Supportive Care in Cancer

, Volume 26, Issue 6, pp 1917–1926 | Cite as

Computerized cognitive training in prostate cancer patients on androgen deprivation therapy: a pilot study

  • Lisa M. WuEmail author
  • Ali Amidi
  • Molly L. Tanenbaum
  • Gary Winkel
  • Wayne A. Gordon
  • Simon J. Hall
  • Katrin Bovbjerg
  • Michael A. Diefenbach
Original Article



Prostate cancer patients who have undergone androgen deprivation therapy (ADT) may experience cognitive impairment, yet there is an unmet need for nonpharmacological interventions to address cognitive impairment in this population. This study examines the feasibility, acceptability, and preliminary efficacy of a home-based computerized cognitive training (CCT) program to treat cancer-related cognitive impairment.


Sixty men who had received ≥ 3 months of ADT were screened for at least mild cognitive or neurobehavioral impairment and randomized to 8 weeks of CCT or usual care. Follow-up assessments occurred immediately post-intervention or equivalent (T2) and 8 weeks later (T3). The acceptability of CCT was also assessed.


Feasibility:A priori feasibility thresholds were partially met (i.e., randomization rate > 50%, retention rate > 70% excluding CCT drop-outs, but < 70% for intent-to-treat). Acceptability: Participants were mostly satisfied with CCT and found it somewhat enjoyable, though barriers to uptake existed. Preliminary efficacy: Linear mixed models indicated significant time by group effects favorable to CCT in reaction time (p = .01), but unfavorable to CCT in verbal and visual memory (p< .05). Memory was temporarily suppressed in the CCT group at T2, but normalized by T3. There was no effect of CCT on self-reported cognitive functioning, neurobehavioral functioning, nor quality of life.


This study provides tentative support for the feasibility and acceptability of CCT to treat mild cognitive impairment in ADT patients. CCT had a beneficial effect on reaction time, but temporarily suppressed memory. CCT’s benefits may be limited to a narrow area of functioning. Larger-scale studies are needed.


Oncology Hormone therapy Cancer-related cognitive impairment Cognition Computers Antiandrogens 



We thank Posit Science and CNS Vital Signs for providing their programs to this study at no cost.

Funding information

This work was supported by the American Cancer Society (L.W., grant no. PF-12-041-01-CPPB) and the National Cancer Institute of the National Institutes of Health (L.W., grant no. 5K07CA184145-03).

Compliance with ethical standards

Informed consent was obtained from all participants.

Conflicts of interest

Wu and Amidi report personal fees from Bayer Pharmaceutical outside the submitted work. The other authors have no conflicts of interest to declare. Wu has full control of all primary data and agrees to allow the journal to review this data if requested.


Content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.


