Background: Limited treatments exist for prostate cancer survivors (PCS) experiencing cancer-related cognitive impairment (CRCI). We investigated the feasibility, acceptability, and potential efficacy of an online group cognitive rehabilitation intervention for PCS on androgen deprivation therapy (ADT) experiencing CRCI.
Methods: We used a mixed methods approach with nonconcurrent, multiple baseline single-case experimental design. Adult, English-speaking PCS receiving ADT who self-reported perceived cognitive changes were eligible. Individuals took part in a four-week online group intervention – ‘Promoting Cognitive Wellbeing in Prostate Cancer Survivors’ (ProCog) – comprising weekly two hour group sessions. Perceived cognitive functioning was measured weekly using FACT-Cog Perceived Cognitive Impairments scale (PCI18). Brief objective cognitive testing, goal attainment scaling, and measures of depression, generalized anxiety, fatigue and self-efficacy were administered at four time-points. Feasibility and acceptability were assessed through attendance, homework adherence, and feedback.
Results: In total 11 PCS were eligible and eight participated, median age 68 years (range 58-86). Most participants had locally advanced prostate cancer, were retired, and lived in regional areas.
Feasibility was supported with session attendance and homework completion at ≥97%. Most participants had mean baseline scores in the poorer cognitive function range. Most (5/8) had clinically significant improvements (≥7.4) on PCI18 post-intervention compared to baseline mean scores. There were significant improvements in perceived cognitive functioning for half post-group, with very large effect sizes. No consistent changes were detected on cognitive testing. All participants made progress towards goal attainment post-intervention. Clinically significant improvements were seen in levels of anxiety, depression, and fatigue. Changes in self-efficacy varied.
Conclusions: ProCog is feasible and acceptable, improving perceived cognitive functions, anxiety, depression, fatigue, and personal goal attainment. However, definitive studies are required to determine its effectiveness. We are now designing a randomised phase II/III clinical trial to confirm feasibility and efficacy of ProCog in PCS on ADT reporting CRCI.