Perceived Cognitive Impairment in Breast Cancer Survivors and Its Relationships with Psychological Factors

Cognitive complaints are common adverse effects for breast cancer survivors, with potential negative impacts on quality of life or return to work. Identifying subjects at risk could allow to reduce cognitive disorders or to set up appropriate care. In this study we explored current cognitive complaints reported by breast cancer survivors, using the Functional Assessment of Cancer Therapy-Cognition (FACT-Cog) questionnaire and examined the relationships between current cognitive complaints and current psychological symptoms (especially post-traumatic stress symptoms). This large survey showed that about half of breast cancer survivors reported cognitive complaints after cancer treatments. These complaints were mainly associated with chemotherapy, age, self-reported sleep difficulties, the frequency of psychotropic treatments and psychological factors including post-traumatic stress symptoms or. Some modifiable risk factors should be detected early to reduce persistent cognitive complaints after cancer, including sleep difficulties and post-traumatic stress symptoms

Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol

Cancer-related cognitive impairment (CRCI) is a frequent side-effect of cancer treatment, with important consequences on patients’ quality of life. Cognitive stimulation and physical activity are the most efficient in improving cognitive impairment, but they are challenging to generalize in hospitals’ routine and to patients’ needs and schedules. Moreover, the added value of a combination of these interventions needs to be more investigated. The Cog-Stim study is an interventional study investigating the feasibility of a web-based multimodal intervention (combining cognitive stimulation and physical activity for the improvement of cognitive complaints among breast-cancer patients currently treated with radiotherapy (n = 20). Patients will take part in a 12-week program, proposing two sessions per week of web-based cognitive stimulation (20 min/session with HappyNeuron®) and two sessions per week of web-based physical activity (30 min/session with Mooven® platform). Cognitive complaints (FACT-Cog) and objective cognitive functioning (CNS Vital Signs®), anxiety, depression (HADS), sleep disorders (ISI) and fatigue (FACIT-Fatigue) will be assessed before and after the intervention. The primary endpoint is the adherence rate to the intervention program. Patients’ satisfaction, reasons for non-attrition and non-adherence to the program will also be assessed. The overall goal of this study is to collect information to develop web-based interventions for cognitive difficulties in supportive care units

Interventions numériques pour améliorer les plaintes cognitives chez les patientes atteintes d'un cancer du sein : mise en œuvre, suivi et promotion du programme de recherche Cog-Stim

Cancer-related cognitive impairment (CRCI) is a common side effect with substantial implications for patients'daily lives, work, and treatment adherence. Many patients would benefit from interventions such as cognitiveand physical training and psychological support. However, CRCI remains relatively unrecognized byhealthcare professionals, and access to interventions in clinical practice is limited. While digital technologieshold promises for expanding intervention access, their acceptance and feasibility, particularly among olderpatients, require further investigation. Multimodal interventions offer potential solutions with enhancedefficacy. Nevertheless, their feasibility demands thorough examination. The primary aim of the Cog-Stimresearch program was to enhance our understanding of feasible and effective interventions for CRCIaccessible to a broader population. Our results demonstrated the feasibility and efficacy of a multimodaldigital intervention, combining non-simultaneous cognitive and physical training, among breast cancerpatients. Additionally, we established the feasibility of implementing a digital cognitive intervention amongelderly breast cancer patients. Notably, both studies underscored the pivotal role of expert supervision as afacilitator for successful intervention outcomes. To implement these interventions in clinical practice, keyconsiderations include patient motivation, preferences regarding intervention format (home-based/on-site,supervised/unsupervised), and the presence of significant cognitive complaints. In summary, addressing CRCInecessitates a multifaceted approach, integrating diverse interventions and patient-centered considerationsto enhance the quality of life for individuals throughout their journey after cancer.Les troubles cognitifs liés au cancer (CRCI) sont un effet secondaire fréquent qui peut avoir des implicationsimportantes sur la vie quotidienne des patients, leur travail et leur observance thérapeutique. De nombreuxpatients expriment le besoin d'interventions telles que l'entraînement cognitif et physique ainsi que lesoutien psychologique. Cependant, les CRCI restent relativement méconnus parmi les professionnels de lasanté, et l'accès aux interventions en pratique clinique est limité. Bien que les interventions digitales offrentdes promesses pour élargir l'accès aux interventions, leur acceptabilité et leur faisabilité, en particulier chezles patients plus âgés, nécessitent des études supplémentaires. Les interventions multimodales, offrent dessolutions potentielles avec une efficacité accrue. Néanmoins, leur faisabilité nécessite un examenapprofondi. L'objectif principal du projet de recherche Cog-Stim était d'implémenter des interventionsfaisables et efficaces afin de rendre la prise en charge des troubles cognitifs liés au cancer accessible à unpublic plus large. Nos résultats ont montré la faisabilité et l'efficacité d’une intervention digitale multimodale,combinant un entraînement cognitif et physique non simultané, chez des patientes atteintes de cancer dusein. De plus, nous avons établi la faisabilité de la mise en œuvre d'une intervention cognitive digitale chezdes patientes âgées atteintes de cancer du sein. Les deux études ont notamment souligné le rôle essentielde la supervision par un expert en tant que facilitateur pour des résultats d'intervention réussis. Pour mettreen œuvre ces interventions en pratique clinique, des considérations clés incluent la motivation des patients,les préférences en matière de format d'intervention (à domicile/sur place, supervisé/non supervisé) et laprésence de plaintes cognitives significatives. En résumé, la prise en charge des troubles cognitifs encancérologie nécessite une approche multidimensionnelle, intégrant diverses interventions et desconsidérations centrées sur le patient pour améliorer la qualité de vie des individus après le cancer

