Internet-based cognitive rehabilitation for working cancer survivors: results of a multicenter randomized controlled trial

Abstract

Background: Cognitive problems contribute to decline in work performance. We evaluated (1) the effectiveness of basic self-management and extensive therapist-guided online cognitive rehabilitation on attainment of individually predetermined work-related goals among occupationally active cancer survivors, and (2) whether effectiveness of the programs differed for survivors with and without formal cognitive impairment. Methods: In a 3-arm randomized controlled trial (NCT03900806), 279 non–central nervous system cancer survivors with cognitive complaints were assigned to the basic program (n ¼ 93), the extensive program (n ¼ 93), or a waiting-list control group (n ¼ 93). Participants completed measurements pre-randomization (T0), 12 weeks post-randomization upon program completion (T1), and 26 weeks post-randomization (T2). Mixed-effects modeling was used to compare intervention groups with the control group on goal attainment, and on self-perceived cognitive problems, work ability, and health-related quality of life. Results: Participants in the extensive program achieved their predetermined goals better than those in the control group, at short- and long-term follow-up (effect size [ES] ¼ .49; P < .001; ES ¼ .34; P ¼ .014). They also had fewer recovery needs after work (ES ¼ -.21; P ¼ .011), more vitality (ES ¼ .20; P ¼ .018), and better physical role functioning (ES ¼ .0.43 P ¼ .015) than controls. At long-term followup, this finding persisted for physical role functioning (ES ¼ .42; P ¼ .034). The basic program elicited a small positive nonsignificant short-term (not long-term) effect on goal attainment for those with adequate adherence (ES ¼ .28, P ¼ .053). Effectiveness of the programs did not differ for patients with or without cognitive impairment. Conclusions: Internet-based therapist-guided extensive cognitive rehabilitation improves work-related goal attainment. Considering the prevalence of cognitive problems in survivors, it is desirable to implement this program.