Supportive Care in Cancer

, Volume 27, Issue 9, pp 3253–3279 | Cite as

Cognitive rehabilitation for cancer-related cognitive dysfunction: a systematic review

  • Holly A. FernandesEmail author
  • Nadine M. Richard
  • Kim Edelstein
Review Article



Individuals with non-central nervous system (CNS) cancers can experience cancer-related cognitive dysfunction (CRCD), negatively impacting daily functioning and quality of life. This systematic review examined cognitive rehabilitation programs aimed at improving cognitive function.


PsychInfo and PubMed were searched in February 2019. Eligible studies evaluated a cognitive rehabilitation program for adults with non-CNS cancers and included at least one objective cognitive measure. Across studies, we assessed methodological quality using relevant criteria based on published intervention-related review guidelines and examined findings from performance-based and self-reported outcome measures.


19 studies met inclusion criteria, totalling 1124 participants altogether. These studies included randomized controlled trials (n = 12), partial, quasi or non-randomized controlled trials (n = 3) and single-arm pilot studies (n = 4). All studies found improvements on at least one cognitive measure (performance-based or self-reported). By cognitive domain, objective improvements in memory were most commonly reported, followed by executive functions and processing speed. In terms of methodological quality, studies generally provided clear descriptions of participants and interventions. However, limitations included lack of standardized terminology for interventions, discrepancies in outcome measures, and incomplete statistical reporting.


The available evidence supports clinical implementation of cognitive rehabilitation to improve CRCD, with further work in program development, dissemination, and feasibility recommended. We provide specific recommendations to facilitate future research and integration in this field.


Neuropsychological intervention Cognitive training Chemobrain 



This work was supported in part by the Princess Margaret Cancer Foundation and the Ontario Ministry of Health and Long Term Care.

Compliance with ethical standards


The views expressed do not necessarily reflect those of the OMOHLTC.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

520_2019_4866_MOESM1_ESM.docx (46 kb)
ESM 1 (DOCX 46 kb)


