A Systematic Review Focused On Understanding the Effects of Modifiable Factors in Patients who Suffer from Chemotherapy Induced Cognitive Impairments or “Chemobrain”

A Systematic Review Focused On Understanding the Effects of Modifiable Factors in Patients who Suffer from Chemotherapy Induced Cognitive Impairments or “Chemobrain” | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Systematic Review Focused On Understanding the Effects of Modifiable Factors in Patients who Suffer from Chemotherapy Induced Cognitive Impairments or “Chemobrain” Saba Sharafkhaneh, Negin Meshkati, Azeem Khan, Hannah Shepherd This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4227713/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background As the prevalence of cancer survivors increases, there have been increased reports of chemotherapy-induced cognitive impairment (CICI). Around 75% of cancer patients experience CICI during or after treatment. From the reported group, up to 35% will have persistent CICI for months to years following their treatments. In this review, the authors focused on modifiable factors (MFs) as variables that can be manipulated to change the impact of CICI on the patient's life. The MFs focused upon psychological factors, sleep, physical activity, and intervention programs. The authors aimed to establish that when certain interventions that address these MFs are added to treatment plans, it may help to decrease the impact of CICI. Search Methods: The authors used the PubMed database to identify articles to be potentially included in the review. A scoping review was conducted to narrow down the topics in relation to CICI. From here, the authors identified a set of factors deemed MFs. Using the inclusion and exclusion criteria, the authors started with 17,242 papers and narrowed down the review to 46 papers. The RoB2 tool from Cochrane Methods Bias was used to conduct risk basis assessment. Results The systematic review established that psychological factors, physical activity, and sleep quality/quantity affect the presence and severity of CICI. Furthermore, interventional programs and exercise can help decrease the effects of CICI. Meta-analysis was not conducted due to varying factors (cancer type, treatment type, and assessments conducted) across included studies. Discussion Cancer patients and survivors reported more severe CICI when depression, anxiety, fatigue, PTSD, decreased sleep quality and quantity were present. The severity of CICI significantly diminished with the use of physical activity programs, psychological programs, and cognitive training programs; however, the use of herbs, supplements, prescribed medication, Tibetan sound meditation, and EGG feedback showed little to no improvement in CICI. The findings suggest that when CICI is diagnosed at earlier stages, and supplementary interventions (medications, exercise programs cognitive behavioral therapy) are incorporated into treatment plans, the impact and severity of CICI can be decreased. This study urges more focus be placed on this aspect of chemotherapy treatment due to the increased prevalence of cancer survivors in the population. Funding: There was no funding provided for this systematic review. Registration: The study protocol was registered on PROSPERO on Aug 18,2022 (CRD42022349831). Chemotherapy Induced Cognitive Impairment Chemobrain Cancer Treatment Modifiable Factors Psychological Factors Sleep Physical Activity Interventions Figures Figure 1 Figure 2 Background Chemotherapy-induced cognitive impairment (CICI), commonly known as chemobrain, is characterized by any type of memory, learning, or cognitive dysfunction caused by any type of cancer treatment—chemotherapy, immunotherapy, hormonal therapy, radiation, and/or surgery. CICI has many other names, cancer-related cognitive impairment (CRCI), post-chemotherapy cognitive impairment, cancer therapy associated cognitive change, and cancer-treatment related cognitive impairment. 1 Around 75% of cancer patients experience CICI during or after treatment for their cancers; 35% of these patients will have cognitive impairment that persists for months to years following their treatments. 2 It is predicted that there will be over 20 million cancer survivors by 2026, 3 indicating the need for better clinician awareness and support for CICI both during and after treatment. As the prevalence of cancer survivors increases due to improved healthcare access, the authors wanted to focus on CICI because of the conflicting views present in both the medical field and scientific world regarding this topic. Some studies have cited that CICI will occur more often if suggested to the patients. The Jacobs et al. study involved 175 breast cancer participants being placed into one of three groups: a control group, one group informed about possible CICI, and one without reassuring information about CICI. They concluded that informing patients about the possibility of CICI occurring led to an increase in occurrence of CICI in patients, especially those classified as belonging to a vulnerable population. 4 Similarly, Schagen et al. reported, in 150 cancer patients that were treated with chemotherapy, higher levels of cognitive complaints after being introduced to the concept of CICI. Furthermore, researchers also concluded that patients who were informed about CICI had more trouble recalling words compared to those who were not informed about CICI . 5 There were numerous studies that found that CICI did, in fact, occur. Marin et al. reported, in 151 breast cancer patients, lower cognitive performance scores two months after completion of the treatment. 6 Von Ah et al. reported that 495 breast cancer survivors (BCS) scored 1.5-2.0 SD below their healthy counterparts (HC) in the study for memory impairment. They were also able to establish a link between younger BCS who reported significant cognitive impairments and greater detriments in quality of life (QoL). 7 Due to the argument in the literature that suggests CICI is subjective, patients may struggle to discuss this topic with their providers and thus not receive the beneficial treatment they need. Further, clinicians may dismiss the complaint if they think it is not valid. Buchanan et al . in a retrospective chart review of 2,537 BCS at least one-year post-treatment, findings indicated that 60.0% of the survivors had self-reported cognitive complaints to their providers, but only 37.0% of those had fully discussed those complaints with their providers. Only 15.00% of these 37.00% sought additional treatment for CICI. 8 The objective for this systematic review is to identify modifiable factors that influence the presence of CICI. Once identified, the factors can be addressed during treatment to improve the incidence and severity of CICI. Methods A scoping review was initially conducted to narrow down topics that could be explored in relation to CICI. The review involved using the PubMed database and uploading the papers for the team evaluation on Zotero. The results of the scoping helped to clarify search terms and the inclusion/exclusion criteria for the systematic literature review. Inclusion criteria encompassed geriatric and adult populations of both sexes who were currently receiving or had received cancer treatment and presented with cognitive impairment. The geographical location of studies was not limited; however, only papers written in English were included. Any type of intervention to diagnose cognitive impairment in cancer patients and survivors was included, as well as control groups and placebo-controlled groups. Outcomes for studies were based on objective measures. Longitudinal, cohort, controlled, randomized controlled, placebo controlled, blinded, cross-section a l studies were included, and all studies had to have been completed within the past ten years. Exclusion criteria encompassed small sample sizes, studies that lack published data, pediatric populations, all animal populations, cell-based studies, twin studies, and conclusions relying on self-reported outcomes in presence of cognitive impairment due to chemotherapy, as well as studies with a limited sample. Excluded study designs included other reviews, (such as systematic reviews, mini-reviews, scoping reviews, and case reviews), as well as books, documents, experiences, case-studies, testimonies, letters, meta-analyses, and studies not conducted within the last ten years. A search on PubMed was conducted using these equivalent search terms: Chemotherapy induced cognitive impairment, Chemofog, Chemobrain, Chemotherapy induced cognitive impairment, post-chemotherapy cognitive impairment, Cancer related cognitive impairment, Cancer related cognitive dysfunction , and Cancer related cognitive decline . All search results were saved as a PubMed.set.txt file and uploaded to the RAYYAN-Intelligent Systematic Review. Next, papers were blinded, and studies were accepted or rejected based first on title and abstract, and then on inclusion/exclusion criteria. Any disagreements about acceptance or rejection were discussed until consensus was reached. Next, the remaining articles were evaluated to confirm they met inclusion criteria. Articles that remained underwent a blinded risk of bias assessment conducted using the Risk of Bias (RoB2) tool from Cochrane. RoB2 was conducted by the second and third authors blindly and any disagreements were resolved by the principal investigator (PI). Based on this process, the authors ensured that the review included studies providing statistical analysis (presented in the results) confirming the validity and presence of Chemotherapy-Induced Cognitive Impairment (CICI) in cancer patients and survivors for all accepted articles, data was abstracted from the results section of each included paper. Statistical information, such as the p value, SD, mean and other relevant information were included in the results section. For this systematic review, the authors were not able to pursue a meta-analysis because the papers included articles that included varying types of cancer, types of treatment, and stages of diagnoses; also, different assessments tools were used for diagnosing cognitive impairments and defining modifiable factors (Table 1 ) across studies. Table 1 Table indicates the differences between the included studies and why meta-analysis could not be conducted. MFs CICI Assessment Tool Assessment / Intervention Type Type of Cancer / Type of Treatment Number of Participants Study Design Results Alvarez et al; Intervention Neuropsychological Battery Computerized Cognitive Training Program Post-treatment Hematological Cancer Survivors 19 participants Single-arm, non-blinding feasibility study Concluded that adherence to the program was a bit difficult and that they only had one participant complete the program and further studies need to be conducted. Ancoll-Isreael et al. Sleep Neuropsychological Battery Pittsburgh Sleep Quality Index (PSQI) Breast cancer chemotherapy treated patients before treatment, end of cycle 4, 1 year after start of chemotherapy 133 participants Observational study Concluded that worse subjective cognition was predicted by a lower sleep quality. Asher et al.; Intervention FACT-Cog v3 Multidimensional Psychoeducation-Based Cognitive Rehabilitation Intervention Program Variety from a Cancer Rehabilitation and Survivorship Program 110 participants Retrospectively study involving 20 cohorts Concluded that there were significant improvements in CICI in the intervention group at post-intervention compared to pre-interventions. Bar-Sela et al.; 2019 Intervention Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution subset (WAIS III) and Digital-Finger Tapping Test Cannabis Variety of Cancer Patients Receiving Chemotherapy 34 participants Pilot Study Concluded that cannabis has no effect or change on CICI complaints. Barton et al.; 2013 Intervention High Sensitivity Cognitive Screen (HSCS) Ginkgo bibloba Breast Cancer Patients Receiving Adjuvant Treatment 166 participants 2 arm randomized, placebo controlled double-blinded phase III trial Concluded no improvement in CICI complaints in intervention group. Bedillion et al.; 2019 Psychological Aspect FACT- Cog Center for epidemiologic studies depression (CES-D) Breast Cancer Survivors 317 participants Not defined Concluded that depression in the 317 BCS less than 10 years post treatment contributed to the impairment in cognitive functioning. Boscher et al.; 2020 Psychological Aspect FACT- Cog IES-R, FACIT-F, and HADS- anxiety Cancer Survivors 1,393 participants Not defined Concluded that depression, anxiety, PTSD worsen symptoms of CICI in survivors. Brayer et al.; 2017 Intervention FACT- Cog Web Based Cognitive Rehabilitation Program Cancer Survivors 242 participants Randomized control trial Concluded that the FACT-Cog PCI significantly improved in the intervention group. Buchanan et al.; 2015 Psychological Aspect Complaint presents in chart review Complaint Presents in Chart Review Breast Cancer Survivors 2,537 participants Retrospective Study Concluded that from 2,537 BCS 60% of the survivors had self-reported cognitive complaints to their providers and only 37% of those had fully discussed those complaints with their providers. Only 15% of these 37% sought out to receive treatment for CICI. Campbell et al.; 2018 Physical Activity FACT-Cog vs.3, Hopkins Verbal Learning Test- Revised, Trail Making Test (TMT), Stroop test 24-week aerobic exercise Stage I-IIIa Breast Cancer 19 participants Randomized Control Trial Concluded that there was no improvement in self-reported cognitive function and that the effect size was small. Cao et al.; 2017 Psychological Aspect Wechsler Adult Intelligence Scale (IQ) and Neuropsychological tests including Color Trails Test (CTT), Stroop test, and Frontal Fluency Rest (FFT) Beck Depression Self Rating Scale and BPRS Esophageal Cancer 65 participants Small Scale Sample Study Concluded that the depressed group showed more impairment in their cognitive impairment assessments compared to cancer patients who were not depressed. Caplette-Gingras et al.; 2013 Sleep 11 different neuropsychological tests Insomnia Severity Index Stage 1-III Breast Cancer 67 participants Observational Study Concluded that the insomnia group displayed greater objective and subjective cognitive impairments from the neuropsychological tests. Cherrier et al.; 2013 Intervention FACT-Cog Mindfulness-based stress reduction Colorectal and Breast Cancer Patients 71 participants Preliminary study Concluded that a larger randomized trial size needs to be utilized in future studies. Cheung et al.; 2016 Psychological Aspect FACT-Cog Vs. 3 Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Brief Fatigue Inventory (BFI) Early-Stage Breast Cancer 45 breast cancer patients Multi-center, cross-section a l study Concluded that anxiety (15.1%), fatigue (27.8%), and cognitive impairments (25.9%) were more prevalent than depression (5.6%). Ding et al.; 2020 Intervention FACT-Cog Managing Cancer and Living Meaningfully (CALM) Intervention Program Breast Cancer Survivors 72 participants Randomized Study Concluded that CALM intervention group reported less CICI complaints. Ferguson et al.; 2016 Intervention Perceived Cognitive Impairment (PCI) and Perceived Cognitive Abilities of the FACT-Cog Memory and Attention Adaptation Training (MAAT) Breast Cancer Survivors 48 participants Small Randomized Control Trial Conclude that the MAAT group reported a decrease in CICI complaints and an increase in neuropsychological processing speed. Gaynor et al.; 2020 Intervention Conners’ Continuous Performance Test (CPT-II) Transcranial direct current stimulation Breast Cancer Survivors 16 participants Randomized study Concluded that the use of this intervention may be an effective intervention, but that a larger sample size would need to be studied in future studies. Gokal et al.; 2018 Intervention Neuropsychological Assessment 12 weeks of Home Based; Self-managed Moderate Intensity Walking Compared with Usual Care Alone. Breast Cancer Patients 50 participants Small randomized control trial Concluded that the intervention group showed improvements in cognitive function. Gutenkunst et al.; 2021 Psychological Aspect FACT-Cog Functional Assessment of Cancer Therapy-Fatigue (FACT-F) and General Health Questionnaire (GHQ) Early-Stage Cancer Survivors 242 participants Not defined Concluded that psychological