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Cognitive Training for Improving Executive Function in Chemotherapy-Treated Breast Cancer Survivors
Open accessAbstract
Background A majority of breast cancer (BC) survivors, particularly those treated with chemotherapy, experience long-term cognitive deficits that significantly reduce quality of life. Among the cognitive domains most commonly affected include executive functions (EF), such as working memory, cognitive flexibility, multitasking, planning, and attention. Previous studies in other populations have shown that cognitive training, a behavioral method for treating cognitive deficits, can result in significant improvements in a number of cognitive skills, including EF.Materials and methods In this study, we conducted a randomized controlled trial to investigate the feasibility and preliminary effectiveness of a novel, online EF training program in long-term BC survivors. A total of 41 BC survivors (21 active, 20 wait list) completed the 48 session training program over 12 weeks. The participants were, on average, 6 years after therapy.Results Cognitive training led to significant improvements in cognitive flexibility, verbal fluency and processing speed, with marginally significant downstream improvements in verbal memory as assessed via standardized measures. Self-ratings of EF skills, including planning, organizing, and task monitoring, also were improved in the active group compared with the wait list group.Conclusions Our findings suggest that EF skills may be improved even in long-term survivors by using a computerized, home-based intervention program. These improvements may potentially include subjective EF skills, which suggest a transfer of the training program to real-world behaviors.
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“Treatment type is known to impact executive functioning, 79 an important mechanism in ER processes. 48”
From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [79]
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“These tasks are described more thoroughly elsewhere (Kesler et al., 2013; Mayas, Parmentier, Andrés, & Ballesteros, 2014; Sternberg et al., 2013).”
MethodTringale, K. R., Nguyen, T. T., Bahrami, N., Marshall, D. C., Leyden, K. M., Karunamuni, R. A., Seibert, T. M., Gorman, M. K., Connor, M. J., Jr., Burkeen, J., et al. (2018) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2018.11.018 · Cited by 51
“, psychostimulants)[38] during a critical period and before permanent injury has occurred[39].”
BackgroundAh, D. M. V., & Crouch, A. (2020) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2019.150977 · Cited by 50
Cognitive behavioral therapy for cancer-related cognitive dysfunction
Kucherer, S., & Ferguson, R. J. (2016) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000247 · Cited by 50
Brown, T., Sykes, D., & Allen, A. R. (2021) · Biomedicines · doi:10.3390/biomedicines9020189 · Cited by 50
Chemobrain in Breast Cancer: Mechanisms, Clinical Manifestations, and Potential Interventions
Onzi, G. R., D’Agustini, N., García, S. C., Guterres, S. S., Pohlmann, P. R., Rosa, D. D., & Pohlmann, A. R. (2022) · Drug Safety · doi:10.1007/s40264-022-01182-3 · Cited by 48
Pergolotti, M., Battisti, N. M. L., Padgett, L. S., Sleight, A. G., Abdallah, M. M., Newman, R. M., Dyk, K. V., Covington, K. R., Williams, G. R., van den Bos, F., et al. (2019) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2019.09.002 · Cited by 48
“computer-based exercises aimed at increasing executive function skills such as cognitive flexibility, processing speed, working memory, and verbal fluency [140,141].”
BackgroundPark, J., Jung, Y. S., Kim, K. S., & Bae, S. H. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3589-8 · Cited by 46
Optimizing Cognitive Function in Persons With Chronic Pain
Baker, K. S., Georgiou‐Karistianis, N., Gibson, S. J., & Giummarra, M. J. (2016) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000423 · Cited by 46
Ding, K., Zhang, X., Zhao, J., Zuo, H., Bi, Z., & Cheng, H. (2020) · Integrative Cancer Therapies · doi:10.1177/1534735420938450 · Cited by 45
Morean, D. F., O’Dwyer, L., & Cherney, L. R. (2015) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2015.05.012 · Cited by 44
Wu, L. M., Amidi, A., Tanenbaum, M. L., Winkel, G. H., Gordon, W. A., Hall, S. J., Bovbjerg, K., & Diefenbach, M. A. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-4026-8 · Cited by 44
“In two breast cancer CCT trials—one that targeted speed of processing (using BrainHQ) and memory and the other that targeted executive functioning—CCT led to domain-specific cognitive improvements that transferred to higher-level cognitive functions, symptom distress and quality of life in the former, and self-reporte…”
BackgroundResultMindfulness-Based Stress Reduction on breast cancer symptoms: systematic review and meta-analysis
Castanhel, F. D., & Liberali, R. (2018) · Einstein (São Paulo) · doi:10.31744/einstein_journal/2018rw4383 · Cited by 45
“(48) Between 17% and 75% of patients with breast cancer, who perform chemotherapy, showed altered brain structure and function which suggests a pattern of diffuse brain injury that underlies the cognitive deficits that may occur during the first 6 months, followed by a recovery of 1 to 2 years and/or a period of stabi…”
BackgroundTraining cognitive control to reduce emotional vulnerability in breast cancer
Swainston, J., & Derakshan, N. (2018) · Psycho-Oncology · doi:10.1002/pon.4727 · Cited by 48
Neuropsychological Practice in the Oncology Setting
Noll, K. R., Bradshaw, M. E., Rexer, J. L., & Wefel, J. S. (2017) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx131 · Cited by 43
“For those with “chemobrain” and other cancer-related cognitive issues, cognitive training may be beneficial (Kesler et al., 2013; Morean, O’Dwyer, & Cherney, 2015).”