  1. 1.
    Hodgson KD, Hutchinson AD, Wilson CJ, Nettelbeck T (2013) A meta-analysis of the effects of chemotherapy on cognition in patients with cancer. Cancer Treat Rev 39(3):297–304PubMedGoogle Scholar
  2. 2.
    Wefel JS, Lenzi R, Theriault RL, Davis RN, Meyers CA (2004) The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma. Cancer 100(11):2292–2299PubMedGoogle Scholar
  3. 3.
    Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T, Kunkler I, Caudrelier J-M, Eisenberg PD, Meerwaldt J (2004) Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 22(1):157–165PubMedPubMedCentralGoogle Scholar
  4. 4.
    Schagen SB, Klein M, Reijneveld J, Brain E, Deprez S, Joly F, Scherwath A, Schrauwen W, Wefel J (2014) Monitoring and optimising cognitive function in cancer patients: present knowledge and future directions. Eur J Cancer Suppl 12(1):29–40Google Scholar
  5. 5.
    Schagen SB, Muller MJ, Boogerd W, Mellenbergh GJ, Van Dam FS (2006) Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. J Natl Cancer Inst 98(23):1742–1745PubMedGoogle Scholar
  6. 6.
    Ahles TA, Saykin AJ, McDonald BC, Li Y, Furstenberg CT, Hanscom BS, Mulrooney TJ, Schwartz GN, Kaufman PA (2010) Longitudinal assessment of cognitive changes associated with adjuvant treatment for breast cancer: impact of age and cognitive reserve. J Clin Oncol 28(29):4434–4440PubMedPubMedCentralGoogle Scholar
  7. 7.
    Schilder CM, Seynaeve C, Beex LV, Boogerd W, Linn SC, Gundy CM, Huizenga HM, Nortier JW, van de Velde CJ, van Dam FS (2010) Effects of tamoxifen and exemestane on cognitive functioning of postmenopausal patients with breast cancer: results from the neuropsychological side study of the tamoxifen and exemestane adjuvant multinational trial. J Clin Oncol 28(8):1294–1300PubMedGoogle Scholar
  8. 8.
    Hermelink K, Bühner M, Sckopke P, Neufeld F, Kaste J, Voigt V, Münzel K, Wuerstlein R, Ditsch N, Hellerhoff K (2017) Chemotherapy and post-traumatic stress in the causation of cognitive dysfunction in breast cancer patients. J Natl Cancer Inst 109(10):djx057Google Scholar
  9. 9.
    Schagen SB, Wefel JS (2017) Post-traumatic stress as the primary cause for cognitive decline—not the whole story, and perhaps no story at all. J Natl Cancer Inst 109(10)Google Scholar
  10. 10.
    Ahles TA, Saykin AJ (2007) Candidate mechanisms for chemotherapy-induced cognitive changes. Nat Rev Cancer 7(3):192–201PubMedPubMedCentralGoogle Scholar
  11. 11.
    Janelsins MC, Kesler SR, Ahles TA, Morrow GR (2014) Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 26(1):102–113PubMedPubMedCentralGoogle Scholar
  12. 12.
    Zer A, Pond GR, Razak ARA, Tirona K, Gan HK, Chen EX, O’sullivan B, Waldron J, Goldstein DP, Weinreb I (2018) Association of neurocognitive deficits with radiotherapy or chemoradiotherapy for patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg 144(1):71–79PubMedGoogle Scholar
  13. 13.
    Alibhai SM, Timilshina N, Duff-Canning S, Breunis H, Tannock IF, Naglie G, Fleshner NE, Krahn MD, Warde P, Marzouk S (2017) Effects of long-term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer. Cancer 123(2):237–244PubMedGoogle Scholar
  14. 14.
    Hoogland AI, Nelson AM, Small BJ, Hyland KA, Gonzalez BD, Booth-Jones M, Anasetti C, Jacobsen PB, Jim HS (2017) The role of age in neurocognitive functioning among adult allogeneic hematopoietic cell transplant recipients. Biol Blood Marrow Transplant 23(11):1974–1979PubMedPubMedCentralGoogle Scholar
  15. 15.
    Simó M, Root JC, Vaquero L, Ripollés P, Jové J, Ahles T, Navarro A, Cardenal F, Bruna J, Rodríguez-Fornells A (2015) Cognitive and brain structural changes in a lung cancer population. J Thorac Oncol 10(1):38–45PubMedPubMedCentralGoogle Scholar
  16. 16.