  1. 1.
    Han M, Partin AW, Pound CR, Epstein JI, Walsh PC (2001) Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. Urol Clin North Am 28(3):555–565. CrossRefPubMedGoogle Scholar
  2. 2.
    Singh J, Trabulsi EJ, Gomella LG (2010) Is there an optimal management for localized prostate cancer? Clin Interv Aging 5:187–197.
  3. 3.
    Gonzalez BD, Jim HS, Booth-Jones M, Small BJ, Sutton SK, Lin HY, Park JY, Spiess PE, Fishman MN, Jacobsen PB (2015) Course and predictors of cognitive function in patients with prostate cancer receiving androgen-deprivation therapy: a controlled comparison. J Clin Oncol 33(18):2021–2027. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    McGinty HL, Phillips KM, Jim HS, Cessna JM, Asvat Y, Cases MG, Small BJ, Jacobsen PB (2014) Cognitive functioning in men receiving androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Support Care Cancer 22(8):2271–2280. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Alibhai SMH, Timilshina N, Duff-Canning S, et al (2017) Effects of long-term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer. Cancer 123(2):237-244. CrossRefGoogle Scholar
  6. 6.
    Wu LM, Tanenbaum ML, Dijkers MPJM, Amidi A, Hall SJ, Penedo FJ, Diefenbach MA (2016) Cognitive and neurobehavioral symptoms in patients with non-metastatic prostate cancer treated with androgen deprivation therapy or observation: a mixed methods study. Soc Sci Med 156:80–89. CrossRefGoogle Scholar
  7. 7.
    Galvão DA, Taaffe DR, Spry N, Joseph D, Newton RU (2010) Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: a randomized controlled trial. J Clin Oncol 28(2):340–347. CrossRefPubMedGoogle Scholar
  8. 8.
    Treanor CJ, McMenamin UC, O’Neill RF, Cardwell CR, Clarke MJ, Cantwell M, Donnelly M (2016) Non-pharmacological interventions for cognitive impairment due to systemic cancer treatment. Cochrane Database Syst Rev 2016:CD011325.
  9. 9.
    Bray VJ, Dhillon HM, Bell ML, Kabourakis M, Fiero MH, Yip D, Boyle F, Price MA, Vardy JL (2017) Evaluation of a web-based cognitive rehabilitation program in cancer survivors reporting cognitive symptoms after chemotherapy. J Clin Oncol 35(2):217–225. CrossRefPubMedGoogle Scholar
  10. 10.
    Mahncke HW, Bronstone A, Merzenich MM (2006) Brain plasticity and functional losses in the aged: scientific bases for a novel intervention. Prog Brain Res 157:81–109. CrossRefPubMedGoogle Scholar
  11. 11.
    Salthouse TA (1996) The processing-speed theory of adult age differences in cognition. Psychol Rev 103(3):403–428. CrossRefPubMedGoogle Scholar
  12. 12.
    Von Ah D, Carpenter JS, Saykin A et al (2012) Advanced cognitive training for breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 135(3):799–809. CrossRefGoogle Scholar
  13. 13.
    Kesler S, Hadi Hosseini SM, Heckler C, Janelsins M, Palesh O, Mustian K, Morrow G (2013) Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clin Breast Cancer 13(4):299–306. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lebowitz MS, Dams-O’Connor K, Cantor JB (2012) Feasibility of computerized brain plasticity-based cognitive training after traumatic brain injury. J Rehabil Res Dev 49(10):1547–1556. CrossRefPubMedGoogle Scholar
  15. 15.
    Boivin MJ, Busman RA, Parikh SM, Bangirana P, Page CF, Opoka RO, Giordani B (2010) A pilot study of the neuropsychological benefits of computerized cognitive rehabilitation in Ugandan children with HIV. Neuropsychology 24(5):667–673. CrossRefPubMedGoogle Scholar
  16. 16.
    Morgan NP, Graves KD, Poggi EA, Cheson BD (2008) Implementing an expressive writing study in a cancer clinic. Oncologist 13(2):196–204. CrossRefPubMedGoogle Scholar
  17. 17.
    Julious SA (2005) Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat 4(4):287–291. CrossRefGoogle Scholar
  18. 18.
    Gualtieri CT, Johnson LG (2006) Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol 21(7):623–643. CrossRefPubMedGoogle Scholar
  19. 19.
    Richardson-Vejlgaard R, Dawes S, Heaton RK, Bell MD (2009) Validity of cognitive complaints in substance-abusing patients and non-clinical controls: the Patient’s Assessment of Own Functioning Inventory (PAOFI). Psychiatry Res 169(1):70–74. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Chelune GJ, Heaton RK, Lehman RAW (1986) Neuropsychological and personality correlates of patients’ complaints of disability. In: Goldstein G, Tarter RE (eds) Advances in Clinical Neuropsychology Vol. 3. Plenum Press, New York, pp 95–126CrossRefGoogle Scholar
  21. 21.
    Grace J, Malloy PF (2001) Frontal Systems Behavior Scale (FrSBe): professional manual. Psychological Assessment Resources, LutzGoogle Scholar
