Impact of Cognitive Rehabilitation on Cognitive and Functional Outcomes in Adult Cancer Survivors: A Systematic Review.

Many included studies were small, single-arm or pilot studies, and few had adequate sample sizes or controlled for confounding, so improvements over time may reflect practice effects, natural recovery or selection rather than the intervention. The review could not pool results because intervention types, cancer populations, outcome measures and study designs were highly heterogeneous. Real-world function was measured in only a few studies, and those studies used different functional outcomes, so the evidence for everyday benefit is limited. Few studies reported clinically important differences or effect sizes, so statistically significant changes may not mean meaningful benefit for patients. Many studies were in breast cancer survivors, and most were conducted during survivorship after multiple treatments, so results may not apply to other cancers, active treatment, immunotherapy, childhood or adolescent and young adult survivors, or treatment-specific cognitive problems. Blinding was limited: many studies reported blinding of outcome assessors, but few had robust methods for blinding investigators or participants, which matters for self-reported outcomes. The review required objective cognitive measures, so studies that looked only at patient-reported cognition or function may have been missed.

One author, Diane Von Ah, reports National Cancer Institute funding (R01CA276222) and relationships with the Midwest Nursing Research Society and the National Cancer Institute PDQ Palliative & Supportive Care Editorial Board involving board membership and travel reimbursement. The article is labelled as supported by NIH extramural funding. No other conflicts are stated.

Do not conclude that cognitive rehabilitation reliably improves real-world function. Few studies measured function, many cognitive improvements were over time rather than versus controls, and functional results were mixed.