# The Effectiveness of a Multidisciplinary Integrative Survivorship Program for Cancer-Related Cognitive Impairment: A Prospective Cohort Study

## TL;DR

A new program combining cognitive training, therapy, and yoga helps cancer survivors improve memory, reduce stress, and regain daily function.

## Contribution

INCRT is a novel multidisciplinary program that effectively addresses cognitive and psychological issues in cancer survivors.

## Key findings

- Participants showed significant improvements in cognitive function immediately after the program and at six months.
- Psychological distress, fatigue, and unhelpful thinking patterns decreased over time.
- Daily functioning and emotional insight improved with sustained benefits at follow-up.

## Abstract

Many cancer survivors experience difficulties with memory, attention, and mental processing, referred to as cancer-related cognitive impairment (CRCI). These challenges can impact daily functioning and returning to work, and frequently occur alongside fatigue and psychological distress. To address these interconnected problems, we developed Integrative Neuro-Cognitive Remediation Therapy (INCRT), a multimodal survivorship program combining individualized cognitive function and strategy training with psychoeducation, psychological therapies, and onco-yoga. We report on the first 38 survivors who completed the program. Patients showed significant improvements in both objectively measured and self-reported cognitive functioning immediately after the program and six months later. They also reported reductions in psychological distress, fatigue, and unhelpful thinking patterns, as well as improved insight into their emotions and daily functioning. These findings suggest that INCRT is a promising approach for CRCI and overall well-being, and its integrative design supports maintained effects through the implementation of the learned strategies in daily life.

Background: Cancer-related cognitive impairment (CRCI) affects quality of life, daily functioning and return-to-work. However, CRCI remains under-addressed in cancer care. Since cognitive complaints often co-occur with fatigue and psychological distress, a multimodal approach is warranted. We developed Integrative Neuro-Cognitive Remediation Therapy (INCRT), a multidisciplinary survivorship program combining personalized cognitive function and strategy training with group-based psychoeducation, cognitive–behavioral therapy and Acceptance and Commitment Therapy, and onco-yoga. Methods: Cancer survivors suffering from CRCI were eligible. Assessments included neuropsychological testing, patient-reported outcomes, and daily functioning at baseline (T0), post-intervention (T1), and 6-month follow-up (T2). Primary outcomes were objective and subjective neurocognitive functioning (NCF); secondary outcomes were psychological distress, fatigue, metacognition, and daily functioning. Changes were analyzed using linear mixed models. Results: Between November 2022 and January 2025, 44 of 56 eligible survivors enrolled; 38 completed the program (71.1% female; median age 53.5). Objective and subjective NCF improved significantly at T1 and T2 (ps < 0.001). Psychological distress, fatigue, and unhelpful metacognitions decreased over time (ps < 0.05). Participants reported greater emotional and cognitive insight and improved daily functioning. Conclusions: INCRT improves cognitive functioning, reduces psychological distress and fatigue, and enhances daily functioning, with benefits maintained at follow-up. The integrative design supports sustained effects by promoting internalization and daily application of learned strategies.