Interventions numériques pour améliorer les plaintes cognitives chez les patientes atteintes d'un cancer du sein : mise en œuvre, suivi et promotion du programme de recherche Cog-Stim

Cancer-related cognitive impairment (CRCI) is a common side effect with substantial implications for patients'daily lives, work, and treatment adherence. Many patients would benefit from interventions such as cognitiveand physical training and psychological support. However, CRCI remains relatively unrecognized byhealthcare professionals, and access to interventions in clinical practice is limited. While digital technologieshold promises for expanding intervention access, their acceptance and feasibility, particularly among olderpatients, require further investigation. Multimodal interventions offer potential solutions with enhancedefficacy. Nevertheless, their feasibility demands thorough examination. The primary aim of the Cog-Stimresearch program was to enhance our understanding of feasible and effective interventions for CRCIaccessible to a broader population. Our results demonstrated the feasibility and efficacy of a multimodaldigital intervention, combining non-simultaneous cognitive and physical training, among breast cancerpatients. Additionally, we established the feasibility of implementing a digital cognitive intervention amongelderly breast cancer patients. Notably, both studies underscored the pivotal role of expert supervision as afacilitator for successful intervention outcomes. To implement these interventions in clinical practice, keyconsiderations include patient motivation, preferences regarding intervention format (home-based/on-site,supervised/unsupervised), and the presence of significant cognitive complaints. In summary, addressing CRCInecessitates a multifaceted approach, integrating diverse interventions and patient-centered considerationsto enhance the quality of life for individuals throughout their journey after cancer.Les troubles cognitifs liés au cancer (CRCI) sont un effet secondaire fréquent qui peut avoir des implicationsimportantes sur la vie quotidienne des patients, leur travail et leur observance thérapeutique. De nombreuxpatients expriment le besoin d'interventions telles que l'entraînement cognitif et physique ainsi que lesoutien psychologique. Cependant, les CRCI restent relativement méconnus parmi les professionnels de lasanté, et l'accès aux interventions en pratique clinique est limité. Bien que les interventions digitales offrentdes promesses pour élargir l'accès aux interventions, leur acceptabilité et leur faisabilité, en particulier chezles patients plus âgés, nécessitent des études supplémentaires. Les interventions multimodales, offrent dessolutions potentielles avec une efficacité accrue. Néanmoins, leur faisabilité nécessite un examenapprofondi. L'objectif principal du projet de recherche Cog-Stim était d'implémenter des interventionsfaisables et efficaces afin de rendre la prise en charge des troubles cognitifs liés au cancer accessible à unpublic plus large. Nos résultats ont montré la faisabilité et l'efficacité d’une intervention digitale multimodale,combinant un entraînement cognitif et physique non simultané, chez des patientes atteintes de cancer dusein. De plus, nous avons établi la faisabilité de la mise en œuvre d'une intervention cognitive digitale chezdes patientes âgées atteintes de cancer du sein. Les deux études ont notamment souligné le rôle essentielde la supervision par un expert en tant que facilitateur pour des résultats d'intervention réussis. Pour mettreen œuvre ces interventions en pratique clinique, des considérations clés incluent la motivation des patients,les préférences en matière de format d'intervention (à domicile/sur place, supervisé/non supervisé) et laprésence de plaintes cognitives significatives. En résumé, la prise en charge des troubles cognitifs encancérologie nécessite une approche multidimensionnelle, intégrant diverses interventions et desconsidérations centrées sur le patient pour améliorer la qualité de vie des individus après le cancer

Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity

Cancer-related cognitive impairment (CRCI) occurs frequently in patients living with cancer, with consequences on quality of life. Recently, research on the management of these difficulties has focused on computerized cognitive stimulation and computerized physical activity programs. This systematic review presents the state of knowledge about interventions based on computerized-cognitive stimulation and/or physical activity to reduce CRCI. The review followed the PRISMA guidelines. A search was conducted in PUBMED and Web of Science databases. Risk of bias analysis was conducted using the Rob2 tool and the quality of evidence was conducted following the GRADE approach. A total of 3776 articles were initially identified and 20 of them met the inclusion criteria. Among them, sixteen investigated computerized-cognitive stimulation and four computerized-physical activity. Most of the studies were randomized controlled trials and assessed the efficacy of a home-based intervention on objective cognition in adults with cancer. Overall, cognitive improvement was found in 11/16 computerized-cognitive stimulation studies and 2/4 computerized-physical activity studies. Cognitive stimulation or physical activity improved especially cognitive complaints, memory, and attention. These results suggest the efficacy of both computerized-cognitive stimulation and physical activity. However, we report a high risk of bias for the majority of studies and a low level of quality of evidence. Therefore, further investigations are needed to confirm the efficacy of these interventions and to investigate the possible added benefit on cognition of a combined computerized-cognitive/physical intervention

Cognitive impairment in older cancer patients treated with first-line chemotherapy

Older cancer patients are vulnerable to chemotherapy-related cognitive impairment. We prospectively evaluated cognitive impairment and its predictive factors during first-line chemotherapy in elderly cancer patients (≥70 years). Cognitive function was evaluated by the Mini-Mental State Examination (MMSE) with adjusted scores for age and sociocultural level. Multidimensional geriatric assessment was performed at baseline and during chemotherapy including the MMSE, Instrumental Activities in Daily Living (IADL), Mini-Nutritional Assessment (MNA), and the Geriatric Depression Scale (GDS15). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer (EORTC) QoL Questionnaire (QLQ-C30). Of 364 patients included, 310 had two MMSE evaluations including one at baseline and were assessed. Among these patients, 86 (27.7%) had abnormal MMSE, 195 (62.9%) abnormal MNA, 223 (71.9%) abnormal IADL, and 137 (43.1%) had depressive symptoms at baseline. MMSE impairment during chemotherapy was observed in 58 (18.7%) patients. Abnormal baseline MNA (odds ratio (OR) = 1.87, p = 0.021) and MMSE (OR = 2.58, p = 0.022) were independent predictive factors of MMSE impairment. These results suggest that pre-existing cognitive impairment and malnutrition are predictive factors for cognitive decline during chemotherapy in elderly cancer patients. Detection and management of these risk factors should be systematically considered in this population before starting chemotherapy

Perceived Cognitive Impairment in Breast Cancer Survivors and Its Relationships with Psychological Factors

