Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity

Binarelli, Giulia; Joly, Florence; Tron, Laure; Lefevre Arbogast, Sophie; Lange, Marie

SIMPLE SUMMARY: Many patients in oncology reports cognitive complaints with consequences on quality of life and seek support. Several interventions have been investigated to improve these symptoms, and, to date, cognitive stimulation and physical activity seem to be the most efficient. Nevertheless, these interventions are difficult to set up in a supportive care routine because they require the presence of professionals such as neuropsychologists and physical therapists, who are not always available. To overcome these barriers, computerized interventions have started to be investigated. This systematic review aimed to present the state of knowledge on computerized interventions based on cognitive stimulation and/or physical activity to improve cognitive difficulties in cancer patients. Both computerized physical activity and cognitive stimulation are efficient for cognitive improvement, although further investigation is necessary to compare efficiency between the two interventions and to investigate the possible added value of a combined intervention. ABSTRACT: Cancer-related cognitive impairment (CRCI) occurs frequently in patients living with cancer, with consequences on quality of life. Recently, research on the management of these difficulties has focused on computerized cognitive stimulation and computerized physical activity programs. This systematic review presents the state of knowledge about interventions based on computerized-cognitive stimulation and/or physical activity to reduce CRCI. The review followed the PRISMA guidelines. A search was conducted in PUBMED and Web of Science databases. Risk of bias analysis was conducted using the Rob2 tool and the quality of evidence was conducted following the GRADE approach. A total of 3776 articles were initially identified and 20 of them met the inclusion criteria. Among them, sixteen investigated computerized-cognitive stimulation and four computerized-physical activity. Most of the studies were randomized controlled trials and assessed the efficacy of a home-based intervention on objective cognition in adults with cancer. Overall, cognitive improvement was found in 11/16 computerized-cognitive stimulation studies and 2/4 computerized-physical activity studies. Cognitive stimulation or physical activity improved especially cognitive complaints, memory, and attention. These results suggest the efficacy of both computerized-cognitive stimulation and physical activity. However, we report a high risk of bias for the majority of studies and a low level of quality of evidence. Therefore, further investigations are needed to confirm the efficacy of these interventions and to investigate the possible added benefit on cognition of a combined computerized-cognitive/physical intervention.