factors, such as fatigue and stress, were more important to consider than demographic or medical characteristics of the cancer in relation to self-reported cognitive impairment. Hansen et al.; 2014 Sleep Mini-Mental State Examination (MMSE), neuropsychological test battery Visual Analogue Scale (VAS) and a Sleep Diary Breast Cancer Surgery 54 participants Randomized double-blind, placebo-controlled trial Concluded that cognitive dysfunction could not be established in the breast cancer patients but concluded that this could have been due to sample size limitations. Hartman et al.; 2015 Physical Activity Neuropsychological Test Physical Activity Questionnaire (GPAQ) Breast Cancer Survivors 136 participants Cross-Section a l Study Concluded that better performance was noted in the patients’ executive functioning domain and attention domain. Hartman et al; 2018 Physical Activity NIH Toolbox Cognition Domain 12 Week Physical Activity Intervention Breast Cancer Survivors 87 participants Randomized Control Trial Concluded that participants reported a decrease in their cognitive impairments with exercise intervention. Hartman et al.; 2019 Intervention NeuroTrax- 45-minute computerized testing battery assessment Metformin Breast Cancer Survivors 333 participants Randomized Control Study Concluded that the use of metformin on obese cancer survivors did not provide any improvements in cognitive complaints but did show a slight improvement in verbal functioning. Henneghan et al.; 2016 Sleep FACT-Cog PCI Pittsburgh Sleep Quality Index24 (PSQI) and the Epworth Sleepiness Scale (ESS) 10 years Post Chemotherapy 90 participants Cross-Section a l Study Concluded that sleep disturbances and daytime sleepiness were linked to cognitive impairments in the 90 breast cancer survivors that were studied. Hormozi et al.; 2019 Psychological Aspect MMSE BDI and BAI Breast Cancer Patients 100 participants Cross-Section a l Study Concluded that cognitive performance decreased, depression (p = 0.02) and anxiety (p = 0.02) increased compared to the start of treatment. Huang et al.; 2018 Intervention Logical Memory Subtest of the Chinese Version of Wechsler Memory Scale Dietary Intake and Supplements Breast Cancer Patients’ Post-therapy 1,047 participants Large population-based cohort study Concluded that a consumption of vegetables, fruits, and fish intake with the supplementation of vitamin B and E and a decrease in alcohol showed an improvement in cognitive capabilities. Jacobs et al.; 2017 Psychological Aspect Cognitive Failure Questionnaire (CFQ) 5-point Likert Scale Breast Cancer 175 participants Not defined Concluded that informing patients about the possibility of CICI occurring led to an increase in occurrence of CICI in patients, especially those classified as vulnerable population. Janelsins et al; 2016 Physical Activity MD Anderson Symptom Inventory (MDASI). Yoga Intervention Mostly Breast Cancer Patients 328 participants Randomized Control Study Concluded that the program significantly reduced memory difficulty compared to the control group. Koevoets et al.; 2022 Physical Activity Hopkins Verbal Learning Test-Revised 6-month Exercise Program Breast Cancer Receiving Chemotherapy 181 participants Randomized Control Trial Concluded that the exercise group reported improvements in self-reported cognitive functioning. Lawrence et al.; 2016 Intervention Hopkins Verbal Learning Test-Revised and HVLT-R Discrimination Donepezil Breast Cancer Survivors 64 participants Small Randomized Pilot Study Concluded that the intervention group performed slightly better on the Hopkins Verbal Learning Test-Revised and the HVLT-R Discrimination compared to the control group. Lee et al.; 2018 Intervention MoCA assessment Gamiguibi-tang (GGBT) Variety of Cancer 30 participants Prospective Randomized Wait-List-Controlled Pilot Study Concluded that there was no improvement in MoCA scores in the GBBT group compared to the control group. Li et al.; 2022 Intervention Rivermead Behavioral Memory Test (RBMT-II) and BADS assessment Multisensory simulation (MS) Training and Audiovisual Training (AV) Breast Cancer Receiving Chemotherapy 80 participants Interventional Study Concluded that MS training provided some improvements compared to AV in CICI complaints Liang et al.; 2019 Intervention FACT-Cog Vs.3 Psychoeducational Intervention Gynecological Cancer Survivors 12 participants Pilot study Concluded that there was an improvement in CICI complaints using the FACT-Cog PCI in the intervention group. Lyu et al.; 2022 Intervention Fact-Cog Vs. 3 Electroacupuncture Variety of Cancers 15 participants Single-arm Pilot Clinical Trial Concluded that the electroacupuncture intervention decreased in CICI complaints in participants with an increase in FACT-COG Martin et al.; 2020 Psychological aspect Wechsler Intelligence Scale and the TMT Hospital Anxiety and Depression Scale (HAD) and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 version 3 (EORTC QLQ-BR23 Scale Breast Cancer 151 participants Analytical, Prospective, Longitudinal Study Concluded that 151 breast cancer patients lower cognitive performance scores two months after completion of the treatment. Mayo et al.; 2021 Intervention Neuropsychological battery test contained 14 tests across 5 domains (Learning Efficiency/Memory, Information Processing/Psychomotor Efficiency, Working Memory, Executive Functioning, and Language ). Self-reported CICI was assessed using Patient’s Assessment of Own Functioning Inventory (PAOFI) Computerized Cognitive Training Program Completed treatment for Hematological Malignancy 14 participants. Single arm, non-blinding feasibility study where all 19 participants were enrolled into a 8-week Computerized Cognitive Training program. There was no control group in this study. Concluded that adherence to the program was difficult and only had one participant complete it. Millbury et al.; 2013 Intervention FACT-Cog Tibetan Sound Mediation (TSM) Variety of Cancer Patients 47 participants Randomized Controlled Pilot Trial Concluded that the TSM group showed improvements in CICI to the control group. Palmer et al.; 2020 Intervention TMT Parts A and B (A-B), Rey Auditory-Verbal Learning Test (RAVLT), Controlled Oral Word Association Test (COWAT) and an inhibitory task type Go / No-Go. Melatonin Breast Cancer Patients 36 participants Randomized, Double blinded placebo-controlled trial Concluded at the use of melatonin improved sleep and CICI to some degree. Park et al.; 2017 Intervention FACT-Cog Vs.3 Compensatory Cognitive Training Intervention Consisting of the Promoting Cognitive Health Program Breast Cancer Patients 54 participants Pilot Study Concluded that there were improved objective and subjective cognitive functioning performances in the intervention group. Schangen et al.; 2012 Psychological Aspect CFQ 5-point Likert Scale Variety of Cancers 150 participants 2x2 factorial between-subjects Design Concluded that patients who were informed about CICI had more trouble recalling words (M = 24.44) compared to those who were not informed about CICI. Tack et al.; 2021 Intervention CFQ Emotional Freedom Techniques (EMOTICON) Solid Tumor or Hematological Malignancy and had Completed Treatment 93 participants Prospective multicenter randomized wait-list controlled study Concluded that CICI was decreased in the immediate treatment group using the cognitive failures questionnaire compared to the wait-list control group. Tong et al.; 2018 Intervention Hopkins Verbal Learning Test- Revised, TMT, Controlled Oral Word Association Test Acupuncture Therapy Breast Cancer Patients 80 participants Prospective study Concluded that the intervention group had decreases in cognitive impairments. Vega et al.; 2019 Intervention Cognitive Complaint Index Nicotinic Treatment Variety of Cancers 22 participants Randomized placebo-controlled parallel group pilot study Concluded that CICI complaints improved in both groups. Von At et al; 2021 Psychological Aspect Rey Auditory Verbal Learning Test (AVLT), Digit Span from the WAIS-III, Controlled Oral Word Association (COWA), Squire Subjective Memory Questionnaire Scale (SSMQ) Quality of life; Center for Epidemiologic Studies-Depression Scale, and Post-traumatic Growth Inventory (PTGI), FACT-F Breast Cancer Survivors 498 participants Large cross-section a l study Concluded that younger BCS reported significant cognitive impairments and greater detriments in the QoL. Wei et al.; 2021 Physical Activity FACT-Cog Baduanjin Exercise Group Breast Cancer Patients Undergoing Chemotherapy 70 participants Randomized Controlled Trial Concluded that the Baduanjin exercise group showed greater improvements in the FACT-COG test compared to their healthy counterparts. Zeng et al.; 2018 Intervention Hopkins Verbal Learning Test–Revised (HVLT-R), TMT, and the Controlled Oral Word Association Test (COWA) Acupuncture Intervention Gynecological Cancers 6 participants Pilot Cohort Study Concluded that the use of acupuncture intervention was beneficial for CICI complaints. Zhang et al.; 2020 Intervention MoCA Electroacupuncture to Stimulate Trigeminal Nerve and Conventional Body Acupuncture Breast Cancer Patients Post or Current Chemotherapy 93 participants Blinded randomized Control Trial Concluded no significant changes in MoCA score between control and intervention group. Results This review focuses on discussing physical activity, sleep, psychological aspects, and related interventions as modifiable factors that can be used in clinical settings to potentially decrease the incidence and the severity of CICI. PRISMA guidelines were used to document the number and stage of exclusion for all rejected articles. First, 17,242 papers were entered into RAYYAN and crossed-referenced with the PubMed database. There were 3,407 duplicate papers removed. Then, based on exclusion criteria, 13,633 papers were excluded from the remaining 13,835 papers. Next, 13,835 papers were removed based on abstract and title because they did not adhere to our criteria or did not pertain to the topic of this review. The remaining 172 articles were read in their entirety, and 126 were excluded due to either a small number of participants, a high loss of participants during the study, or not having results published for their abstracts that were blind screened using RAYYAN. In total, this review included 46 articles. Figure 2 A &B. The Risk of Bias 2 tool was used to ascertain the validity of the studies utilized in this systematic review. Figure 2 A indicates the summary of the ROB2 run. Figure 2 B indicates the individual bias results for the paper. A risk-bias assessment was conducted on the 46 papers included in the review. The findings indicated that all the papers used in this review were of low risk of bias overall. Only one paper had 50.00% high risk of bias overall, and 4 papers had 33.00% high risk of bias overall. The most consistent occurrence of high risk of bias in the studies were regarding selective reporting (15 papers). I. Psychological Aspects Receiving a cancer diagnosis, undergoing cancer treatment, and being told they are cancer free can impose significant psychological burdens on patients. In addition to coping with the diagnosis and treatment regimens, patients often experience cognitive impairments, exacerbating the strain on their mental well-being. This results in greater stress to their mental health. Cheung et al. studied 54 breast cancer patients and concluded that anxiety (15.1%), fatigue (27.8%), and cognitive impairments (25.9%) were more prevalent than depression (5.6%). 9 Hormozi et al. showed that 100 breast cancer patients had greater cognitive impairment compared to pre-chemotherapy treatment by evaluating cognitive performance both before chemotherapy and after the start of treatment at 1, 3, and 6 months. The cognitive performance decreased (before chemotherapy: x̄= 25.20 ± 4.02; after 6 months: x̄=22.80 ± 4.22;p = 0.001), depression (before chemotherapy: x̄= 12.96 ± 9.95; after 6 months: x̄=16.52 ± 11.07;p = 0.02) and anxiety (after one month: x̄=15.32 ± 11.54; after 6 months: x̄=20.88 ± 13.50;p = 0.02) increased after 6 months compared to levels measured at the start of treatment. 10 Bedillion et al. studied 317 BCS who had either stage 0 to IIIC BC and were less than 10 years post treatment who received different treatments (Tamoxifen, Anastrozole, Letrozole, Exemestane, CES-D). They divided the BCS into perceived cognitive impairment (PCI) and perceived cognitive ability (PCA) groups. Cognitive impairment was measured using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and depression was measured using the Epidemiologic Studies Depression Scale. Bedillion et al. concluded that depression in the 317 BCS less than 10 years posttreatment contributed to the impairment in cognitive functioning. Specifically, BCS who received Tamoxifen treatment has significantly higher rates of depression affecting CICI (PCI: -2.665, 95% CI=-5.113 to -0.447; PCA: -3.332, 95% CI= -6.396 to -0.516). 11 Boscher et al. used the FACT-Cog questionnaire to examine the relationship between cognitive impairments and current psychological symptoms. Out of the 1,393 cancer survivors, 47.2% (n = 657) reported cognitive complaints. Depression (x͂ =5.00, x̄ =5.4 ± 3.5) and anxiety (x͂ =8.9, x̄ =8 ± 4.00) were reported to worsen CICI in participants. Fatigue (x͂ =19.00, x̄ =195.00 ± 11.8) was also reported to worsen CICI according to results of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Finally, the authors concluded that PTSD symptoms were strongly associated with cognitive impairments (OR = 2.05, 95% CI = 1.57–2.69). 12 Cao et al. studied 65 esophageal cancer patients that were divided into a psychotic depressed (PD) group and a nonpsychotic depressed (NPD) group. The PD group reported higher scores in the Stroop Test (x̄=22.89 ± 2.07, p = 0.009) and the Color Trails Test (x̄=13.16 ± 1.71, p = 0.008). 13 Gutenkunst et al. reported that psychological factors, such as fatigue and stress (p < 0.0001), were more important to consider than demographic or medical characteristics of the cancer (cancer type, tumor location and size, staging, type of therapy etc.) in relation to self-reported cognitive impairment. 14 Overall, the six studies presented indicate a consistent association between worsening mental health, including depression, anxiety, fatigue, stress, and post-traumatic stress disorder (PTSD) symptoms, and increased cognitive impairment in cancer patients and survivors compared to healthy counterparts. These findings underscore the importance of extending clinical roles beyond traditional medical care. They emphasize the necessity of integrating mental health assessments seamlessly into clinical practice to provide timely support and interventions for cancer patients. II. Physical Activity Physical activity has many positive effects on the body and mind. These studies showed a positive correlation between cancer patients and survivors’ participation in physical activity and improvements in cognitive impairments. 15–21 Hartman et al. , observed 136 early-stage post-menopausal breast cancer patients. It was noted that participants had higher levels of physical activity had better performance in executive functioning domain (OR = 0.42, 95%CI:0.12–1.46) and attention domain (OR = 0.46, 95%CI:0.13–1.60) compared to those who had less physical activity levels. 15 Wei et al. looked at the effects of Baduanjin exercise on CICI in 70 breast cancer patients. The Banduanjin exercise group consisted of 35 participants that were recommended to do half an hour of banduanjin exercise at home five times a week for a duration of 12 weeks. The control group consisted of 25 participants given face-to-face health education. The control group was asked about their condition twice a week during the same 12-week period. They concluded that the Baduanjin exercise group showed greater improvements in the FACT-COG test (p < 0.001) compared to their healthy counterparts. Furthermore, the exercise-cognition relationship identified an indirect effect on reports of both decreased fatigue (β = 0.132, 95% CI: 0.046, 0.237) and decreased anxiety (β = 0.075; 95% CI: -0.0165, -0.004). 16 Janelsins et al. studied the effect of yoga on 328 cancer survivors who suffered from CICI. Yoga for Cancer Survivors (YOCAS) program consisted of breathing exercises, postures, and mediation, which were focused on improving sleep quality in cancer patients. They reported that the program significantly reduced memory difficulty compared to standard care (yoga:x̄=-0. 