    Vardy JL, Dhillon HM, Pond GR, Rourke SB, Bekele T, Renton C, Dodd A, Zhang H, Beale P, Clarke S (2015) Cognitive function in patients with colorectal cancer who do and do not receive chemotherapy: a prospective, longitudinal, controlled study. J Clin Oncol 33(34):4085–4092PubMedPubMedCentralGoogle Scholar
  17. 17.
    Wefel JS, Vidrine DJ, Marani SK, Swartz RJ, Veramonti TL, Meyers CA, Hoekstra HJ, Hoekstra-Weebers JE, Gritz ER (2014) A prospective study of cognitive function in men with non-seminomatous germ cell tumors. Psycho-oncology 23(6):626–633PubMedGoogle Scholar
  18. 18.
    Ahles TA, Root JC, Ryan EL (2012) Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol 30(30):3675–3686PubMedPubMedCentralGoogle Scholar
  19. 19.
    Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C (2012) Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev 38(7):926–934PubMedGoogle Scholar
  20. 20.
    Koppelmans V, Breteler M, Boogerd W, Seynaeve C, Gundy C, Schagen S (2012) Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol 30(10):1080–1086PubMedGoogle Scholar
  21. 21.
    Boykoff N, Moieni M, Subramanian SK (2009) Confronting chemobrain: an in-depth look at survivors’ reports of impact on work, social networks, and health care response. J Cancer Surviv 3(4):223–232PubMedPubMedCentralGoogle Scholar
  22. 22.
    Munir F, Burrows J, Yarker J, Kalawsky K, Bains M (2010) Women’s perceptions of chemotherapy-induced cognitive side affects on work ability: a focus group study. J Clin Nurs 19(9–10):1362–1370PubMedGoogle Scholar
  23. 23.
    Von Ah D, Habermann B, Carpenter JS, Schneider BL (2013) Impact of perceived cognitive impairment in breast cancer survivors. Eur J Oncol Nurs 17(2):236–241Google Scholar
  24. 24.
    Beck JS (2011) Cognitive behavior therapy: basics and beyond. Guilford Press, New YorkGoogle Scholar
  25. 25.
    Ferguson RJ, Ahles TA, Saykin AJ, McDonald BC, Furstenberg CT, Cole BF, Mott LA (2007) Cognitive-behavioral management of chemotherapy-related cognitive change. Psycho-Oncology 16(8):772–777. PubMedPubMedCentralGoogle Scholar
  26. 26.
    Cherrier MM, Anderson K, David D, Higano CS, Gray H, Church A, Willis SL (2013) A randomized trial of cognitive rehabilitation in cancer survivors. Life Sci 93(17):617–622. PubMedGoogle Scholar
  27. 27.
    Ferguson RJ, McDonald BC, Rocque MA, Furstenberg CT, Horrigan S, Ahles TA, Saykin AJ (2012) Development of CBT for chemotherapy-related cognitive change: results of a waitlist control trial. Psychooncology 21(2):176–186. PubMedGoogle Scholar
  28. 28.
    Ferguson RJ, Sigmon ST, Pritchard AJ, LaBrie SL, Goetze RE, Fink CM, Garrett AM (2016) A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer 122(11):1782–1791. PubMedGoogle Scholar
  29. 29.
    King S, Green HJ (2015) Psychological intervention for improving cognitive function in cancer survivors: a literature review and randomized controlled trial. Front Oncol 5:72. PubMedPubMedCentralGoogle Scholar
  30. 30.
    McDougall GJ, Becker H, Acee TW, Vaughan PW, Delville CL (2011) Symptom management of affective and cognitive disturbance with a group of cancer survivors. Arch Psychiatr Nurs 25(1):24–35. PubMedGoogle Scholar
  31. 31.
    Park JH, Jung YS, Kim KS, Bae SH (2017) Effects of compensatory cognitive training intervention for breast cancer patients undergoing chemotherapy: a pilot study. Support Care Cancer 25(6):1887–1896. PubMedGoogle Scholar
  32. 32.
    Bray VJ, Dhillon HM, Bell ML, Kabourakis M, Fiero MH, Yip D, Boyle F, Price MA, Vardy JL (2017) Evaluation of a web-based cognitive rehabilitation program in cancer survivors reporting cognitive symptoms after chemotherapy. J Clin Oncol 35(2):217–225. PubMedGoogle Scholar
  33. 33.