BackgroundMustian, K. M., Cole, C. L., Lin, P., Asare, M., Fung, C., Janelsins, M. C., Kamen, C. S., Peppone, L. J., & Magnuson, A. M. (2016) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2016.09.002 · Cited by 43
Self-citationCaeyenberghs, K., Duprat, R., Leemans, A., Hosseini, S. M. H., Wilson, P. H., Klooster, D., & Baeken, C. (2018) · Network Neuroscience · doi:10.1162/netn_a_00060 · Cited by 39
Cheng, A. S. K., Wang, X., Niu, N., Liang, M., & Zeng, Y. (2022) · Neuropsychology Review · doi:10.1007/s11065-021-09532-1 · Cited by 45
Shining the Light of Research on Lumosity
Bainbridge, K., & Mayer, R. E. (2017) · Journal of Cognitive Enhancement · doi:10.1007/s41465-017-0040-5 · Cited by 43
“en receiving chemotherapy for breast cancer, in 48 sessions spread over 12 weeks, using Lumosity games (Kesler et al. 2013).”
BackgroundMethodInfluentialLiou, K. T., Root, J. C., Garland, S. N., Green, J. A., Li, Y., Li, Q. S., Kantoff, P. W., Ahles, T. A., & Mao, J. J. J. (2020) · Cancer · doi:10.1002/cncr.32847 · Cited by 39
Zeng, Y., Cheng, A. S. K., & Chan, C. C. H. (2016) · Integrative Cancer Therapies · doi:10.1177/1534735416638737 · Cited by 38
“For example, CT interventions by an online and home-based program significantly improved multiple executive function skills, as reported by objective and self-report measures.(14) CR interventions have positive effects in formal neurocognitive tests, such as the domains of immediate and delayed memory by RBANS, and se…”
BackgroundIulio, F. D., Cravello, L., Shofany, J., Paolucci, S., Caltagirone, C., & Morone, G. (2019) · Neurological Sciences · doi:10.1007/s10072-019-03898-0 · Cited by 40
Cognitive Changes Associated With Cancer and Cancer Treatment: State of the Science
Ah, D. M. V. (2015) · Clinical journal of oncology nursing · doi:10.1188/15.cjon.19-01ap · Cited by 39
“, 2008; McDougall, 2001; McDougall, Becker, Acee, Vaughan, & Delville, 2011; Schuurs & Green, 2012; Sherer, Meyers, & Bergloff, 1997), cognitive training (Gehring et al., 2009; Hassler et al., 2010; Kesler et al., 2013; Miotto et al., 2013; Poppelreuter, Weis, & Bartsch, 2009; Von Ah et al., 2012; Zucchella et al., 20…”
Neurocognitive Effects Following Cranial Irradiation for Brain Metastases
Pinkham, M. B., Sanghera, P., Wall, G., Dawson, B., & Whitfield, G. A. (2015) · Clinical Oncology · doi:10.1016/j.clon.2015.06.005 · Cited by 39
Hoogland, A. I., Nelson, A. M., Gonzalez, B. D., Small, B. J., Breen, E. C., Sutton, S. K., Syrjala, K. L., Bower, J. E., Pidala, J., Booth‐Jones, M., et al. (2019) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2019.04.008 · Cited by 36
Binarelli, G., Joly, F., Tron, L., Lefèvre‐Arbogast, S., & Lange, M. (2021) · Cancers · doi:10.3390/cancers13205161 · Cited by 36
Improvement of quality of life and psychological distress after inpatient cancer rehabilitation
Riedl, D., Giesinger, J. M., Wintner, L. M., Loth, F. L. C., Rumpold, G., Greil, R., Nickels, A., Licht, T., & Holzner, B. (2017) · Wiener klinische Wochenschrift · doi:10.1007/s00508-017-1266-z · Cited by 36
Binarelli, G., Duivon, M., Joly, F., Ahmed-Lecheheb, D., & Lange, M. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2187288 · Cited by 35