06; standard care: x̄=-0.16; P < 0.05). 17 Koevoets et al. stated that the use of a 6-month exercise intervention in participants resulted in reports of improvements in cognitive functioning. The study included randomization of 181 patients into either the exercise (n = 91) or the control group (n = 90); they concluded that the exercise group reported improvements in self-reported cognitive functioning (β = 0.7, 95% CI – 1.2; -0.1). Besides improvement in self-reported impairment, data analysis showed that exercise had a positive effect on ACS reaction time (β = 26.8, 95% CI – 52.9; -0.6) and ACS Wordlist learning (β = 4.4, 95% CI 0.5; 8.3) when testing cognitive functioning in highly fatigued patients. They also discussed the improvements in other factors, such as fatigue, QoL, and depression. 18 Campbell et al. studied breast cancer patients who were placed in an exercise group (n = 10) or a usual lifestyle control group (n = 9). The exercise group participated in 24 weeks of 150 mins of moderate-to-vigorous aerobic exercise per week, with two 45-minute supervised sessions per week at the gym. Interestingly, this study concluded that there was no improvement in self-reported cognitive function and that the effect size was small. 19 In another study by Hartman et al. , discussed obesity, physical activity, and sleep all affected cognitive functioning for cancer survivors. They observed 87 sedentary BCS. The 87 participants were randomized into an exercise arm (n = 43) and a control arm (n = 44). The exercise arm received a 12-week physical activity intervention. They conducted a memory and motion study for a 12-week physical activity intervention program and concluded that participants reported a decrease in their cognitive impairments (β = 2.01; 95% CI = 0.01, 4.01; p = 0.049). 20 Gokal et al . investigated whether12 weeks of moderate intensity walking mid-way through chemotherapy decreased the effects of CICI more than what was observed in the control (non-walking) group. They concluded that the intervention group showed improvements in cognitive function (F = 3.90, p = 0.05 np 2 = 0.075). 21 Overall, the seven studies discussed underscore the significant relationship between physical activity and CICI in cancer patients and survivors. Notably, these interventions include various forms such as exercise programs, yoga, and walking routines. The collective evidence suggests that integrating physical activity into patient care plans may serve as a crucial element in managing and potentially alleviating CICI symptoms. III. Sleep Sleep plays a crucial role in cognitive functioning, with both its quality and quantity influencing cognitive abilities. 26 . This review includes five studies that examined the effects of sleep on cognitive impairment. 23–27 Palmer et al. studied the effects of melatonin therapy in breast cancer patients in relation to cognition. Palmer et al. studied the effects of melatonin therapy in breast cancer patients in relation to cognition. They stated that the use of melatonin may have a neuroprotective effect to counteract the adverse effects of chemotherapy on cognitive function, sleep quality, and depressive symptoms when comparing baseline to end of treatment in the intervention group (Intervention: x̄ = 39.10(± 9.64),p = 0.002; Control: x̄ = 47.49(± 8.64), p = 0.002). 23 The study by Hansen et al. (2014) involved a randomized double-blind, placebo-controlled trial with 54 participants who underwent breast cancer surgery. Cognitive function was assessed using the Mini-Mental State Examination, a neuropsychological test battery, and the MDI visual analogue scale (VAS). Participants also maintained a sleep diary. The study concluded that cognitive dysfunction could not be established in the breast cancer patients, but it was suggested that this limitation might be attributed to sample size constraints. 24 In the second included manuscript, Caplette-Gingras et al. conducted an observational study to assess cognitive impairments in individuals with insomnia. The study included 67 participants diagnosed with Stage I-III breast cancer. Cognitive function was evaluated using 11 different neuropsychological tests, while sleep severity was measured using the Insomnia Severity Index. The researchers concluded that the insomnia group (n = 47) exhibited greater objective and subjective cognitive impairments based on the results of the neuropsychological tests (p = 0.049). Furthermore, the insomnia group reported sleep efficacy below 85% in their sleep diaries compared to the good sleepers group. 25 The Ancoli-Israel et al. study compared 69 women with breast cancer and 64 matched-controls with no cancer. Data was collected at pre-chemotherapy, at the end of the fourth cycle of chemotherapy treatment, and one year after the start of treatment. The researchers assessed cognition, total sleep and nap time, circadian activity rhythms, and sleep quality. The findings indicated that lower sleep quality predicted worse subjective cognition. Specifically, women with breast cancer reported higher levels of cognitive impairment compared to their counterparts at cycle 4 (p = 0.0054) and one year after treatment initiation (p = 0.0222). This was measured with PAOF total scores (p = 0.0052, standard error = 0.0513 and adjusted β-value= -0.147), the PSQI score (p = 0.0055, standard error = 0.00746, adj β-value= -0.0212), and the naptime data (p = 0.042, standard error = 0.0285, adjusted β-value=-0.0586). 26 Henneghan et al. conducted a cross-section a l study examining the association between sleep disturbances, daytime sleepiness, and cognitive impairments in 90 breast cancer survivors. Participants were assessed using the FACT-Cog PCI, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) to measure cognitive function, sleep quality, and daytime sleepiness, respectively. The study evaluated participants who were 10 years post-chemotherapy. The researchers concluded that sleep disturbances and daytime sleepiness were linked to cognitive impairments in the studied breast cancer survivors (p < 0.0001). 27 Overall, the reviewed studies illustrate the relationship between CICI and physical activity, demonstrating the significant influence of sleep quality and duration on cognitive abilities. Notably, Caplette-Gingras et al. link insomnia severity to greater cognitive impairments, while Henneghan et al. demonstrate the association between sleep disturbances, daytime sleepiness, and cognitive deficits in breast cancer survivors. Importantly, increased sleep duration has been associated with reduced complaints of CICI, emphasizing the need to address sleep disturbances to improve cognitive outcomes in cancer patients and survivors. IV. Interventions Interventions involving cognitive behavioral therapy, use of drugs, and specific exercise regimens have been shown to affect positively both the body and the mind. These studies showed a positive correlation between cancer patients and survivors participating in these interventions and improvements in cognitive impairments present at baseline. A. A. Use of Herbal, Supplements, Specific Medication and Sound Lee et al. studied the effectiveness of Gamiguibi-tang (GGBT) on cognition between an intervention (n = 15) and a control (n = 15) group. They concluded that there was no improvement in MoCA scores (p = 0.454) in the GBBT group compared to the control group. 28 Bar-Sela et al. studied the effects of cannabis use on cognition in one group (n = 17) compared to a control group without cannabis use (n = 17) over a period of three months. They concluded that use of cannabis in patients helped with other cancer-related symptoms but had no effect on CICI. There were no statistically significant changes in MoCA scores between baseline and the end of the 3 months (p = 0.9 and 0.7). 29 Barton et al. investigated the interventional use of Ginkgo biloba in 166 women who were receiving breast cancer treatment. Data indicated that Ginkgo biloba did not improve CICI complaints. 30 Huang et al. examined dietary intervention through supplement usage in BCS and concluded that a consumption of vegetables, fruits, and fish intake with the supplementation of vitamin B and E and a decrease in alcohol showed an improvement in cognitive capabilities 31 . Tibetan sound meditation (TSM) was studied by Milbury et al. in cancer patients with CICI. They concluded that the TSM group (n = 23) showed improvements in the verbal memory test (p = 0.06), the short-term memory and processing speed task (p = 0.09), and cognitive function task (p = 0.06) at the end of one month compared to the control group (n = 24). 32 Vega et al. explored the effects of nicotinic treatment (n = 11) vs placebo group (n = 11) for 6 weeks in cancer survivors that reported CICI. They reported there was no significant improvement in both groups. Hartman et al , investigated the use of metformin intervention for 333 BCS with CICI complaints. The study concluded that use of metformin on obese cancer survivors did not provide any improvements in cognitive complaints, but did show a significant improvement in verbal functioning (p = 0.009). 34 Lawrence et al. used donepezil as an intervention in 32 BCS with reported CICI compared to control group (n = 32). The intervention group performed slightly better on the Hopkins Verbal Learning Test-Revised (p = 0.033) and the HVLT-R Discrimination (p = 0.036) compared to the control group. Other cognitive domains did not show any improvement. 35 Overall, the 9 studies showed the potential benefits of various interventions, including cognitive behavioral therapy, medications, supplements, and sound therapy, on cognitive impairments in cancer patients and survivors. While some interventions such as melatonin therapy and Tibetan sound meditation showed promising results in improving cognitive function, others like Gamiguibi-tang (GGBT) and cannabis use did not demonstrate significant effects. Additionally, interventions like Ginkgo biloba, dietary supplements, and nicotinic treatment yielded mixed findings regarding their impact on cognitive impairment. Further research with larger sample sizes is necessary to establish a more definitive correlation between these interventions and their impact on the severity of CICI. B. Acupuncture Lyu et al. studied the use of electroacupuncture intervention for CICI in twelve cancer patients twice a week, for 30 mins each time, for 8 weeks. FACT-Cog scores were found to be at a baseline average of 81.17 points and had increased to 93.70 at 4 weeks (p = 0.145), 90.04 at 8 weeks (p = 0.326), and reached 101.14 at 12 weeks (p = 0.058). The study concluded that the electroacupuncture intervention decreased CICI complaints in participants with an increase in FACT-COG of 81.17 to 101.14 after 12 weeks (p = 0.058). 3 Tong et al . also investigated the benefits of acupuncture therapy as an intervention for breast cancer patients. They reported that the patients had decreases in cognitive impairments (p < 0.05). The battery of tests used to determine cognitive impairment in this study was Hopkins Verbal Learning Test- Revised, Trail Making Test, Controlled Oral Word Association Test. 37 Zeng et al. investigated the effects of acupuncture on CICI complaints in 6 gynecological cancer patients with 3 receiving the intervention and 3 serving as the control. They concluded that the use of acupuncture intervention was beneficial for cancer patients vs control groups for CICI complaints in attention and working memory (Intervention: x̄= 6.23 (± 2.71); Control: x̄=7.46 (± 1.99)), verbal memory (Intervention: x̄= 11.60 (± 4.76); Control: x̄=13.33 (± 3.65)), executive function (Intervention: x̄= 72.33 (± 36.07); Control: x̄=75.13 (± 29.55)), and language (Intervention: x̄= 31.08 (± 6.48); Control: x̄=32.93 (±8.89)). 38 Zhang et al. explored the benefits of using electroacupuncture to stimulate the trigeminal nerve in addition to conventional body acupuncture in CICI breast cancer patients and reported no significant changes in MoCA score. 39 Overall, the 4 studies illustrate the potential efficacy of acupuncture interventions in alleviating cognitive impairment in cancer patients and survivors. Electroacupuncture interventions led to a significant decrease in CICI complaints. Additionally, acupuncture therapy was associated with decreases in cognitive impairments in breast cancer patients and improvements in attention, working memory, verbal memory, executive function, and language in gynecological cancer patients. However, acupuncture stimulation of the trigeminal nerve did not yield significant changes in cognitive function. Further research is warranted to better understand the role of acupuncture in managing CICI. C. EGG Feedback Alvarez et al. conducted a 6-month study that involved monitoring the effects of electroencephalogram biofeedback on CICI in 23 female BCS. Baseline measurements revealed dysfunction in all cognitive domains using the FACT-Cog assessment; repeating measurements indicated strong improvement in all cognitive domains (p < 0.001). 40 Gaynor et al. used transcranial direct current stimulation as an intervention in 16 BCS with CICI followed by two days of sham stimulation (vice versa). The study concluded that the use of this intervention may be an effective intervention compared to the control group, but that a larger sample size would need to be studied in future studies. 41 Overall, the 2 studies illustrated that the use of EGG feedback can help decrease the severity of CICI in cancer patients and survivors. But there is need for more studies to be conducted to see the true effectiveness of EGG feedback on the severity of CICI in the cancer population. D. Cognitive Training Programs Bray et al. studied the effects of a web-based cognitive rehabilitation program in 242 cancer survivors that were randomly assigned to either the intervention (n = 121) or the control groups (n = 121). The study concluded that the FACT-Cog PCI significantly improved (-7.47; 95% CI, -10.80 to -4.13; P < 0.001). 42 Mayo et al. conducted an 8-week computerized cognitive training program with 19 hematological cancer survivors. The researchers reported that adherence to the program was a bit difficult and that they only had one participant complete the program. 43 Ferguson et al. conducted a randomized trial involving 47 BCS to evaluate the effectiveness of videoconference-delivered cognitive behavioral therapy (CBT). The intervention group (n = 27) received memory and attention adaptation training (MAAT) via videoconference. Results showed a decrease in complaints related to CICI (F ( 1 , 28 ) = 6.07; p = 0.02) and an increase in neuropsychological processing speed (F ( 1 , 32 ) = 5.25; p = 0.03) compared to the control group (n = 20) receiving supportive treatment. 44 Park et al. investigated the benefits of compensatory cognitive training intervention consisting of the Promoting Cognitive Health Program for 54 breast cancer patients. They reported that there were improved objective and subjective cognitive functioning performances. ( p = 0.001) The study called for a future experiment that would utilize a larger sample size and a longer follow up period. 45 Johns et al. proposed the use of mindfulness-based stress reduction for their intervention group (n = 35). For the control group, which included both colorectal and breast cancer patients, fatigue education and support (n = 36) was implemented for patients with CICI. They reported that the intervention group had slight improvements in both the attention criteria (p = 0.001) and the Stroop test (p = 0.030). 46 They also suggested that future studies should consider utilizing a larger randomized trial size. Overall, the 5 studies illustrated that the use of cognitive training programs did decrease the severity of CICI in the cancer population. The use of cognitive training programs is beneficial and should be considered for cancer patients or survivors who complain about CICI. E. Psychological programs Asher et al. proposed using a multidimensional psychoeducation-based cognitive rehabilitation intervention program, consisting of six weeks of 2.5-hour sessions that were facilitated by neuropsychologists and cancer rehabilitation physicians. The focus was on collecting data from 20 cohorts (n = 110).The study concluded that there were significant improvements in CICI from preintervention to 12 months postintervention for the FACT-Cog PCI ( x̄ =46.65 (± 16.55)), the FACT-Cog PCA (x̄ =16.36 (± 5.71)), and the FACT-Cog QOL (x̄ =10.83 (± 3.70)). 