title: Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors.
abstract: 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.
  
  
  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.
authors: Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA 94305-5795, USA. skesler@stanford.edu
authors: Shelli
authors: S
authors: Kesler
authors: S M
authors: SM
authors: Hadi Hosseini
authors: Charles
authors: C
authors: Heckler
authors: Michelle
authors: M
authors: Janelsins
authors: Oxana
authors: O
authors: Palesh
authors: Karen
authors: K
authors: Mustian
authors: Gary
authors: G
authors: Morrow
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D056344:Executive Function; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006293:Health Promotion; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D017741:Survivors / Q000523:psychology*
keywords: Chemotherapy; Cognitive flexibility; Memory; Processing speed; Rehabilitation
references: Brain Behav Immun. 2013 Mar;30 Suppl:S109-16
references: 22698992
references: Psychooncology. 2008 Feb;17(2):122-30
references: 17518411
references: Front Hum Neurosci. 2010 Oct 14;4:182
references: 21048895
references: Psychol Aging. 2008 Dec;23(4):692-701
references: 19140641
references: Psychol Aging. 2008 Dec;23(4):743-53
references: 19140646
references: Breast Cancer Res Treat. 2012 Oct;135(3):799-809
references: 22918524
references: Med Teach. 2009 Sep;31(9):807-11
references: 19811185
references: Brain Lang. 2007 Jul;102(1):46-51
references: 17161455
references: Int J Geriatr Psychiatry. 2009 Feb;24(2):163-8
references: 18636436
references: Breast Cancer Res Treat. 2012 Apr;132(3):1099-106
references: 22205140
references: Neurobiol Aging. 2011 Apr;32(4):655-68
references: 19428142
references: J Neuropsychiatry Clin Neurosci. 2010 Winter;22(1):48-54
references: 20160209
references: BMC Neurol. 2012 May 28;12:28
references: 22632066
references: Breast Cancer Res Treat. 2010 Oct;123(3):819-28
references: 20690040
references: J Clin Oncol. 2012 Jan 20;30(3):274-81
references: 22184379
references: Work. 2010;36(4):371-2
references: 20714091
references: Brain Inj. 2011;25(1):101-12
references: 21142826
references: J Affect Disord. 2000 Oct;60(1):13-23
references: 10940443
references: Hum Brain Mapp. 2011 Aug;32(8):1206-19
references: 20669165
references: Arch Phys Med Rehabil. 2011 Apr;92(4):519-30
references: 21440699
references: Clin Neuropsychol. 1999 Aug;13(3):348-58
references: 10726605
references: J Clin Exp Neuropsychol. 2009 Jan;31(1):73-89
references: 18608651
references: J Clin Exp Neuropsychol. 2004 Oct;26(7):955-69
references: 15742545
references: Cancer Treat Res. 2009;151:387-419
references: 19593525
references: J Clin Oncol. 2010 Oct 10;28(29):4434-40
references: 20837957
references: Psychooncology. 2012 Feb;21(2):176-86
references: 22271538
references: Cancer J. 2008 Nov-Dec;14(6):396-400
references: 19060604
references: JAMA. 2006 Dec 20;296(23):2805-14
references: 17179457
references: J Am Geriatr Soc. 2011 Feb;59(2):258-65
references: 21314646
references: Brain Cogn. 2006 Mar;60(2):213-4
references: 16646127
references: Dev Disabil Res Rev. 2009;15(4):270-8
references: 20014362
references: Proc Natl Acad Sci U S A. 2008 May 13;105(19):6829-33
references: 18443283
references: Dev Sci. 2009 Jan;12(1):106-13
references: 19120418
references: Phys Med Rehabil Clin N Am. 2007 Feb;18(1):27-42, v-vi
references: 17292811
references: Front Aging Neurosci. 2010 Jul 13;2:
references: 20725526
references: Front Hum Neurosci. 2010 Mar 12;4:16
references: 20300200
references: J Neurol Phys Ther. 2007 Sep;31(3):119-27
references: 18025957
references: J Gerontol A Biol Sci Med Sci. 2006 Dec;61(12):1324-9
references: 17234829
references: J Clin Exp Neuropsychol. 2005 Jul;27(5):599-609
references: 16019636
references: Neuroimage. 2010 Aug 15;52(2):658-68
references: 20399274
references: Trends Cogn Sci. 2010 Jul;14(7):317-24
references: 20630350
references: Int J Geriatr Psychiatry. 2007 Apr;22(4):356-60
references: 17117398
references: Breast Cancer Res Treat. 2009 Jul;116(1):125-7
references: 18923899
references: Schizophr Bull. 2010 Jul;36(4):869-79
references: 19269924
references: Brain Behav Immun. 2013 Mar;30 Suppl:S117-25
references: 22613170
references: Cancer. 2010 Jul 15;116(14):3348-56
references: 20564075
references: J Gerontol A Biol Sci Med Sci. 2010 Jun;65(6):680-8
references: 20418350
references: Curr Neurol Neurosci Rep. 2012 Jun;12(3):267-75
references: 22453825
references: Support Care Cancer. 2008 Jun;16(6):577-83
references: 17972110
references: J Cancer Surviv. 2009 Dec;3(4):223-32
references: 19760150
references: Psychol Aging. 2008 Dec;23(4):731-42
references: 19140644
references: Am J Geriatr Psychiatry. 2010 Apr;18(4):281-96
references: 20220584
references: Cancer. 2007 Jan 1;109(1):146-56
references: 17131349
references: J Neurosci. 2010 Mar 3;30(9):3297-303
references: 20203189
references: Brain Cogn. 2009 Dec;71(3):437-51
references: 19375839
references: Health Psychol. 2010 Jan;29(1):50-5
references: 20063935
references: Am J Health Syst Pharm. 2009 Jul 1;66(13):1180-5
references: 19535656
references: Neuroimage. 2006 Apr 15;30(3):1038-49
references: 16414280
references: Front Hum Neurosci. 2012 Jun 06;6:166
references: 22685428
references: Int Psychogeriatr. 2010 Jun;22(4):537-48
references: 20170585
references: Arch Neurol. 2011 Nov;68(11):1447-53
references: 22084128
references: Work. 2010;36(4):381-8
references: 20714093
references: Drug Alcohol Depend. 2004 Dec 7;76 Suppl:S45-52
references: 15555816
references: Neurobiol Dis. 2012 Dec;48(3):329-38
references: 22820143
references: J Psychosoc Oncol. 2009;27(2):274-96
references: 19337933