Cognitive complaints are common adverse effects in cancer patients. Identifying subjects at risk could make it possible to limit their impact. We aimed to explore the relationship between current cognitive complaints and demographic and psychological factors in a group of breast cancer survivors. Through an online survey, cancer survivors reported current cognitive complaints using the FACT-Cog questionnaire (Perceived Cognitive Impairment) and answered questions about their demographics, lifestyle and cancer-related characteristics. Anxiety, depression, fatigue and post-traumatic stress symptoms were also assessed. We used multivariable logistic regression models to explore the relationships between current cognitive complaints and social and psychological factors. Among the 1393 breast cancer survivors, 47.2% (n = 657) reported current cognitive complaints. Chemotherapy (OR = 2.26, 95%CI = 1.67–3.05), age (OR21-44 vs. >65 = 0.14, 95%CI = 0.07–0.27), sleep difficulties (ORnever vs. often = 2.41, 95%CI = 1.47–3.95), frequency of psychotropic treatments (ORnever vs. >1/week = 1.70, 95%CI = 1.23–2.36), post-traumatic stress symptoms (OR = 2.05, 95%CI = 1.57–2.69) and employment status (ORfull-time or part-time vs. sick leave = 1.64, 95%CI = 1.08–2.49) were strongly associated with current cognitive complaints. In this large study, about half of breast cancer survivors reported cognitive complaints, particularly after chemotherapy. Some risk factors should be detected early to reduce persistent cognitive complaints after cancer: mainly sleep difficulties, post-traumatic stress symptoms and psychotropic medications

J Cancer Surviv

PurposeCancer-related cognitive impairment (CRCI) is under-addressed by healthcare professionals owing to a lack of clinical management guidelines. This European Delphi study proposes recommendations to healthcare professionals for the management of CRCI in patients with non-central nervous system (non-CNS) cancers.MethodsTwenty-two recommendations were developed based on a literature review and authors' clinical experience, split into three categories: screening, cognitive assessment, intervention. The survey included European professionals, experts in CRCI. The Delphi method was used: experts rated the clinical relevancy of recommendations on a 9-point Likert scale in three rounds. A recommendation was accepted if all votes were between 7 and 9. Recommendations not accepted in round 1 and round 2 were deleted, or modified and rated in round 3.ResultsEighteen professionals (psychologists, physicians, researchers) voted and accepted 15 recommendations. Experts recommended the systematic screening of CRCI, followed by a short objective cognitive assessment, if complaints screened. A comprehensive evaluation is recommended if CRCI persists 6 months post-treatment. Cognitive rehabilitation, physical activity, meditative-movement therapy, and multimodal intervention should be offered. Recommendations about frequency and duration of interventions, the professional to administer cognitive rehabilitation and the use of meditation and cognitive training without psychoeducation were not accepted.ConclusionsThis survey provides 15 recommendations to assist healthcare professionals in detecting, assessing and offering interventions for CRCI.Implications for cancer survivorsThese recommendations should be included in supportive care to help healthcare professionals to detect CRCI and propose the best available intervention for patients with cognitive complaints. Developing CRCI management in clinical settings would improve patients' quality of life

Cancer-related cognitive impairment in non-CNS cancer patients: Targeted review and future action plans in Europe

Cancer-related cognitive impairment (CRCI) has increasingly been identified over the last two decades in non-CNS system cancer patients. Across Europe, researchers have contributed to this effort by developing preclinical models, exploring underlying mechanisms and assessing cognitive and quality of life changes. The ultimate goal is to develop interventions to treat patients experiencing CRCI. To do so, new challenges need to be addressed requiring the implementation of multidisciplinary research groups. In this consensus paper, we summarize the state of the art in the field of CRCI combined with the future challenges and action plans in Europe. These challenges include data sharing/pooling, standardization of assessments as well as assessing additional biomarkers and neuroimaging investigations, notably through translational studies. We conclude this position paper with specific actions for Europe based on shared scientific expert opinion and stakeholders involved in the Innovative Partnership for Action Against Cancer, with a particular focus on cognitive intervention programs

Cancer-related cognitive impairment in non-CNS cancer patients: Targeted review and future action plans in Europe

International audienceCancer-related cognitive impairment (CRCI) has increasingly been identified over the last two decades in non-CNS system cancer patients. Across Europe, researchers have contributed to this effort by developing preclinical models, exploring underlying mechanisms and assessing cognitive and quality of life changes. The ultimate goal is to develop interventions to treat patients experiencing CRCI. To do so, new challenges need to be addressed requiring the implementation of multidisciplinary research groups. In this consensus paper, we summarize the state of the art in the field of CRCI combined with the future challenges and action plans in Europe. These challenges include data sharing/pooling, standardization of assessments as well as assessing additional biomarkers and neuroimaging investigations, notably through translational studies. We conclude this position paper with specific actions for Europe based on shared scientific expert opinion and stakeholders involved in the Innovative Partnership for Action Against Cancer, with a particular focus on cognitive intervention programs