Comparative Effectiveness of Interventions to Treat Cancer Treatment-Related Cognitive Impairment in Adult Cancer Survivors Following Systemic Therapy: A Systematic Review with Network Meta-Analyses

TL;DR

This study reviews treatments for cognitive issues in cancer survivors and finds that group therapy combining education and cognitive rehab is most promising, while drugs like donepezil are ineffective.

Contribution

The study provides a systematic review and network meta-analysis comparing the effectiveness of various interventions for cancer treatment-related cognitive impairment.

Findings

Therapist-led group programs combining education and cognitive rehabilitation improved multiple cognitive domains.

Mindfulness-based interventions showed some benefits for processing speed.

Pharmacological treatments like donepezil showed no significant benefit.

Abstract

Many cancer survivors experience lasting problems with memory, attention, and other aspects of cognitive functioning after chemotherapy or other systemic treatments—often referred to as cancer treatment-related cognitive impairment (CTRCI). To better understand which treatments may help, we reviewed evidence from randomized controlled trials testing psychological, pharmacological, and other interventions for adults with established CTRCI. Across 18 studies, a structured, therapist-led group program that combined patient education with cognitive rehabilitation showed the most consistent benefits, improving several areas of thinking and memory, while mindfulness-based interventions also showed some positive effects. In contrast, medications such as donepezil did not show benefit. Although the evidence remains limited and of low certainty, these findings suggest that group-based rehabilitation programs may offer the most promise for improving cognitive function in cancer survivors.

Background. Cancer treatment-related cognitive impairment (CTRCI) is a frequent and persistent consequence of systemic cancer therapy, adversely affecting quality of life and independence among cancer survivors. Methods. To clarify the relative effectiveness of available treatments, we conducted a systematic review and network meta-analyses of randomized controlled trials evaluating psychological, pharmacological, and other interventions for established CTRCI in adult survivors of non-central nervous system cancers. Eligible trials reported objective outcomes in one or more of eight cognitive domains, including learning, memory, processing speed, word generation, cognitive flexibility, attention, working memory, and abstraction. Results. Eighteen studies met inclusion criteria, with 14 trials (n = 1100) contributing to network meta-analyses of immediate post-intervention effects across seven domains. A therapist-guided group intervention combining patient education and cognitive rehabilitation consistently ranked highest and was associated with significantly improved learning, memory, processing speed, attention, and working memory compared with a waitlist control, although the certainty of evidence (CoE) was low to very low and largely based on a single trial. Mindfulness-based interventions were also associated with improved processing speed (low CoE). Donepezil was associated with no benefit versus placebo for any domain. Conclusions. While findings suggest that structured multimodal group interventions may represent the most promising strategy for CTRCI, CoE was low, and additional rigorous, standardized trials are required.

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