Cognitive strategies for cancer survivors

The Cherrier and Gray Groups

An estimated 16.9 million cancer survivors have reported cognitive deficits, which can interfere with everyday activities.  Cognitive impairment may include difficulty with memory, attention, language, executive functions, and speed of information processing. Adequate treatments for cognitive impairments are currently being studied to aid in the quality of life for survivors.  Previous studies highlighted the importance of behavioral interventions on advancing cognition with an emphasis on skills training.  However, most were limited by their research design, these studies did not include an education intervention as a controlled condition. Therefore, the objective of the current study by the Cherrier and Gray groups in the Public Health Sciences Division was to examine the effectiveness of a behavioral skills training intervention to improve objectively measured cognitive performance as well as cognitive symptoms in cancer survivors. Study design included in-person, group, and workshop style education control (EC) and behavioral skills training (TX) intervention.  The authors hypothesized that the behavioral cognitive skill training (TX) would enhance objectively measured cognitive capabilities and decrease cognitive symptoms; EC and wait list (WL) would not significantly enhance cognitive abilities. The study is published in Supportive Care in Cancer. 

The study’s participants consisted of adult cancer survivors recruited via health care providers or support organizations. The inclusion criteria included adults who completed cancer treatments for at least 6 months, had a diagnosed psychiatric disorder with prescribed medication use, history of neurological illness, and a score of 25 or more on the Patient Health Questionnaire- the higher the score, the higher the symptoms of depression.  The Cherrier and Gray Groups created a randomized unblinded trial of a group-based cognitive training intervention.  Subjective cognitive symptoms were measured at visits 1,3, and 4 and, objective neurocognitive functions were measured at visits 1,2,3, and 4. Eligible participants repeated neurocognitive tests and questionnaires for the second, third, and fourth visit. After the second visit, participants were randomized to one of three study conditions: active treatment (TX) – 7 weeks of behavioral cognitive skill training, education control (EC) – 7 weeks of education control on cognitive principles that can be compared to TX or wait list – 7 weeks of a waiting period with no contact from the study staffers. Both EC and TX were 75 mins per session, with a total of seven sessions. TX workshops focused on memory aids, development of memory skills, mindful meditation, working memory strategies, and overall brain health developed by neuroscience. Educational workshops taught concepts of human cognition, working memory, declarative memory, interaction of emotions and memory, attention, positive thinking, and mindfulness. There was a limit of 12 participants for each session, EC and TX.  

Graphical Representation of Neurons
Photo of Neurons for Cognitive Function

The total intervention population after randomization included 50 participants for WL, 66 participants for the active treatment workshops (TX), and 12 participants for education control (EC). The statistical analyses consisted of a linear mixed model analyses with random effects of pre/post for visits 2 and 4. Interaction effects by visit and between-group effects were also assessed utilizing linear mixed model analysis.

The following were observed as improvements for objective cognitive tests of verbal memory: verbal memory (word list and story recall- immediate and delayed), attention (digit span), sustained attention, and working memory (letter sequencing).  Participants in the EC condition improved on one aspect of verbal memory - words list delayed, but not recall.  Participants improved on subjective cognitive measures as well. The TX group reported a decrease in the frequency and severity of their cognitive symptoms. The EC and WL groups did not report a decrease in cognitive dysfunction symptoms.

The results of the study report that cognitive skills training as a behavioral intervention was effective in reducing cognitive dysfunction in cancer survivors. This study’s methodological approach differs from prior studies. Their study design elements aid in the strength and validity of the intervention The Cherrier and Gray Groups concluded that “ this approach should be incorporated into survivorship programs and further studied. Health care professionals should consider referral for cognitive skill training for cancer survivors who report cognitive dysfunction symptoms, including patients who report both mood, anxiety, and cognitive dysfunction as the treatment resulted in significantly improved mood and improved fatigue as well as cognition.”


This research was supported by the National Cancer Institute, Rivkin Center pilot grant, University of Washington Royalty Research Foundation, Fred Hutchinson Cancer Research Center-Cancer Consortium. 

Fred Hutch/UW Cancer Consortium members Monique Cherrier, Celestia Hiagno, and Heidi Gray contributed to this work.

Cherrier MM, Higano CS, Gray HJ. Cognitive skill training improves memory, function, and use of cognitive strategies in cancer survivors. Supportive Care in Cancer. 2021 Aug 9:1-0. doi: 10.1007/s00520-021-0645