Originally published as JCO Early Release 10.1200/JCO.2008.20.5765 on May 26 2009

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Cognitive Rehabilitation in Patients With Gliomas: A Randomized, Controlled Trial

From the University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Utrecht; Tilburg University; St Elisabeth Hospital; and Dr Bernard Verbeeten Institute, Tilburg; the Netherlands Cancer Institute; and VU University Medical Center, Amsterdam; Erasmus Medical Center, Rotterdam; University Medical Center Groningen, Groningen; Radboud University Nijmegen Medical Center, Nijmegen; University Hospital azM, Maastricht; Rijnstate Hospital Arnhem, Arnhem; and Medical Center Haaglanden, the Hague, the Netherlands.

Corresponding author: Neil K. Aaronson, PhD, Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: n.aaronson{at}nki.nl.

Purpose Patients with gliomas often experience cognitive deficits, including problems with attention and memory. This randomized, controlled trial evaluated the effects of a multifaceted cognitive rehabilitation program (CRP) on cognitive functioning and selected quality-of-life domains in patients with gliomas.

Patients and Methods One hundred forty adult patients with low-grade and anaplastic gliomas, favorable prognostic factors, and both subjective cognitive symptoms and objective cognitive deficits were recruited from 11 hospitals in the Netherlands. Patients were randomly assigned to an intervention group or to a waiting-list control group. The intervention incorporated both computer-based attention retraining and compensatory skills training of attention, memory, and executive functioning. Participants completed a battery of neuropsychological (NP) tests and self-report questionnaires on cognitive functioning, fatigue, mental health–related quality of life, and community integration at baseline, after completion of the CRP, and at 6-month follow-up.

Results At the immediate post-treatment evaluation, statistically significant intervention effects were observed for measures of subjective cognitive functioning and its perceived burden but not for the objective NP outcomes or for any of the other self-report measures. At the 6-month follow-up, the CRP group performed significantly better than the control group on NP tests of attention and verbal memory and reported less mental fatigue. Group differences in other subjective outcomes were not significant at 6 months.

Conclusion The CRP has a salutary effect on short-term cognitive complaints and on longer-term cognitive performance and mental fatigue. Additional research is needed to identify which elements of the intervention are most effective.

Funded by Grant No. UU2003-2783 from the Dutch Cancer Society; by the Health Insurers Innovation Foundation; and by NeuroCognitief Centrum Nederland (M.M.S.).

Presented in part at the 10th International Psycho-Oncology Society Congress, June 9-13, 2008, Madrid, Spain; the 8th European Association of Neuro-Oncology Congress, September 12-14, 2008, Barcelona, Spain; and the 13th Society for Neuro-Oncology Congress, November 20-23, 2008, Las Vegas, NV.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Clinical Trials repository link available on JCO.org.

Clinical trial information can be found for the following: NCT00256425 [ClinicalTrials.gov] .

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