How the Design of Technology-Mediated Cognitive Training Paradigms Impacts Efficacy in Childhood Cancer Survivors: A Systematic Review

Background/Objectives: Cancer and its subsequent treatments have been shown to cause significant cognitive impairment, known as Cancer-Related Cognitive Impairment (CRCI). CRCI impacts a range of cognitive domains, including working memory and executive function, attention, concentration, short-term memory, visuospatial control, problem solving, and information processing speed. Treatment options for these cancer sequelae are limited, with many patients never receiving any medical rehabilitation efforts. Current treatment recommendations include pharmaceutical intervention, cognitive training (CT), physical activity, and self-management strategies, with a prior meta-analysis in adults supporting CT as the most promising of these options. Thus, this systematic review aims to explore the current body of evidence for the use of CT as a treatment for childhood cancer survivors and assess the strengths and weaknesses of previously utilised programs to determine how to best test and optimise CT for this population. Methods: A systematic search was conducted using PubMed, Scopus, PsycINFO and CINAHL. The review was prepared following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 reporting guidelines. Results: From an initial 6172 studies, six were included in the final review, covering 208 intervention participants who completed CT. CT platforms used by the included studies were all technology-mediated, and consisted of ‘Cogmed’ (n = 4), Attention Process Training (n = 1) and ‘Captain’s log’ (n = 1). Cognitive testing in the included studies covered three domains: working memory, attention and delayed recall (memory). Studies showed varied improvement across these domains, with most positive effects in the domain of working memory, although certainty of evidence across the included studies was all assessed as low or very low. Conclusions: This systematic review provides preliminary evidence for the use of CT in childhood cancer survivors, but also makes a range of recommendations for future studies in this population, given the current gaps in the literature. This includes utilisation of a control group, use of consistent cognitive testing protocols, and CT design that targets the diverse nature of the cognitive change seen in CRCI. Together, these recommendations will allow future studies to more fully probe the utility of CT as an intervention for this population, while also optimising its usage.