    Damholdt MF, Mehlsen M, O’Toole MS, Andreasen RK, Pedersen AD, Zachariae R (2016) Web-based cognitive training for breast cancer survivors with cognitive complaints—a randomized controlled trial. Psycho-Oncology 25(11):1293–1300. PubMedPubMedCentralGoogle Scholar
  34. 34.
    Kesler S, Hadi Hosseini SM, Heckler C, Janelsins M, Palesh O, Mustian K, Morrow G (2013) Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clin Breast Cancer 13(4):299–306. PubMedPubMedCentralGoogle Scholar
  35. 35.
    Wu LM, Amidi A, Tanenbaum ML, Winkel G, Gordon WA, Hall SJ, Bovbjerg K, Diefenbach MA (2018) Computerized cognitive training in prostate cancer patients on androgen deprivation therapy: a pilot study. Support Care Cancer 26(6):1917–1926PubMedGoogle Scholar
  36. 36.
    Ercoli LM, Petersen L, Hunter AM, Castellon SA, Kwan L, Kahn-Mills BA, Embree LM, Cernin PA, Leuchter AF, Ganz PA (2015) Cognitive rehabilitation group intervention for breast cancer survivors: results of a randomized clinical trial. Psychooncology 24(11):1360–1367. PubMedGoogle Scholar
  37. 37.
    Von Ah D, Carpenter JS, Saykin A, Monahan P, Wu J, Yu M, Rebok G, Ball K, Schneider B, Weaver M, Tallman E, Unverzagt F (2012) Advanced cognitive training for breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 135(3):799–809. Google Scholar
  38. 38.
    Poppelreuter M, Weis J, Bartsch HH (2009) Effects of specific neuropsychological training programs for breast cancer patients after adjuvant chemotherapy. J Psychosoc Oncol 27(2):274–296. PubMedGoogle Scholar
  39. 39.
    Mihuta M, Green H, Shum D (2018) Efficacy of a web-based cognitive rehabilitation intervention for adult cancer survivors: a pilot study. Eur J Cancer Care 27(2):e12805Google Scholar
  40. 40.
    Schuurs A, Green HJ (2013) A feasibility study of group cognitive rehabilitation for cancer survivors: enhancing cognitive function and quality of life. Psycho-Oncology 22(5):1043–1049. PubMedGoogle Scholar
  41. 41.
    McDougall GJ (2001) Memory improvement program for elderly cancer survivors. Geriatr Nurs (New York, NY) 22(4):185–190. Google Scholar
  42. 42.
    Becker H, Henneghan AM, Volker DL, Mikan SQ (2017) A pilot study of a cognitive-behavioral intervention for breast cancer survivors. Oncol Nurs Forum 44(2):255–264. PubMedGoogle Scholar
  43. 43.
    Ercoli LM, Castellon SA, Hunter AM, Kwan L, Kahn-Mills BA, Cernin PA, Leuchter AF, Ganz PA (2013) Assessment of the feasibility of a rehabilitation intervention program for breast cancer survivors with cognitive complaints. Brain Imaging Behav 7(4):543–553. PubMedGoogle Scholar
  44. 44.
    Cicerone KD, Azulay J, Trott C (2009) Methodological quality of research on cognitive rehabilitation after traumatic brain injury. Arch Phys Med Rehabil 90(11):S52–S59PubMedGoogle Scholar
  45. 45.
    Cicerone KD, Langenbahn DM, Braden C, Malec JF, Kalmar K, Fraas M, Felicetti T, Laatsch L, Harley JP, Bergquist T (2011) Evidence-based cognitive rehabilitation: updated review of the literature from 2003 through 2008. Arch Phys Med Rehabil 92(4):519–530PubMedGoogle Scholar
  46. 46.
    Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52(6):377–384PubMedPubMedCentralGoogle Scholar
  47. 47.
    Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928PubMedPubMedCentralGoogle Scholar
  48. 48.
    Milbury K, Chaoul A, Biegler K, Wangyal T, Spelman A, Meyers C, Arun B, Palmer J, Taylor J, Cohen L (2013) Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial. Psycho-Oncology 22(10):2354–2363PubMedPubMedCentralGoogle Scholar
  49. 49.
    Strauss E, Sherman EM, Spreen O (2006) A compendium of neuropsychological tests: administration, norms, and commentary. American Chemical Society, WashingtonGoogle Scholar
  50. 50.
    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198Google Scholar