47 Liang et al. tested a psychoeducational intervention in 12 gynecologic cancer survivors and concluded that there was an improvement in CICI complaints using the FACT-Cog PCI (p < 0.048) . 48 Ding et al. used the managing cancer and living meaningfully (CALM) intervention program for an intervention group (n = 36) vs control group (n = 36) in breast cancer patients. They concluded that the CALM intervention lessened CICI complaints (p = 0.000 respectively). 49 Tack et al. studied the effects of Emotional Freedom Techniques (EMOTICON) in both an immediate treatment (ITG) group (n = 43) and a wait-list control (WLC) group (n = 50). It was concluded that CICI decreased in the ITG using the cognitive failures questionnaire (x̄=25.98, 95%CI (18.13, 33.83); p < 0.01) compared to wait-list control group (x̄ = 16.94, 95%CI (9.51,24.37); p < 0.001). 50 Li et al. investigated the use of multisensory stimulation training intervention on CICI in breast cancer patients during four intervention cycles. It was concluded that multisensory stimulation training provided improvements (x̄ =22.45(± 1.6), p < 0.01) compared to audiovisual training (x̄=19.00(± 2.148), p = 0.05). 51 Overall, the 5 studies that illustrated the use of psychological programs did decrease the severity of CICI in cancer population. Additionally, multisensory stimulation training intervention provided substantial improvements in cognitive impairment, suggesting its potential as a valuable psychological intervention for enhancing cognitive functioning in cancer survivors. Discussion The study conducted a systematic review to evaluate the effects of various modifiable factors on CICI. A total of 46 relevant studies were included in the review. The studies showed that modifiable factors, including psychological, physical, and sleep related factors, improved with various interventions, which subsequently reduced the burden of CICI on the patients’ cognitive functioning and QoL. Studies included in this review concluded that managing anxiety, depression, fatigue, and other psychological aspects reported by cancer patients and survivors could decrease the severity of cognitive impairment in these patients. This indicates that greater support may be needed by cancer patients and survivors than is currently acknowledged. Sleep was another important factor that contributed to how efficiently the body and the mind completed daily tasks. Overall, there were a limited number of published papers that fit the inclusion criteria the authors had established. Also, there were not as many published studies about sleep compared to the other factors discussed. Clinicians and researchers should consider conducting more studies with either a larger sample size or a longer duration. The studies included in the systematic review used a variety of interventions, ranging from simple support programs, either in person or virtually, to a wide variety of treatments and medications. Studies suggest that clinicians should consider implementing cognitive behavioral therapy, physician activity regimens, and the use of medication or supplements in cancer patients and survivors as an addition to the patients’ treatment plans. Furthermore, it would be interesting to see longitudinal studies, looking at all the factors discussed in this paper, with a larger population. Conclusion The primary objective of this systematic review was to establish the presence of cognitive impairment in patients undergoing or having undergone any type of cancer treatment and to evaluate the efficacy of specific interventions, including those related to sleep, physical activity, and others, in ameliorating cancer-related cognitive impairment (CICI). In addition, the healthcare field must discover methods to diagnose CICI at earlier stages, incorporate earlier interventions to decrease the severity and impact of CICI in patients' daily lives, and improve the standard of care. The authors urge more focus on this aspect of chemotherapy treatment and post treatment due to the increased prevalence of cancer survivors in the American population. Abbreviations Chemotherapy induced cognitive impairment ( CICI), Breast Cancer Survivors (BCS), Quality of Life ( QoL), Risk of Basis (RoB2), Rey Auditory Verbal Learning Test (AVLT), Squire Subjective Memory Questionnaire Scale (SSMQ), Mini-Mental State Examination (MMSE), Color Trails Test (CTT), Verbal Fluency Test (VTT), Index of Well-being (IWB), Center for Epidemiologic Studies Depression (CES-D), psychotic depressed (PD) group, nonpsychotic depressed (NPD) group, MD Anderson Symptom Inventory for Multiple Myeloma (MDASI-MM), MD Anderson Symptom Inventory (MDASI), Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Visual Analogue Scale (VAS), Patient’s Assessment of Own Functioning Inventory (PAOF) Declarations Ethics approval and Consent to participate - This paper is a systematic review and did not require any ethic approval and consent to participate. Consent for publication - All authors consent for this paper to be published. Availability of data and materials – Because there was no meta-analysis conducted, there is no data sets used of created. All articles included in this review can be access through PubMed. Competing Interests - There are not competing interests for the article. Funding- There was no funding for this paper. Authors Contributions SPS proposed and defined the definition of chemobrai n, definition of modifiable factors and chose a variety of modifiable factors focused on in this systematic review. SPS, and HKS conducted the scoping review, defining the inclusion/exclusion criteria. SPS and HKS uploaded PubMed searches to RAYYANN. SPS and HKS, removed articles based on title and abstract that did not match the inclusion/exclusion criteria. SPS and HKS read the full articles and removed those articles that did not match the inclusion and exclusion criteria. NM and AK conducted a blinded risk basis assessment and then compared their results. For conflicts on risk basis assessment, SPS was the tiebreaker. SPS wrote the abstract, background, objective, methods, result, discussion and conclusion. SPS and NM editting the paper together. Acknowledgements Many thanks to Dr. Bijan Najafi, Ph.D., MSc. , Dr. Javad Razjouyan Ph.D., MSc, and Interdisciplinary Consortium on Advance Motion Performance (iCAMP) Lab at Baylor College of Medicine for allowing Saba Parastu Sharafkhaneh to continue this project to William Carey University College of Osteopathic Medicine. Many thanks to Dr. Danielle Fastring Ph.D, MPH for providing mentorship during this project and allowing Saba Parastu Sharafkhaneh to be the principal investigator for the systematic review. References Gaman AM, Uzoni A, Popa-Wagner A, Andrei A, Petcu EB. The Role of Oxidative Stress in Etiopathogenesis of Chemotherapy Induced Cognitive Impairment (CICI)-Chemobrain. 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A randomised wait-list controlled trial to evaluate Emotional Freedom Techniques for self-reported cancer-related cognitive impairment in cancer survivors (EMOTICON). EClinicalMedicine. 2021;39:101081. Li Z. Patients With Breast Cancer Receiving Chemotherapy: Effects of Multisensory Stimulation Training on Cognitive Impairment. Number 1 / Febr 2022. 2022;26(1):71–7. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4227713","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":295497629,"identity":"f01ce9b5-56cd-41ff-9e1a-5cc4aae16c04","order_by":0,"name":"Saba Sharafkhaneh","email":"data:image/png;base64,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","orcid":"https://orcid.org/0009-0004-7737-3611","institution":"William Carey University College of Osteopathic Medicine","correspondingAuthor":true,"prefix":"","firstName":"Saba","middleName":"","lastName":"Sharafkhaneh","suffix":""},{"id":295497630,"identity":"c5607b7d-3e57-4f0e-b281-bbae64a0e58e","order_by":1,"name":"Negin Meshkati","email":"","orcid":"","institution":"William Carey University College of Osteopathic Medicine","correspondingAuthor":false,"prefix":"","firstName":"Negin","middleName":"","lastName":"Meshkati","suffix":""},{"id":295497631,"identity":"7351b3dd-8aa3-4353-8f16-fd5044b706da","order_by":2,"name":"Azeem Khan","email":"","orcid":"","institution":"William Carey University College of Osteopathic Medicine","correspondingAuthor":false,"prefix":"","firstName":"Azeem","middleName":"","lastName":"Khan","suffix":""},{"id":295497632,"identity":"5cacc61e-5c76-4d36-b30b-474c8f5a0489","order_by":3,"name":"Hannah Shepherd","email":"","orcid":"","institution":"William Carey University College of Osteopathic Medicine","correspondingAuthor":false,"prefix":"","firstName":"Hannah","middleName":"","lastName":"Shepherd","suffix":""}],"badges":[],"createdAt":"2024-04-06 13:50:51","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4227713/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4227713/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55768981,"identity":"b5535880-8724-4f01-ba60-e0083f9800c3","added_by":"auto","created_at":"2024-05-02 20:40:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":129021,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePRISMA Flow depicts the screening process in selecting papers for the modifiable systematic review.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4227713/v1/84a3e093f7fab09a6d6275cd.jpg"},{"id":55768979,"identity":"f27c7310-6019-4cb2-81b5-59c104bc710a","added_by":"auto","created_at":"2024-05-02 20:40:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":109086,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA\u0026amp;B. The Risk of Bias 2 tool was used to ascertain the validity of the studies utilized in this systematic review. Figure 2A indicates the summary of the ROB2 run. Figure 2B indicates the individual bias results for the paper.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Picture2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4227713/v1/f976569adad070ac3181e0a5.jpg"},{"id":68783873,"identity":"5fdb491d-1012-409a-b562-3f096a0d13c2","added_by":"auto","created_at":"2024-11-12 03:27:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1248301,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4227713/v1/3423c21d-9e6b-48db-91b9-daaf3968f4a6.pdf"}],"financialInterests":"","formattedTitle":"A Systematic Review Focused On Understanding the Effects of Modifiable Factors in Patients who Suffer from Chemotherapy Induced Cognitive Impairments or “Chemobrain”","fulltext":[{"header":"Background","content":"\u003cp\u003eChemotherapy-induced cognitive impairment (CICI), commonly known as chemobrain, is characterized by any type of memory, learning, or cognitive dysfunction caused by any type of cancer treatment\u0026mdash;chemotherapy, immunotherapy, hormonal therapy, radiation, and/or surgery. CICI has many other names, cancer-related cognitive impairment (CRCI), post-chemotherapy cognitive impairment, cancer therapy associated cognitive change, and cancer-treatment related cognitive impairment.\u003csup\u003e1\u003c/sup\u003e Around 75% of cancer patients experience CICI during or after treatment for their cancers; 35% of these patients will have cognitive impairment that persists for months to years following their treatments.\u003csup\u003e2\u003c/sup\u003e It is predicted that there will be over 20\u0026nbsp;million cancer survivors by 2026,\u003csup\u003e3\u003c/sup\u003e indicating the need for better clinician awareness and support for CICI both during and after treatment.\u003c/p\u003e \u003cp\u003eAs the prevalence of cancer survivors increases due to improved healthcare access, the authors wanted to focus on CICI because of the conflicting views present in both the medical field and scientific world regarding this topic. Some studies have cited that CICI will occur more often if suggested to the patients. The \u003cem\u003eJacobs et al.\u003c/em\u003e study involved 175 breast cancer participants being placed into one of three groups: a control group, one group informed about possible CICI, and one without reassuring information about CICI. They concluded that informing patients about the possibility of CICI occurring led to an increase in occurrence of CICI in patients, especially those classified as belonging to a vulnerable population.\u003csup\u003e4\u003c/sup\u003e Similarly, \u003cem\u003eSchagen et al.\u003c/em\u003e reported, in 150 cancer patients that were treated with chemotherapy, higher levels of cognitive complaints after being introduced to the concept of CICI. Furthermore, researchers also concluded that patients who were informed about CICI had more trouble recalling words compared to those who were not informed about CICI .\u003csup\u003e5\u003c/sup\u003e There were numerous studies that found that CICI did, in fact, occur. \u003cem\u003eMarin et al.\u003c/em\u003e reported, in 151 breast cancer patients, lower cognitive performance scores two months after completion of the treatment.\u003csup\u003e6\u003c/sup\u003e \u003cem\u003eVon Ah et al.\u003c/em\u003e reported that 495 breast cancer survivors (BCS) scored 1.5-2.0 SD below their healthy counterparts (HC) in the study for memory impairment. They were also able to establish a link between younger BCS who reported significant cognitive impairments and greater detriments in quality of life (QoL).\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDue to the argument in the literature that suggests CICI is subjective, patients may struggle to discuss this topic with their providers and thus not receive the beneficial treatment they need. Further, clinicians may dismiss the complaint if they think it is not valid. \u003cem\u003eBuchanan et al\u003c/em\u003e. in a retrospective chart review of 2,537 BCS at least one-year post-treatment, findings indicated that 60.0% of the survivors had self-reported cognitive complaints to their providers, but only 37.0% of those had fully discussed those complaints with their providers. Only 15.00% of these 37.00% sought additional treatment for CICI.\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe objective for this systematic review is to identify modifiable factors that influence the presence of CICI. Once identified, the factors can be addressed during treatment to improve the incidence and severity of CICI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e A scoping review was initially conducted to narrow down topics that could be explored in relation to CICI. The review involved using the PubMed database and uploading the papers for the team evaluation on Zotero. The results of the scoping helped to clarify search terms and the inclusion/exclusion criteria for the systematic literature review.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eInclusion criteria\u003c/b\u003e encompassed geriatric and adult populations of both sexes who were currently receiving or had received cancer treatment and presented with cognitive impairment. The geographical location of studies was not limited; however, only papers written in English were included. Any type of intervention to diagnose cognitive impairment in cancer patients and survivors was included, as well as control groups and placebo-controlled groups. Outcomes for studies were based on objective measures. Longitudinal, cohort, controlled, randomized controlled, placebo controlled, blinded, cross-section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el studies were included, and all studies had to have been completed within the past ten years.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eExclusion criteria\u003c/b\u003e encompassed small sample sizes, studies that lack published data, pediatric populations, all animal populations, cell-based studies, twin studies, and conclusions relying on self-reported outcomes in presence of cognitive impairment due to chemotherapy, as well as studies with a limited sample. Excluded study designs included other reviews, (such as systematic reviews, mini-reviews, scoping reviews, and case reviews), as well as books, documents, experiences, case-studies, testimonies, letters, meta-analyses, and studies not conducted within the last ten years.