Unicare Rehabilitation Røros, Røros, Norway.
Unicare Norway, Oslo, Norway.
Integr Cancer Ther. 2023 Jan-Dec;22:15347354231164401. doi: 10.1177/15347354231164401.
Cognitive complaints are common late effects in patients with cancer, and no standard treatment exists. Recent studies with several patient populations have indicated that there is potential to improve working memory (WM) via web-based WM training. However, the feasibility of including web-based WM training as part of inpatient cancer rehabilitation, in combination with unprompted home-based training, has not been studied. The aim of this study was to assess the feasibility of including web-based WM training (using Cogmed QM) during inpatient rehabilitation and its subsequent unprompted completion in a home-based setting.
Patients with cancer who self-reported cognitive complaints were instructed to complete 25 Cogmed QM sessions during their 3-week inpatient multidisciplinary cancer rehabilitation and subsequently at home after discharge from rehabilitation. The feasibility was determined by assessing the study recruitment, adherence to the WM training, improvements in training tasks (compliance measure) and patient experiences by individual interviews.
Twenty-nine (27 women) of 32 eligible patients (89.6%) started WM training, 1 declined participation and 2 patients withdrew before WM training started. Twenty-six of 29 (89.6%) participants adhered to the intervention during rehabilitation, while 19 of 29 (65.5%) also adhered to the subsequent unprompted home-based intervention. All participants who completed the Cogmed QM sessions demonstrated improvements in the training tasks, as defined by the Cogmed Improvement Index (MD = 24.05, SD = 9.38, range 2-44, < .011). Interview data suggested that practical limitations, including a lack of time, technical difficulties, difficulties finding a suitable disturbance-free environment and low motivation were barriers to completing the training at home.
The findings show that it is feasible to include web-based WM training during inpatient multidisciplinary rehabilitation for adult patients with cancer with cognitive complaints. However, patient adherence to unprompted web-based WM training after discharge from rehabilitation was not optimal. Thus, future studies should consider the barriers to adherence and the need for supervision and social support to reinforce home-based training.
认知障碍是癌症患者的常见晚期效应，但目前尚无标准治疗方法。最近对多个患者群体的研究表明，通过基于网络的工作记忆训练，有可能改善工作记忆（WM）。然而，将基于网络的 WM 训练纳入住院癌症康复治疗中，并结合无提示的家庭训练，其可行性尚未得到研究。本研究的目的是评估在住院康复期间纳入基于网络的 WM 训练（使用 Cogmed QM）的可行性，以及在康复后无提示的家庭环境中完成该训练的可行性。
自我报告认知障碍的癌症患者被指示在 3 周的多学科癌症康复住院期间完成 25 次 Cogmed QM 训练，然后在康复出院后在家中继续完成。通过评估研究招募情况、WM 训练的依从性、训练任务的改善（依从性衡量）以及通过个人访谈评估患者体验来确定可行性。
32 名符合条件的患者中有 29 名（27 名女性）开始进行 WM 训练，1 名拒绝参与，2 名患者在开始 WM 训练前退出。29 名参与者中有 26 名（89.6%）在康复期间坚持了干预措施，而 29 名中有 19 名（65.5%）在随后无提示的家庭干预中也坚持了训练。所有完成 Cogmed QM 课程的参与者在训练任务中都表现出了改善，这一结果由 Cogmed 改善指数（MD=24.05，SD=9.38，范围 2-44，<0.011）定义。访谈数据表明，实际限制，包括缺乏时间、技术困难、难以找到合适的无干扰环境以及低动力，是在家中完成训练的障碍。
研究结果表明，在有认知障碍的癌症住院患者的多学科康复治疗中纳入基于网络的 WM 训练是可行的。然而，患者在康复后对无提示的基于网络的 WM 训练的依从性并不理想。因此，未来的研究应考虑到依从性的障碍，以及需要监督和社会支持来加强家庭训练。
