Early Cognitive Interventions in Digital Format for Cancer Survivors

One of the adverse effects of cancer and its treatments is cognitive decline, which can affect up to 70% of patients throughout the course of their cancer journey. This decline leads to significant difficulties in resuming professional or social roles, among others, and to a reduced quality of life. Results from previous studies suggest that cognitive intervention can help restore affected functions. Within the framework of this project, two digital cognitive intervention platforms (BrainHQ and Enhance VR) have been selected because they offer advantages that make them viable, accessible and effective, such as: (1) being based on proven psychological paradigms; (2) providing a sufficient variety of exercises and difficulty levels; and (3) the ability to be administered at home. Virtual reality (VR) is demonstrating its potential in the healthcare field because it could help address the limitations of transfer and adherence in some cognitive intervention programs. In general, the virtual reality interventions are more ecological, so it is expected that the results will translate more effectively to the patient's daily activities. On the other hand, the greater immersion provides by VR increases motivation and, therefore, improves adherence to this type of interventions.

BrainHQ program consists of online exercises that target the following functions: attention, processing speed, memory, spatial orientation, interpersonal skills and intelligence. BrainHQ will be compared with the Enhace VR cognitive intervention, a library of 15 cognitive exercises developed in virtual reality to train and monitor specific cognitive functions (memory, attention, task flexibility, information processing, orientation, and problem-solving) and motor control.

The interventions will be implemented after the completion of cancer treatments (1-6 months post-chemotherapy) with the aim of promoting early detection of cognitive impairment and preventing it from becoming chronic over time. This will help patients resume their previous roles quickly and effectively.

The purpose of this randomized controlled trial is to test the usability and effectiveness of two digital cognitive interventions in cancer survivors in comparison with a control group.

The specific objectives are:

1\) To compare the acceptance and adherence of the cognitive interventions. 2) To analyze the preliminary effectiveness of the interventions on patients' cognitive functioning and quality of life at two different time points: 2.A. Upon completion of the interventions 2.B. One year after completion of the interventions

Exploratory objective:

3\) Conduct an exploratory cost study of the interventions compared to CAU (Care as Usual) The study is open to patients over 18 years of age with a cancer diagnosis (stages I-III) and subjective complaints of cognitive functioning related to the cancer diagnosis and/or cancer treatments, who completed chemotherapy treatment between 1 and 6 months prior.

After a first usability session at the hospital where the interventions dynamics are introduced, the interventions will be administered remotely under supervision. A psychologist will maintain weekly contact with the participants to check everything is going well.

Participants will be assessed before the intervention begins (T0) and again 10 weeks after (T1), once the intervention has finished. The follow-up assessment (T2) will take place one year after the intervention ends to examine the sustained effects of the intervention programs.

Improving the quality of life for cancer survivors is a global challenge that this project will help to address. The interventions of this project would help to reduce the time required to successfully resume work, family, and social responsibilities.

• Adherence [Time frame: Throughout the 10-week intervention]
• Change in Montreal Cognitive Assessment (MoCA) score [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention]
• Change in Hopkins Verbal Learning Test-Revised (HVLT-R) score [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention]
• Change in Trail Making Test (TMT) completion time [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention]
• Change in Verbal Fluency score [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in Digit Span (WAIS-IV) score [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in Symbol Search (WAIS-IV) score [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in CANTAB Reaction Time (RTI) [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in CANTAB Rapid Visual Information Processin (RVP) [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in CANTAB Delayed Matching to Sample (DMS) [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in CANTAB Paired Associated Matching (PAL) [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]
• Change in CANTAB Spatial Working Memory (SWM) [Time frame: Baseline (before randomization and intervention), after completion of the 10-week intervention, and 1 year after completion of the intervention.]