitating effects of chemo brain for cancer survivors.
Source: Bray VJ, Dhillon HM, Bell ML et al. Evaluation of a Web-Based Cognitive Rehabilitation Program in Cancer Survivors Reporting Cognitive Symptoms After Chemotherapy. Journal of Clinical Oncology. 2016.