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eA search on PubMed was conducted using these equivalent search terms:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eChemotherapy induced cognitive impairment, Chemofog, Chemobrain, Chemotherapy induced cognitive impairment, post-chemotherapy cognitive impairment, Cancer related cognitive impairment, Cancer related cognitive dysfunction\u003c/em\u003e, and \u003cem\u003eCancer related cognitive decline\u003c/em\u003e.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAll search results were saved as a PubMed.set.txt file and uploaded to the RAYYAN-Intelligent Systematic Review. Next, papers were blinded, and studies were accepted or rejected based first on title and abstract, and then on inclusion/exclusion criteria. Any disagreements about acceptance or rejection were discussed until consensus was reached. Next, the remaining articles were evaluated to confirm they met inclusion criteria. Articles that remained underwent a blinded risk of bias assessment conducted using the Risk of Bias (RoB2) tool from Cochrane. RoB2 was conducted by the second and third authors blindly and any disagreements were resolved by the principal investigator (PI).\u003c/p\u003e \u003cp\u003eBased on this process, the authors ensured that the review included studies providing statistical analysis (presented in the results) confirming the validity and presence of Chemotherapy-Induced Cognitive Impairment (CICI) in cancer patients and survivors for all accepted articles, data was abstracted from the \u003cspan refid=\"Sec3\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section of each included paper. Statistical information, such as the p value, SD, mean and other relevant information were included in the \u003cspan refid=\"Sec3\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section. For this systematic review, the authors were not able to pursue a meta-analysis because the papers included articles that included varying types of cancer, types of treatment, and stages of diagnoses; also, different assessments tools were used for diagnosing cognitive impairments and defining modifiable factors (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) across studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTable indicates the differences between the included studies and why meta-analysis could not be conducted.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMFs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCICI Assessment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTool Assessment / Intervention Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eType of Cancer / Type of Treatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber of Participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eResults\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAlvarez et al;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuropsychological Battery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComputerized Cognitive Training Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-treatment Hematological Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSingle-arm, non-blinding feasibility study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that adherence to the program was a bit difficult and that they only had one participant complete the program and further studies need to be conducted.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAncoll-Isreael et al.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuropsychological Battery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePittsburgh Sleep Quality Index (PSQI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast cancer chemotherapy treated patients before treatment, end of cycle 4, 1 year after start of chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e133 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eObservational study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that worse subjective cognition was predicted by a lower sleep quality.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAsher et al.;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog v3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultidimensional Psychoeducation-Based Cognitive Rehabilitation Intervention Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety from a Cancer Rehabilitation and Survivorship Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRetrospectively study involving 20 cohorts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that there were significant improvements in CICI in the intervention group at post-intervention compared to pre-interventions.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBar-Sela et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMontreal Cognitive Assessment (MoCA), Digit Symbol Substitution subset (WAIS III) and Digital-Finger Tapping Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCannabis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancer Patients Receiving Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e34 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePilot Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that cannabis has no effect or change on CICI complaints.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBarton et al.;\u003c/em\u003e 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh Sensitivity Cognitive Screen (HSCS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGinkgo bibloba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients Receiving Adjuvant Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e166 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2 arm randomized, placebo controlled double-blinded phase III trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded no improvement in CICI complaints in intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBedillion et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT- Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCenter for epidemiologic studies depression (CES-D)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e317 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eNot defined\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that depression in the 317 BCS less than 10 years post treatment contributed to the impairment in cognitive functioning.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBoscher et al.;\u003c/em\u003e 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT- Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIES-R, FACIT-F, and HADS- anxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,393 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eNot defined\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that depression, anxiety, PTSD worsen symptoms of CICI in survivors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBrayer et al.;\u003c/em\u003e 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT- Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeb Based Cognitive Rehabilitation Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e242 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized control trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the FACT-Cog PCI significantly improved in the intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBuchanan et al.;\u003c/em\u003e 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComplaint presents in chart review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComplaint Presents in Chart Review\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2,537 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRetrospective Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that from 2,537 BCS 60% of the survivors had self-reported cognitive complaints to their providers and only 37% of those had fully discussed those complaints with their providers. Only 15% of these 37% sought out to receive treatment for CICI.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCampbell et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog vs.3, Hopkins Verbal Learning Test- Revised, Trail Making Test (TMT), Stroop test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24-week aerobic exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStage I-IIIa Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Control Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that there was no improvement in self-reported cognitive function and that the effect size was small.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCao et al.;\u003c/em\u003e 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWechsler Adult Intelligence Scale (IQ) and Neuropsychological tests including Color Trails Test (CTT), Stroop test, and Frontal Fluency Rest (FFT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeck Depression Self Rating Scale and BPRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEsophageal Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e65 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall Scale Sample Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the depressed group showed more impairment in their cognitive impairment assessments compared to cancer patients who were not depressed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCaplette-Gingras et al.;\u003c/em\u003e 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 different neuropsychological tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInsomnia Severity Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStage 1-III Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eObservational Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the insomnia group displayed greater objective and subjective cognitive impairments from the neuropsychological tests.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCherrier et al.;\u003c/em\u003e 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMindfulness-based stress reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eColorectal and Breast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePreliminary study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that a larger randomized trial size needs to be utilized in future studies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCheung et al.;\u003c/em\u003e 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog Vs. 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBeck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Brief Fatigue Inventory (BFI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEarly-Stage Breast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45 breast cancer patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMulti-center, cross-section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that anxiety (15.1%), fatigue (27.8%), and cognitive impairments (25.9%) were more prevalent than depression (5.6%).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDing et al.;\u003c/em\u003e 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eManaging Cancer and Living Meaningfully (CALM) Intervention Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e72 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that CALM intervention group reported less CICI complaints.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eFerguson et al.;\u003c/em\u003e 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePerceived Cognitive Impairment (PCI) and Perceived Cognitive Abilities of the FACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMemory and Attention Adaptation Training (MAAT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall Randomized Control Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConclude that the MAAT group reported a decrease in CICI complaints and an increase in neuropsychological processing speed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGaynor et al.;\u003c/em\u003e 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConners\u0026rsquo; Continuous Performance Test (CPT-II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTranscranial direct current stimulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the use of this intervention may be an effective intervention, but that a larger sample size would need to be studied in future studies.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGokal et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuropsychological Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 weeks of Home Based; Self-managed Moderate Intensity Walking Compared with Usual Care Alone.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall randomized control trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the intervention group showed improvements in cognitive function.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGutenkunst et al.;\u003c/em\u003e 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFunctional Assessment of Cancer Therapy-Fatigue (FACT-F) and General Health Questionnaire (GHQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEarly-Stage Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e242 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eNot defined\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that psychological factors, such as fatigue and stress, were more important to consider than demographic or medical characteristics of the cancer in relation to self-reported cognitive impairment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHansen et al.;\u003c/em\u003e 2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMini-Mental State Examination (MMSE), neuropsychological test battery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eVisual Analogue Scale (VAS) and a Sleep Diary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized double-blind, placebo-controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that cognitive dysfunction could not be established in the breast cancer patients but concluded that this could have been due to sample size limitations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHartman et al.;\u003c/em\u003e 2015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuropsychological Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePhysical Activity Questionnaire (GPAQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e136 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCross-Section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that better performance was noted in the patients\u0026rsquo; executive functioning domain and attention domain.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHartman et al;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNIH Toolbox Cognition Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 Week Physical Activity Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Control Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that participants reported a decrease in their cognitive impairments with exercise intervention.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHartman et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuroTrax- 45-minute computerized testing battery assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMetformin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e333 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Control Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the use of metformin on obese cancer survivors did not provide any improvements in cognitive complaints but did show a slight improvement in verbal functioning.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHenneghan et al.;\u003c/em\u003e 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog PCI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePittsburgh Sleep Quality Index24 (PSQI) and the Epworth Sleepiness Scale (ESS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 years Post Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCross-Section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that sleep disturbances and daytime sleepiness were linked to cognitive impairments in the 90 breast cancer survivors that were studied.