  22. 22.
    Hutchinson AD, Hosking JR, Kichenadasse G, Mattiske JK, Wilson C (2012) Objective and subjective cognitive impairment following chemotherapy for cancer: a systematic review. Cancer Treat Rev 38(7):926–934. CrossRefPubMedGoogle Scholar
  23. 23.
    Suresh K (2011) An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci 4(1):8–11. CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Smith GE, Housen P, Yaffe K, Ruff R, Kennison RF, Mahncke HW, Zelinski EM (2009) A cognitive training program based on principles of brain plasticity: results from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study. J Am Geriatr Soc 57(4):594–603. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Ball K, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, Morris JN, Rebok GW, Smith DM, Tennstedt SL, Unverzagt FW, Willis SL, ACTIVE Study Group (2002) Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA 288(18):2271–2281. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, Marsiske M, Morris JN, Tennstedt SL, Unverzagt FW, Willis SL, ACTIVE Study Group (2014) Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc 62(1):16–24. CrossRefGoogle Scholar
  27. 27.
    Wolinsky FD, Vander Weg MW, Howren MB, Jones MP, Dotson MM (2013) A randomized controlled trial of cognitive training using a visual speed of processing intervention in middle aged and older adults. PLoS One 8(5):e61624. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Larsen DL, Attkisson CC, Hargreaves WA, Nguyen TD (1979) Assessment of client/patient satisfaction: development of a general scale. Eval Program Plann 2(3):197–207. CrossRefPubMedGoogle Scholar
  29. 29.
    Choi J, Mogami T, Medalia A (2010) Intrinsic motivation inventory: an adapted measure for schizophrenia research. Schizophr Bull 36(5):966–976. CrossRefPubMedGoogle Scholar
  30. 30.
    Esper P, Mo F, Chodak G, Sinner M, Cella D, Pienta KJ (1997) Measuring quality of life in men with prostate cancer using the functional assessment of cancer therapy-prostate instrument. Urology 50(6):920–928. CrossRefPubMedGoogle Scholar
  31. 31.
    Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 49(2):156–163. CrossRefPubMedGoogle Scholar
  32. 32.
    Farmer ME, Kittner SJ, Rae DS, Bartko JJ, Regier DA (1995) Education and change in cognitive function. The Epidemiologic Catchment Area Study. Ann Epidemiol 5(1):1–7. CrossRefPubMedGoogle Scholar
  33. 33.
    Cohen J (1988) Statistical power analysis for the behavioural sciences, 2nd edn. Lawrence Erlbaum Associates, New YorkGoogle Scholar
  34. 34.
    Mahncke HW, Connor BB, Appelman J, Ahsanuddin ON, Hardy JL, Wood RA, Joyce NM, Boniske T, Atkins SM, Merzenich MM (2006) Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci U S A 103(33):12523–12528. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    van der Linden D, Frese M, Meijman TF (2003) Mental fatigue and the control of cognitive processes: effects on perseveration and planning. Acta Psychol 113(1):45–65. CrossRefGoogle Scholar
  36. 36.
    Cook DB, O’Connor PJ, Lange G, Steffener J (2007) Functional neuroimaging correlates of mental fatigue induced by cognition among chronic fatigue syndrome patients and controls. NeuroImage 36(1):108–122. CrossRefPubMedGoogle Scholar
  37. 37.
    Northouse LL, Rosset T, Phillips L, Mood D, Schafenacker A, Kershaw T (2006) Research with families facing cancer: the challenges of accrual and retention. Res Nurs Health 29(3):199–211. CrossRefPubMedGoogle Scholar
  38. 38.
    Yanez B, McGinty HL, Mohr DC, Begale MJ, Dahn JR, Flury SC, Perry KT, Penedo FJ (2015) Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer. Cancer 121(24):4407–4415. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Lisa M. Wu
    • 1
    Email author
  • Ali Amidi
    • 2
  • Molly L. Tanenbaum
    • 3
  • Gary Winkel
    • 4
  • Wayne A. Gordon
    • 5
  • Simon J. Hall
    • 6
  • Katrin Bovbjerg
    • 1
  • Michael A. Diefenbach
    • 6
  1. 1.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Unit for Psychooncology and Health Psychology, Department of Oncology and Department of Psychology and Behavioural SciencesAarhus University Hospital and Aarhus UniversityAarhusDenmark
  3. 3.Department of PediatricsStanford University School of MedicineStanfordUSA
  4. 4.Department of Oncological SciencesIcahn School of Medicine at Mount SinaiNew YorkUSA
  5. 5.Department of Rehabilitation MedicineIcahn School of Medicine at Mount SinaiNew YorkUSA
  6. 6.Department of Medicine and UrologyNorthwell HealthGreat NeckUSA

Personalised recommendations