Web‐based cognitive training for breast cancer survivors


Damholdt M., Mehlsen M., O'Toole M., Andreasen R., Pedersen A., and Zachariae R. (2016) Web‐based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial. Psycho‐Oncology, 25: 1293–1300.


Cognitive deficits, whether objective or self-reported, are a frequent occurrence among survivors of breast cancer and no standard approaches exist to treat these difficulties.  Efforts are increasingly made by both researchers and clinicians to improve cognitive deficits after cancer using cognitive training or rehabilitation.  In an intriguing recent study by Damholdt and colleagues, 157 female breast cancer survivors with cognitive complaints were recruited from an existing cohort and randomly assigned to receive one of two conditions (web-based cognitive training) or a "usual care" control condition.  Web-based cognitive training took place over 30 self-initiated training sessions over 6 weeks.   Cognitive assessments were done via a telephonic battery that evaluated multiple domains of neuropsychological functioning including memory, executive functioning, and working memory as well as mental health outcomes. Using mixed-linear models, the study identified statistically significant (although very modest) improvements on a test of working memory (digit span backwards) and verbal learning (p 0.040–0.043) in patients receiving cognitive training and these improvements persisted for up to 5 months.  This study adds to the controversy and general lack of clarity surrounding computerized approaches to cognitive training.  While patients receiving cognitive training improved, their improvement occurred only on a few tests of cognition, as opposed to tests of "real world" outcomes (likely deemed more important by patients but not assessed), and improvement was not observed on the study's pre-defined "primary" outcome measure, the PASAT, nor were there differences between groups observed on a measure of self-reported cognitive failures (the Cognitive Failures Questionnaire).  Having said that, this study reflects the largest randomized trial of computerized cognitive training done in cancer patients with cognitive impairment to date, was well-received by patients who perceived it to be very helpful (57% of who said it had either "some effect" or "great effect" on their cognition) and was done at a very low cost.

I chose this study because I think the application of cognitive training and rehabilitation to non-traditional populations (e.g. individuals with cancer, HIV-AIDs, post-intensive care syndrome, etc) as opposed to those with clear neurologic conditions is both relevant and important.  Computerized approaches to cognitive training are increasingly being studied and rehabilitation psychologists should consider whether they can improve patient outcomes, on the one hand, even as they should appropriately scrutinize them, on the other hand.  This is particularly true because interest in using technology based interventions is growing rapidly among patients, who are intrigued by the idea of self-directed, structured interventions that they can do at home, as opposed to in the clinic.

This research spotlight was done by Jim Jackson PsyD, Associate Professor at Vanderbilt University School of Medicine in the Department of Medicine and a Member of Division 22's Science Committee.