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHormozi et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMMSE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBDI and BAI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCross-Section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that\u0026nbsp;cognitive performance decreased, depression (p\u0026thinsp;=\u0026thinsp;0.02) and anxiety (p\u0026thinsp;=\u0026thinsp;0.02) increased compared to the start of treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eHuang et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLogical Memory Subtest of the Chinese Version of Wechsler Memory Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDietary Intake and Supplements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u0026rsquo; Post-therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1,047 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLarge population-based cohort study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that a consumption of vegetables, fruits, and fish intake with the supplementation of vitamin B and E and a decrease in alcohol showed an improvement in cognitive capabilities.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJacobs et al.;\u003c/em\u003e 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognitive Failure Questionnaire (CFQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5-point Likert Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e175 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eNot defined\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that informing patients about the possibility of CICI occurring led to an increase in occurrence of CICI in patients, especially those classified as vulnerable population.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eJanelsins et al; 2016\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMD Anderson Symptom Inventory (MDASI).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYoga Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMostly Breast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e328 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Control Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the program significantly reduced memory difficulty compared to the control group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eKoevoets et al.;\u003c/em\u003e 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHopkins Verbal Learning Test-Revised\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6-month Exercise Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Receiving Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e181 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Control Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the exercise group reported improvements in self-reported cognitive functioning.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLawrence et al.;\u003c/em\u003e 2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHopkins Verbal Learning Test-Revised and HVLT-R Discrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDonepezil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e64 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSmall Randomized Pilot Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the intervention group performed slightly better on the Hopkins Verbal Learning Test-Revised and the HVLT-R Discrimination compared to the control group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLee et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMoCA assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGamiguibi-tang (GGBT)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eProspective Randomized Wait-List-Controlled Pilot Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that there was no improvement in MoCA scores in the GBBT group compared to the control group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLi et al.;\u003c/em\u003e 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRivermead Behavioral Memory Test (RBMT-II) and BADS assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMultisensory simulation (MS) Training and Audiovisual Training (AV)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Receiving Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterventional Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that MS training provided some improvements compared to AV\u0026nbsp;in CICI complaints\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLiang et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog Vs.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePsychoeducational Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGynecological Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePilot study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that there was an improvement in CICI complaints using the FACT-Cog PCI in the intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eLyu et al.;\u003c/em\u003e 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFact-Cog Vs. 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eElectroacupuncture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSingle-arm Pilot Clinical Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the electroacupuncture intervention decreased in CICI complaints in participants with an increase in FACT-COG\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMartin et al.;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e2020\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWechsler Intelligence Scale and the TMT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHospital Anxiety and Depression Scale (HAD) and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 version 3 (EORTC QLQ-BR23 Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e151 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAnalytical, Prospective, Longitudinal Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that 151 breast cancer patients lower cognitive performance scores two months after completion of the treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMayo et al.;\u003c/em\u003e 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeuropsychological battery test contained 14 tests across 5 domains \u003cem\u003e(Learning Efficiency/Memory, Information Processing/Psychomotor Efficiency, Working Memory, Executive Functioning, and Language\u003c/em\u003e). Self-reported CICI was assessed using \u003cem\u003ePatient\u0026rsquo;s Assessment of Own Functioning Inventory (PAOFI)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eComputerized Cognitive Training Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCompleted treatment for Hematological Malignancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14 participants.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSingle arm, non-blinding feasibility study where all 19 participants were enrolled into a 8-week Computerized Cognitive Training program. There was no control group in this study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that adherence to the program was difficult and only had one participant complete it.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMillbury et al.;\u003c/em\u003e 2013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTibetan Sound Mediation (TSM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e47 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Controlled Pilot Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the TSM group showed improvements in CICI to the control group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePalmer et al.;\u003c/em\u003e 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTMT Parts A and B (A-B), Rey Auditory-Verbal Learning Test (RAVLT), Controlled Oral Word Association Test (COWAT) and an inhibitory task type Go / No-Go.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMelatonin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e36 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized, Double blinded placebo-controlled trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded at the use of melatonin improved sleep and CICI to some degree.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePark et al.;\u003c/em\u003e 2017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog Vs.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCompensatory Cognitive Training Intervention Consisting of the Promoting Cognitive Health Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e54 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePilot Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that there were improved objective and subjective cognitive functioning performances in the intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSchangen et al.;\u003c/em\u003e 2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCFQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5-point Likert Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e150 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2x2 factorial between-subjects Design\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that patients who were informed about CICI had more trouble recalling words (M\u0026thinsp;=\u0026thinsp;24.44) compared to those who were not informed about CICI.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTack et al.;\u003c/em\u003e 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCFQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEmotional Freedom Techniques (EMOTICON)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSolid Tumor or Hematological Malignancy and had Completed Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eProspective multicenter randomized wait-list controlled study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that CICI was decreased in the immediate treatment group using the cognitive failures questionnaire compared to the wait-list control group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTong et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHopkins Verbal Learning Test- Revised, TMT, Controlled Oral Word Association Test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcupuncture Therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e80 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eProspective study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the intervention group had decreases in cognitive impairments.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVega et al.;\u003c/em\u003e 2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCognitive Complaint Index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNicotinic Treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVariety of Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized placebo-controlled parallel group pilot study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that CICI complaints improved in both groups.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eVon At et al; 2021\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychological Aspect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRey Auditory Verbal Learning Test (AVLT), Digit Span from the WAIS-III, Controlled Oral Word Association (COWA), Squire Subjective Memory Questionnaire Scale (SSMQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQuality of life; Center for Epidemiologic Studies-Depression Scale, and Post-traumatic Growth Inventory (PTGI), FACT-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e498 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eLarge cross-section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that\u0026nbsp;younger BCS reported significant cognitive impairments and greater detriments in the QoL.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eWei et al.;\u003c/em\u003e 2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFACT-Cog\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBaduanjin Exercise Group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients Undergoing Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRandomized Controlled Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the Baduanjin exercise group showed greater improvements in the FACT-COG test compared to their healthy counterparts.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZeng et al.;\u003c/em\u003e 2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHopkins Verbal Learning Test\u0026ndash;Revised (HVLT-R), TMT, and the Controlled Oral Word Association Test (COWA)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcupuncture Intervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGynecological Cancers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePilot Cohort Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded that the use of acupuncture intervention was beneficial for CICI complaints.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eZhang et al.;\u003c/em\u003e 2020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMoCA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eElectroacupuncture to Stimulate Trigeminal Nerve and Conventional Body Acupuncture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast Cancer Patients Post or Current Chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93 participants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBlinded randomized Control Trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eConcluded no significant changes in MoCA score between control and intervention group.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003c/p\u003e \u003cp\u003eThis review focuses on discussing physical activity, sleep, psychological aspects, and related interventions as modifiable factors that can be used in clinical settings to potentially decrease the incidence and the severity of CICI. PRISMA guidelines were used to document the number and stage of exclusion for all rejected articles. First, 17,242 papers were entered into RAYYAN and crossed-referenced with the PubMed database. There were 3,407 duplicate papers removed. Then, based on exclusion criteria, 13,633 papers were excluded from the remaining 13,835 papers. Next, 13,835 papers were removed based on abstract and title because they did not adhere to our criteria or did not pertain to the topic of this review. The remaining 172 articles were read in their entirety, and 126 were excluded due to either a small number of participants, a high loss of participants during the study, or not having results published for their abstracts that were blind screened using RAYYAN. In total, this review included 46 articles.\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA\u003cb\u003e\u0026amp;B. The Risk of Bias 2 tool was used to ascertain the validity of the studies utilized in this systematic review.\u003c/b\u003e Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA \u003cb\u003eindicates the summary of the ROB2 run.\u003c/b\u003e Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB \u003cb\u003eindicates the individual bias results for the paper.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA risk-bias assessment was conducted on the 46 papers included in the review. The findings indicated that all the papers used in this review were of low risk of bias overall. Only one paper had 50.00% high risk of bias overall, and 4 papers had 33.00% high risk of bias overall. The most consistent occurrence of high risk of bias in the studies were regarding selective reporting (15 papers).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eI. Psychological Aspects\u003c/h2\u003e \u003cp\u003eReceiving a cancer diagnosis, undergoing cancer treatment, and being told they are cancer free can impose significant psychological burdens on patients. In addition to coping with the diagnosis and treatment regimens, patients often experience cognitive impairments, exacerbating the strain on their mental well-being. This results in greater stress to their mental health.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCheung et al.\u003c/em\u003e studied 54 breast cancer patients and concluded that anxiety (15.1%), fatigue (27.8%), and cognitive impairments (25.9%) were more prevalent than depression (5.6%).\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eHormozi et al.\u003c/em\u003e showed that 100 breast cancer patients had greater cognitive impairment compared to pre-chemotherapy treatment by evaluating cognitive performance both before chemotherapy and after the start of treatment at 1, 3, and 6 months. The cognitive performance decreased (before chemotherapy: x̄= 25.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.02; after 6 months: x̄=22.