Zhang, T., Ren, Z., Wakefield, C. E., Hui, B. P. H., Akechi, T., Shi, C., Du, X., Chen, W., Lai, L., Zhao, C., et al. (2024) · Clinical Psychology Review · doi:10.1016/j.cpr.2024.102520 · Cited by 44
Myers, J. S., Cook‐Wiens, G., Baynes, R., Jo, M.-Y., Bailey, C. S. L., Krigel, S., Klemp, J. R., & Asher, A. (2020) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2020.01.021 · Cited by 35
Harrison, R. A., Sharafeldin, N., Rexer, J. L., Streck, B. P., Petersen, M. E., Henneghan, A. M., & Kesler, S. R. (2021) · The Oncologist · doi:10.1002/onco.13867 · Cited by 38
Self-citationOldacres, L., Hegarty, J. M., O’Regan, P., Murphy‐Coakley, N. M., & Saab, M. M. (2022) · Psycho-Oncology · doi:10.1002/pon.6073 · Cited by 33
“Studies investigating brain‐training were heterogenous, with some including patients with cognitive impairment(57,77) and others not.(76) In addition, brain‐training interventions were administered either during chemotherapy,(77) once chemotherapy is completed,(78) or up to 5 years following treatment.”
BackgroundMethodResultInfluentialSymptoms: Fatigue and Cognitive Dysfunction
Bower, J. E., & Ganz, P. A. (2015) · Advances in experimental medicine and biology · doi:10.1007/978-3-319-16366-6_5 · Cited by 34
“Indeed, several studies of breast cancer patients have demonstrated relationships between systemic levels of infl ammation and brain imaging structural and metabolic changes (Kesler et al. 2013b ; Pomykala et al. 2013 ).”
BackgroundBaseline Cognition Assessment Among Patients With Oropharyngeal Cancer Using PROMIS and NIH Toolbox
Sinha, P., Wong, A., Kallogjeri, D., & Piccirillo, J. F. (2018) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2018.0283 · Cited by 31
MACKENZIE, L., & MARSHALL, K. (2021) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.21.06898-2 · Cited by 31
Metadata
- Authors
- Kesler, S., Hadi Hosseini, S. M., Heckler, C., Janelsins, M., Palesh, O., Mustian, K., & Morrow, G.
- Affiliations
- Stanford Medicine (US)
- University of Rochester Medicine (US)
- Corresponding author
- Kesler, Shelli
- Venue
- Clinical Breast Cancer
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 13
- Issue
- 4
- Pages
- 299-306
- ISSN
- 1526-8209 (ISSN-L)
- PMC
- PMC3726272
- OpenAlex
- W1988359564
- Cited by
- 300
- References
- 71
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 20 · 2023: 19 · 2022: 23 · 2021: 26 · 2020: 25 · 2019: 34 · 2018: 22 · 2017: 29 · 2016: 29 · 2015: 25 · 2014: 17
- FWCI
- 19.24
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Breast Cancer (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health (1dp2od004445-01)
- National Cancer Institute (K07CA168886)
- Topics
- Health Sciences › Medicine › Oncology › Cancer-related cognitive impairment studies
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Functions and Memory
- Keywords
- cognitive training, executive function, breast cancer survivors, chemotherapy, cognitive impairment, cognitive flexibility, verbal fluency, processing speed, verbal memory, online intervention, home-based intervention, feasibility, quality of life
- MeSH terms
- Adult, Breast Neoplasms, Cognition Disorders, Feasibility Studies, Female, Follow-Up Studies, Health Promotion, Humans, Middle Aged, Prognosis, Quality of Life, Cognitive Behavioral Therapy, Survivors, Executive Function
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