  51. 51.
    Randolph C (1998) Repeatable battery for the assessment of neuropsychological status manual. The Psychological Corporation, San AntonioGoogle Scholar
  52. 52.
    Sullivan G, Feinn R (2012) Using effect size- or why the p value is not enough. J Grad Med Educ 4:279–282. PubMedPubMedCentralGoogle Scholar
  53. 53.
    Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, HillsdaleGoogle Scholar
  54. 54.
    Owen AM, Hampshire A, Grahn JA, Stenton R, Dajani S, Burns AS, Howard RJ, Ballard CG (2010) Putting brain training to the test. Nature 465:775–778. - supplementary-informationPubMedPubMedCentralGoogle Scholar
  55. 55.
    Morris SB (2008) Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods 11(2):364–386Google Scholar
  56. 56.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Nat l Cancer Inst 85(5):365–376Google Scholar
  57. 57.
    Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579PubMedGoogle Scholar
  58. 58.
    Devins GM (2010) Using the illness intrusiveness ratings scale to understand health-related quality of life in chronic disease. J Psychosom Res 68(6):591–602PubMedGoogle Scholar
  59. 59.
    Catt S, Starkings R, Shilling V, Fallowfield L (2017) Patient-reported outcome measures of the impact of cancer on patients’ everyday lives: a systematic review. J Cancer Surviv 11(2):211–232PubMedGoogle Scholar
  60. 60.
    Goedendorp MM, Knoop H, Gielissen MF, Verhagen CA, Bleijenberg G (2014) The effects of cognitive behavioral therapy for postcancer fatigue on perceived cognitive disabilities and neuropsychological test performance. J Pain Symptom Manag 47(1):35–44Google Scholar
  61. 61.
    Kucherer S, Ferguson RJ (2017) Cognitive behavioral therapy for cancer-related cognitive dysfunction. Curr Opin Support Palliat Care 11(1):46–51PubMedPubMedCentralGoogle Scholar
  62. 62.
    Wefel JS, Vardy J, Ahles T, Schagen SB (2011) International Cognition and Cancer Task Force recommendations to harmonise studies of cognitive function in patients with cancer. Lancet Oncol 12(7):703–708PubMedGoogle Scholar
  63. 63.
    Downie FP, Mar Fan HG, Houédé-Tchen N, Yi Q, Tannock IF (2006) Cognitive function, fatigue, and menopausal symptoms in breast cancer patients receiving adjuvant chemotherapy: evaluation with patient interview after formal assessment. Psycho-Oncology 15(10):921–930PubMedGoogle Scholar
  64. 64.
    Myers JS (2009) Chemotherapy-related cognitive impairment. Clin J Oncol Nurs 13(4):413–421PubMedGoogle Scholar
  65. 65.
    Mlinac ME, Feng MC (2016) Assessment of activities of daily living, self-care, and independence. Arch Clin Neuropsychol 31(6):506–516PubMedGoogle Scholar
  66. 66.
    Turner-Stokes L (2009) Goal attainment scaling (GAS) in rehabilitation: a practical guide. Clin Rehabil 23(4):362–370PubMedGoogle Scholar
  67. 67.
    Sleight A (2016) Coping with cancer-related cognitive dysfunction: a scoping review of the literature. Disabil Rehabil 38(4):400–408PubMedGoogle Scholar
  68. 68.
    Janelsins MC, Peppone LJ, Heckler CE, Kesler SR, Sprod LK, Atkins J, Melnik M, Kamen C, Giguere J, Messino MJ (2016) YOCAS©® yoga reduces self-reported memory difficulty in cancer survivors in a nationwide randomized clinical trial: investigating relationships between memory and sleep. Integr Cancer Ther 15(3):263–271PubMedGoogle Scholar
  69. 69.
    Perneger TV (1998) What’s wrong with Bonferroni adjustments. BMJ 316(7139):1236–1238PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Psychology, Faculty of HealthYork UniversityTorontoCanada
  2. 2.Department of Supportive CarePrincess Margaret Cancer CentreTorontoCanada
  3. 3.Department of Psychiatry, Faculty of MedicineUniversity of TorontoTorontoCanada

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