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22;p\u0026thinsp;=\u0026thinsp;0.001), depression (before chemotherapy: x̄= 12.96\u0026thinsp;\u0026plusmn;\u0026thinsp;9.95; after 6 months: x̄=16.52\u0026thinsp;\u0026plusmn;\u0026thinsp;11.07;p\u0026thinsp;=\u0026thinsp;0.02) and anxiety (after one month: x̄=15.32\u0026thinsp;\u0026plusmn;\u0026thinsp;11.54; after 6 months: x̄=20.88\u0026thinsp;\u0026plusmn;\u0026thinsp;13.50;p\u0026thinsp;=\u0026thinsp;0.02) increased after 6 months compared to levels measured at the start of treatment.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eBedillion et al.\u003c/em\u003e studied 317 BCS who had either stage 0 to IIIC BC and were less than 10 years post treatment who received different treatments (Tamoxifen, Anastrozole, Letrozole, Exemestane, CES-D). They divided the BCS into perceived cognitive impairment (PCI) and perceived cognitive ability (PCA) groups. Cognitive impairment was measured using the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) and depression was measured using the Epidemiologic Studies Depression Scale. \u003cem\u003eBedillion et al.\u003c/em\u003e concluded that depression in the 317 BCS less than 10 years posttreatment contributed to the impairment in cognitive functioning. Specifically, BCS who received Tamoxifen treatment has significantly higher rates of depression affecting CICI (PCI: -2.665, 95% CI=-5.113 to -0.447; PCA: -3.332, 95% CI= -6.396 to -0.516). \u003csup\u003e11\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eBoscher et al.\u003c/em\u003e used the FACT-Cog questionnaire to examine the relationship between cognitive impairments and current psychological symptoms. Out of the 1,393 cancer survivors, 47.2% (n\u0026thinsp;=\u0026thinsp;657) reported cognitive complaints. Depression (x͂ =5.00, x̄ =5.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5) and anxiety (x͂ =8.9, x̄ =8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.00) were reported to worsen CICI in participants. Fatigue (x͂ =19.00, x̄ =195.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8) was also reported to worsen CICI according to results of the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire. Finally, the authors concluded that PTSD symptoms were strongly associated with cognitive impairments (OR\u0026thinsp;=\u0026thinsp;2.05, 95% CI\u0026thinsp;=\u0026thinsp;1.57\u0026ndash;2.69).\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eCao et al.\u003c/em\u003e studied 65 esophageal cancer patients that were divided into a psychotic depressed (PD) group and a nonpsychotic depressed (NPD) group. The PD group reported higher scores in the Stroop Test (x̄=22.89\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07, p\u0026thinsp;=\u0026thinsp;0.009) and the Color Trails Test (x̄=13.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.71, p\u0026thinsp;=\u0026thinsp;0.008).\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eGutenkunst et al.\u003c/em\u003e reported that psychological factors, such as fatigue and stress (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), were more important to consider than demographic or medical characteristics of the cancer (cancer type, tumor location and size, staging, type of therapy etc.) in relation to self-reported cognitive impairment.\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the six studies presented indicate a consistent association between worsening mental health, including depression, anxiety, fatigue, stress, and post-traumatic stress disorder (PTSD) symptoms, and increased cognitive impairment in cancer patients and survivors compared to healthy counterparts. These findings underscore the importance of extending clinical roles beyond traditional medical care. They emphasize the necessity of integrating mental health assessments seamlessly into clinical practice to provide timely support and interventions for cancer patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eII. Physical Activity\u003c/h2\u003e \u003cp\u003ePhysical activity has many positive effects on the body and mind. These studies showed a positive correlation between cancer patients and survivors\u0026rsquo; participation in physical activity and improvements in cognitive impairments.\u003csup\u003e15\u0026ndash;21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eHartman et al.\u003c/em\u003e, observed 136 early-stage post-menopausal breast cancer patients. It was noted that participants had higher levels of physical activity had better performance in executive functioning domain (OR\u0026thinsp;=\u0026thinsp;0.42, 95%CI:0.12\u0026ndash;1.46) and attention domain (OR\u0026thinsp;=\u0026thinsp;0.46, 95%CI:0.13\u0026ndash;1.60) compared to those who had less physical activity levels.\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eWei et al.\u003c/em\u003e looked at the effects of Baduanjin exercise on CICI in 70 breast cancer patients. The Banduanjin exercise group consisted of 35 participants that were recommended to do half an hour of banduanjin exercise at home five times a week for a duration of 12 weeks. The control group consisted of 25 participants given face-to-face health education. The control group was asked about their condition twice a week during the same 12-week period. They concluded that the Baduanjin exercise group showed greater improvements in the FACT-COG test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared to their healthy counterparts. Furthermore, the exercise-cognition relationship identified an indirect effect on reports of both decreased fatigue (β\u0026thinsp;=\u0026thinsp;0.132, 95% CI: 0.046, 0.237) and decreased anxiety (β\u0026thinsp;=\u0026thinsp;0.075; 95% CI: -0.0165, -0.004).\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eJanelsins et al.\u003c/em\u003e studied the effect of yoga on 328 cancer survivors who suffered from CICI. Yoga for Cancer Survivors \u003cem\u003e(YOCAS)\u003c/em\u003e program consisted of breathing exercises, postures, and mediation, which were focused on improving sleep quality in cancer patients. They reported that the program significantly reduced memory difficulty compared to standard care (yoga:x̄=-0. 06; standard care: x̄=-0.16; P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eKoevoets et al.\u003c/em\u003e stated that the use of a 6-month exercise intervention in participants resulted in reports of improvements in cognitive functioning. The study included randomization of 181 patients into either the exercise (n\u0026thinsp;=\u0026thinsp;91) or the control group (n\u0026thinsp;=\u0026thinsp;90); they concluded that the exercise group reported improvements in self-reported cognitive functioning (β\u0026thinsp;=\u0026thinsp;0.7, 95% CI \u0026ndash; 1.2; -0.1). Besides improvement in self-reported impairment, data analysis showed that exercise had a positive effect on ACS reaction time (β\u0026thinsp;=\u0026thinsp;26.8, 95% CI \u0026ndash; 52.9; -0.6) and ACS Wordlist learning (β\u0026thinsp;=\u0026thinsp;4.4, 95% CI 0.5; 8.3) when testing cognitive functioning in highly fatigued patients. They also discussed the improvements in other factors, such as fatigue, QoL, and depression.\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eCampbell et al.\u003c/em\u003e studied breast cancer patients who were placed in an exercise group (n\u0026thinsp;=\u0026thinsp;10) or a usual lifestyle control group (n\u0026thinsp;=\u0026thinsp;9). The exercise group participated in 24 weeks of 150 mins of moderate-to-vigorous aerobic exercise per week, with two 45-minute supervised sessions per week at the gym. Interestingly, this study concluded that there was no improvement in self-reported cognitive function and that the effect size was small.\u003csup\u003e19\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn another study by \u003cem\u003eHartman et al.\u003c/em\u003e, discussed obesity, physical activity, and sleep all affected cognitive functioning for cancer survivors. They observed 87 sedentary BCS. The 87 participants were randomized into an exercise arm (n\u0026thinsp;=\u0026thinsp;43) and a control arm (n\u0026thinsp;=\u0026thinsp;44). The exercise arm received a 12-week physical activity intervention. They conducted a memory and motion study for a 12-week physical activity intervention program and concluded that participants reported a decrease in their cognitive impairments (β\u0026thinsp;=\u0026thinsp;2.01; 95% CI\u0026thinsp;=\u0026thinsp;0.01, 4.01; p\u0026thinsp;=\u0026thinsp;0.049).\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eGokal et al\u003c/em\u003e. investigated whether12 weeks of moderate intensity walking mid-way through chemotherapy decreased the effects of CICI more than what was observed in the control (non-walking) group. They concluded that the intervention group showed improvements in cognitive function (F\u0026thinsp;=\u0026thinsp;3.90, p\u0026thinsp;=\u0026thinsp;0.05 np\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.075).\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the seven studies discussed underscore the significant relationship between physical activity and CICI in cancer patients and survivors. Notably, these interventions include various forms such as exercise programs, yoga, and walking routines. The collective evidence suggests that integrating physical activity into patient care plans may serve as a crucial element in managing and potentially alleviating CICI symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIII. Sleep\u003c/h2\u003e \u003cp\u003eSleep plays a crucial role in cognitive functioning, with both its quality and quantity influencing cognitive abilities. \u003csup\u003e26\u003c/sup\u003e. This review includes five studies that examined the effects of sleep on cognitive impairment.\u003csup\u003e23\u0026ndash;27\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003ePalmer et al.\u003c/em\u003e studied the effects of melatonin therapy in breast cancer patients in relation to cognition. \u003cem\u003ePalmer et al.\u003c/em\u003e studied the effects of melatonin therapy in breast cancer patients in relation to cognition. They stated that the use of melatonin may have a neuroprotective effect to counteract the adverse effects of chemotherapy on cognitive function, sleep quality, and depressive symptoms when comparing baseline to end of treatment in the intervention group (Intervention: x̄ = 39.10(\u0026plusmn;\u0026thinsp;9.64),p\u0026thinsp;=\u0026thinsp;0.002; Control: x̄ = 47.49(\u0026plusmn;\u0026thinsp;8.64), p\u0026thinsp;=\u0026thinsp;0.002).\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe study by \u003cem\u003eHansen et al.\u003c/em\u003e (2014) involved a randomized double-blind, placebo-controlled trial with 54 participants who underwent breast cancer surgery. Cognitive function was assessed using the Mini-Mental State Examination, a neuropsychological test battery, and the MDI visual analogue scale (VAS). Participants also maintained a sleep diary. The study concluded that cognitive dysfunction could not be established in the breast cancer patients, but it was suggested that this limitation might be attributed to sample size constraints.\u003csup\u003e24\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn the second included manuscript, \u003cem\u003eCaplette-Gingras et al.\u003c/em\u003e conducted an observational study to assess cognitive impairments in individuals with insomnia. The study included 67 participants diagnosed with Stage I-III breast cancer. Cognitive function was evaluated using 11 different neuropsychological tests, while sleep severity was measured using the Insomnia Severity Index. The researchers concluded that the insomnia group (n\u0026thinsp;=\u0026thinsp;47) exhibited greater objective and subjective cognitive impairments based on the results of the neuropsychological tests (p\u0026thinsp;=\u0026thinsp;0.049). Furthermore, the insomnia group reported sleep efficacy below 85% in their sleep diaries compared to the good sleepers group.\u003csup\u003e25\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe \u003cem\u003eAncoli-Israel et al.\u003c/em\u003e study compared 69 women with breast cancer and 64 matched-controls with no cancer. Data was collected at pre-chemotherapy, at the end of the fourth cycle of chemotherapy treatment, and one year after the start of treatment. The researchers assessed cognition, total sleep and nap time, circadian activity rhythms, and sleep quality. The findings indicated that lower sleep quality predicted worse subjective cognition. Specifically, women with breast cancer reported higher levels of cognitive impairment compared to their counterparts at cycle 4 (p\u0026thinsp;=\u0026thinsp;0.0054) and one year after treatment initiation (p\u0026thinsp;=\u0026thinsp;0.0222). This was measured with PAOF total scores (p\u0026thinsp;=\u0026thinsp;0.0052, standard error\u0026thinsp;=\u0026thinsp;0.0513 and adjusted β-value= -0.147), the PSQI score (p\u0026thinsp;=\u0026thinsp;0.0055, standard error\u0026thinsp;=\u0026thinsp;0.00746, adj β-value= -0.0212), and the naptime data (p\u0026thinsp;=\u0026thinsp;0.042, standard error\u0026thinsp;=\u0026thinsp;0.0285, adjusted β-value=-0.0586).\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eHenneghan et al.\u003c/em\u003e conducted a cross-section\u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003ea\u003c/span\u003el study examining the association between sleep disturbances, daytime sleepiness, and cognitive impairments in 90 breast cancer survivors. Participants were assessed using the FACT-Cog PCI, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) to measure cognitive function, sleep quality, and daytime sleepiness, respectively. The study evaluated participants who were 10 years post-chemotherapy. The researchers concluded that sleep disturbances and daytime sleepiness were linked to cognitive impairments in the studied breast cancer survivors (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). \u003csup\u003e27\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the reviewed studies illustrate the relationship between CICI and physical activity, demonstrating the significant influence of sleep quality and duration on cognitive abilities. Notably, \u003cem\u003eCaplette-Gingras et al.\u003c/em\u003e link insomnia severity to greater cognitive impairments, while \u003cem\u003eHenneghan et al.\u003c/em\u003e demonstrate the association between sleep disturbances, daytime sleepiness, and cognitive deficits in breast cancer survivors. Importantly, increased sleep duration has been associated with reduced complaints of CICI, emphasizing the need to address sleep disturbances to improve cognitive outcomes in cancer patients and survivors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eIV. Interventions\u003c/h2\u003e \u003cp\u003eInterventions involving cognitive behavioral therapy, use of drugs, and specific exercise regimens have been shown to affect positively both the body and the mind. These studies showed a positive correlation between cancer patients and survivors participating in these interventions and improvements in cognitive impairments present at baseline.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eA. A. Use of Herbal, Supplements, Specific Medication and Sound\u003c/h2\u003e \u003cp\u003e \u003cem\u003eLee et al.\u003c/em\u003e studied the effectiveness of Gamiguibi-tang (GGBT) on cognition between an intervention (n\u0026thinsp;=\u0026thinsp;15) and a control (n\u0026thinsp;=\u0026thinsp;15) group. They concluded that there was no improvement in MoCA scores (p\u0026thinsp;=\u0026thinsp;0.454) in the GBBT group compared to the control group.\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eBar-Sela et al.\u003c/em\u003e studied the effects of cannabis use on cognition in one group (n\u0026thinsp;=\u0026thinsp;17) compared to a control group without cannabis use (n\u0026thinsp;=\u0026thinsp;17) over a period of three months. They concluded that use of cannabis in patients helped with other cancer-related symptoms but had no effect on CICI. There were no statistically significant changes in MoCA scores between baseline and the end of the 3 months (p\u0026thinsp;=\u0026thinsp;0.9 and 0.7).\u003csup\u003e29\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eBarton et al.\u003c/em\u003e investigated the interventional use of Ginkgo biloba in 166 women who were receiving breast cancer treatment. Data indicated that Ginkgo biloba did not improve CICI complaints.