Background. Cancer treatment-related cognitive impairment (CTRCI) is a frequent and persistent consequence of systemic cancer therapy, adversely affecting quality of life and independence among cancer survivors. Methods. To clarify the relative effectiveness of available treatments, we conducted a systematic review and network meta-analyses of randomized controlled trials evaluating psychological, pharmacological, and other interventions for established CTRCI in adult survivors of non-central nervous system cancers. Eligible trials reported objective outcomes in one or more of eight cognitive domains, including learning, memory, processing speed, word generation, cognitive flexibility, attention, working memory, and abstraction. Results. Eighteen studies met inclusion criteria, with 14 trials (n= 1100) contributing to network meta-analyses of immediate post-intervention effects across seven domains. A therapist-guided group intervention combining patient education and cognitive rehabilitation consistently ranked highest and was associated with significantly improved learning, memory, processing speed, attention, and working memory compared with a waitlist control, although the certainty of evidence (CoE) was low to very low and largely based on a single trial. Mindfulness-based interventions were also associated with improved processing speed (low CoE). Donepezil was associated with no benefit versus placebo for any domain. Conclusions. While findings suggest that structured multimodal group interventions may represent the most promising strategy for CTRCI, CoE was low, and additional rigorous, standardized trials are required.
背景。癌症治疗相关认知障碍（CTRCI）是系统性癌症治疗常见且持久的后遗症，对癌症幸存者的生活质量和独立性产生不利影响。方法。为阐明现有治疗方法的相对有效性，我们对评估心理、药物及其他干预措施针对非中枢神经系统癌症成年幸存者已确诊CTRCI的随机对照试验进行了系统综述和网状荟萃分析。符合条件的研究报告了八个认知领域中一个或多个领域的客观结果，包括学习、记忆、处理速度、词语生成、认知灵活性、注意力、工作记忆和抽象能力。结果。十八项研究符合纳入标准，其中14项试验（n=1100）被纳入针对七个认知领域的干预后即刻效应的网状荟萃分析。一项结合患者教育和认知康复的治疗师指导团体干预在所有比较中始终排名最高，与等待列表对照组相比，该干预与学习、记忆、处理速度、注意力和工作记忆的显著改善相关，但证据确定性（CoE）为低至极低，且主要基于单一试验。基于正念的干预措施也与处理速度的改善相关（低CoE）。多奈哌齐在所有认知领域均未显示出优于安慰剂的益处。结论。尽管研究结果表明结构化的多模式团体干预可能是CTRCI最有前景的策略，但证据确定性较低，仍需更多严谨、标准化的试验加以验证。
肿瘤(癌症)患者之家