\u003csup\u003e30\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eHuang et al.\u003c/em\u003e examined dietary intervention through supplement usage in BCS and concluded that a consumption of vegetables, fruits, and fish intake with the supplementation of vitamin B and E and a decrease in alcohol showed an improvement in cognitive capabilities\u003csup\u003e31\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTibetan sound meditation (TSM) was studied by \u003cem\u003eMilbury et al.\u003c/em\u003e in cancer patients with CICI. They concluded that the TSM group (n\u0026thinsp;=\u0026thinsp;23) showed improvements in the verbal memory test (p\u0026thinsp;=\u0026thinsp;0.06), the short-term memory and processing speed task (p\u0026thinsp;=\u0026thinsp;0.09), and cognitive function task (p\u0026thinsp;=\u0026thinsp;0.06) at the end of one month compared to the control group (n\u0026thinsp;=\u0026thinsp;24).\u003csup\u003e32\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eVega et al.\u003c/em\u003e explored the effects of nicotinic treatment (n\u0026thinsp;=\u0026thinsp;11) vs placebo group (n\u0026thinsp;=\u0026thinsp;11) for 6 weeks in cancer survivors that reported CICI. They reported there was no significant improvement in both groups.\u003c/p\u003e \u003cp\u003e \u003cem\u003eHartman et al\u003c/em\u003e, investigated the use of metformin intervention for 333 BCS with CICI complaints. The study concluded that use of metformin on obese cancer survivors did not provide any improvements in cognitive complaints, but did show a significant improvement in verbal functioning (p\u0026thinsp;=\u0026thinsp;0.009).\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eLawrence et al.\u003c/em\u003e used donepezil as an intervention in 32 BCS with reported CICI compared to control group (n\u0026thinsp;=\u0026thinsp;32). The intervention group performed slightly better on the Hopkins Verbal Learning Test-Revised (p\u0026thinsp;=\u0026thinsp;0.033) and the HVLT-R Discrimination (p\u0026thinsp;=\u0026thinsp;0.036) compared to the control group. Other cognitive domains did not show any improvement.\u003csup\u003e35\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the 9 studies showed the potential benefits of various interventions, including cognitive behavioral therapy, medications, supplements, and sound therapy, on cognitive impairments in cancer patients and survivors. While some interventions such as melatonin therapy and Tibetan sound meditation showed promising results in improving cognitive function, others like Gamiguibi-tang (GGBT) and cannabis use did not demonstrate significant effects. Additionally, interventions like Ginkgo biloba, dietary supplements, and nicotinic treatment yielded mixed findings regarding their impact on cognitive impairment. Further research with larger sample sizes is necessary to establish a more definitive correlation between these interventions and their impact on the severity of CICI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eB. Acupuncture\u003c/h2\u003e \u003cp\u003e \u003cem\u003eLyu et al.\u003c/em\u003e studied the use of electroacupuncture intervention for CICI in twelve cancer patients twice a week, for 30 mins each time, for 8 weeks. FACT-Cog scores were found to be at a baseline average of 81.17 points and had increased to 93.70 at 4 weeks (p\u0026thinsp;=\u0026thinsp;0.145), 90.04 at 8 weeks (p\u0026thinsp;=\u0026thinsp;0.326), and reached 101.14 at 12 weeks (p\u0026thinsp;=\u0026thinsp;0.058). The study concluded that the electroacupuncture intervention decreased CICI complaints in participants with an increase in FACT-COG of 81.17 to 101.14 after 12 weeks (p\u0026thinsp;=\u0026thinsp;0.058).\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eTong et al\u003c/em\u003e. also investigated the benefits of acupuncture therapy as an intervention for breast cancer patients. They reported that the patients had decreases in cognitive impairments (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The battery of tests used to determine cognitive impairment in this study was Hopkins Verbal Learning Test- Revised, Trail Making Test, Controlled Oral Word Association Test.\u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003eZeng et al.\u003c/em\u003e investigated the effects of acupuncture on CICI complaints in 6 gynecological cancer patients with 3 receiving the intervention and 3 serving as the control. They concluded that the use of acupuncture intervention was beneficial for cancer patients vs control groups for CICI complaints in attention and working memory (Intervention: x̄= 6.23 (\u0026plusmn;\u0026thinsp;2.71); Control: x̄=7.46 (\u0026plusmn;\u0026thinsp;1.99)), verbal memory (Intervention: x̄= 11.60 (\u0026plusmn;\u0026thinsp;4.76); Control: x̄=13.33 (\u0026plusmn;\u0026thinsp;3.65)), executive function (Intervention: x̄= 72.33 (\u0026plusmn;\u0026thinsp;36.07); Control: x̄=75.13 (\u0026plusmn;\u0026thinsp;29.55)), and language (Intervention: x̄= 31.08 (\u0026plusmn;\u0026thinsp;6.48); Control: x̄=32.93 (\u0026plusmn;8.89)). \u003csup\u003e38\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eZhang et al.\u003c/em\u003e explored the benefits of using electroacupuncture to stimulate the trigeminal nerve in addition to conventional body acupuncture in CICI breast cancer patients and reported no significant changes in MoCA score.\u003csup\u003e39\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the 4 studies illustrate the potential efficacy of acupuncture interventions in alleviating cognitive impairment in cancer patients and survivors. Electroacupuncture interventions led to a significant decrease in CICI complaints. Additionally, acupuncture therapy was associated with decreases in cognitive impairments in breast cancer patients and improvements in attention, working memory, verbal memory, executive function, and language in gynecological cancer patients. However, acupuncture stimulation of the trigeminal nerve did not yield significant changes in cognitive function. Further research is warranted to better understand the role of acupuncture in managing CICI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eC. EGG Feedback\u003c/h2\u003e \u003cp\u003e \u003cem\u003eAlvarez et al.\u003c/em\u003e conducted a 6-month study that involved monitoring the effects of electroencephalogram biofeedback on CICI in 23 female BCS. Baseline measurements revealed dysfunction in all cognitive domains using the FACT-Cog assessment; repeating measurements indicated strong improvement in all cognitive domains (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e40\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eGaynor et al.\u003c/em\u003e used transcranial direct current stimulation as an intervention in 16 BCS with CICI followed by two days of sham stimulation (vice versa). The study concluded that the use of this intervention may be an effective intervention compared to the control group, but that a larger sample size would need to be studied in future studies.\u003csup\u003e41\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the 2 studies illustrated that the use of EGG feedback can help decrease the severity of CICI in cancer patients and survivors. But there is need for more studies to be conducted to see the true effectiveness of EGG feedback on the severity of CICI in the cancer population.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eD. Cognitive Training Programs\u003c/h2\u003e \u003cp\u003e \u003cem\u003eBray et al.\u003c/em\u003e studied the effects of a web-based cognitive rehabilitation program in 242 cancer survivors that were randomly assigned to either the intervention (n\u0026thinsp;=\u0026thinsp;121) or the control groups (n\u0026thinsp;=\u0026thinsp;121). The study concluded that the FACT-Cog PCI significantly improved (-7.47; 95% CI, -10.80 to -4.13; P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e42\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eMayo et al.\u003c/em\u003e conducted an 8-week computerized cognitive training program with 19 hematological cancer survivors. The researchers reported that adherence to the program was a bit difficult and that they only had one participant complete the program.\u003csup\u003e43\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eFerguson et al. conducted a randomized trial involving 47 BCS to evaluate the effectiveness of videoconference-delivered cognitive behavioral therapy (CBT). The intervention group (n\u0026thinsp;=\u0026thinsp;27) received memory and attention adaptation training (MAAT) via videoconference. Results showed a decrease in complaints related to CICI (F (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;6.07; p\u0026thinsp;=\u0026thinsp;0.02) and an increase in neuropsychological processing speed (F (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;5.25; p\u0026thinsp;=\u0026thinsp;0.03) compared to the control group (n\u0026thinsp;=\u0026thinsp;20) receiving supportive treatment.\u003csup\u003e44\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003ePark et al.\u003c/em\u003e investigated the benefits of compensatory cognitive training intervention consisting of the Promoting Cognitive Health Program for 54 breast cancer patients. They reported that there were improved objective and subjective cognitive functioning performances. ( p\u0026thinsp;=\u0026thinsp;0.001) The study called for a future experiment that would utilize a larger sample size and a longer follow up period.\u003csup\u003e45\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eJohns et al.\u003c/em\u003e proposed the use of mindfulness-based stress reduction for their intervention group (n\u0026thinsp;=\u0026thinsp;35). For the control group, which included both colorectal and breast cancer patients, fatigue education and support (n\u0026thinsp;=\u0026thinsp;36) was implemented for patients with CICI. They reported that the intervention group had slight improvements in both the attention criteria (p\u0026thinsp;=\u0026thinsp;0.001) and the Stroop test (p\u0026thinsp;=\u0026thinsp;0.030).\u003csup\u003e46\u003c/sup\u003e They also suggested that future studies should consider utilizing a larger randomized trial size.\u003c/p\u003e \u003cp\u003eOverall, the 5 studies illustrated that the use of cognitive training programs did decrease the severity of CICI in the cancer population. The use of cognitive training programs is beneficial and should be considered for cancer patients or survivors who complain about CICI.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eE. Psychological programs\u003c/h2\u003e \u003cp\u003e \u003cem\u003eAsher et al.\u003c/em\u003e proposed using a multidimensional psychoeducation-based cognitive rehabilitation intervention program, consisting of six weeks of 2.5-hour sessions that were facilitated by neuropsychologists and cancer rehabilitation physicians. The focus was on collecting data from 20 cohorts (n\u0026thinsp;=\u0026thinsp;110).The study concluded that there were significant improvements in CICI from preintervention to 12 months postintervention for the FACT-Cog PCI ( x̄ =46.65 (\u0026plusmn;\u0026thinsp;16.55)), the FACT-Cog PCA (x̄ =16.36 (\u0026plusmn;\u0026thinsp;5.71)), and the FACT-Cog QOL (x̄ =10.83 (\u0026plusmn;\u0026thinsp;3.70)).\u003csup\u003e47\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eLiang et al.\u003c/em\u003e tested a psychoeducational intervention in 12 gynecologic cancer survivors and concluded that there was an improvement in CICI complaints using the FACT-Cog PCI (p\u0026thinsp;\u0026lt;\u0026thinsp;0.048) .\u003csup\u003e48\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eDing et al.\u003c/em\u003e used the managing cancer and living meaningfully (CALM) intervention program for an intervention group (n\u0026thinsp;=\u0026thinsp;36) vs control group (n\u0026thinsp;=\u0026thinsp;36) in breast cancer patients. They concluded that the CALM intervention lessened CICI complaints (p\u0026thinsp;=\u0026thinsp;0.000 respectively).\u003csup\u003e49\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eTack et al.\u003c/em\u003e studied the effects of Emotional Freedom Techniques (EMOTICON) in both an immediate treatment (ITG) group (n\u0026thinsp;=\u0026thinsp;43) and a wait-list control (WLC) group (n\u0026thinsp;=\u0026thinsp;50). It was concluded that CICI decreased in the ITG using the cognitive failures questionnaire (x̄=25.98, 95%CI (18.13, 33.83); p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared to wait-list control group (x̄ = 16.94, 95%CI (9.51,24.37); p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003csup\u003e50\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003eLi et al.\u003c/em\u003e investigated the use of multisensory stimulation training intervention on CICI in breast cancer patients during four intervention cycles. It was concluded that multisensory stimulation training provided improvements (x̄ =22.45(\u0026plusmn;\u0026thinsp;1.6), p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) compared to audiovisual training (x̄=19.00(\u0026plusmn;\u0026thinsp;2.148), p\u0026thinsp;=\u0026thinsp;0.05).\u003csup\u003e51\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOverall, the 5 studies that illustrated the use of psychological programs did decrease the severity of CICI in cancer population. Additionally, multisensory stimulation training intervention provided substantial improvements in cognitive impairment, suggesting its potential as a valuable psychological intervention for enhancing cognitive functioning in cancer survivors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study conducted a systematic review to evaluate the effects of various modifiable factors on CICI. A total of 46 relevant studies were included in the review. The studies showed that modifiable factors, including psychological, physical, and sleep related factors, improved with various interventions, which subsequently reduced the burden of CICI on the patients\u0026rsquo; cognitive functioning and QoL.\u003c/p\u003e \u003cp\u003eStudies included in this review concluded that managing anxiety, depression, fatigue, and other psychological aspects reported by cancer patients and survivors could decrease the severity of cognitive impairment in these patients. This indicates that greater support may be needed by cancer patients and survivors than is currently acknowledged. Sleep was another important factor that contributed to how efficiently the body and the mind completed daily tasks. Overall, there were a limited number of published papers that fit the inclusion criteria the authors had established. Also, there were not as many published studies about sleep compared to the other factors discussed. Clinicians and researchers should consider conducting more studies with either a larger sample size or a longer duration. The studies included in the systematic review used a variety of interventions, ranging from simple support programs, either in person or virtually, to a wide variety of treatments and medications. Studies suggest that clinicians should consider implementing cognitive behavioral therapy, physician activity regimens, and the use of medication or supplements in cancer patients and survivors as an addition to the patients\u0026rsquo; treatment plans. Furthermore, it would be interesting to see longitudinal studies, looking at all the factors discussed in this paper, with a larger population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe primary objective of this systematic review was to establish the presence of cognitive impairment in patients undergoing or having undergone any type of cancer treatment and to evaluate the efficacy of specific interventions, including those related to sleep, physical activity, and others, in ameliorating cancer-related cognitive impairment (CICI). In addition, the healthcare field must discover methods to diagnose CICI at earlier stages, incorporate earlier interventions to decrease the severity and impact of CICI in patients' daily lives, and improve the standard of care. The authors urge more focus on this aspect of chemotherapy treatment and post treatment due to the increased prevalence of cancer survivors in the American population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eChemotherapy induced cognitive impairment ( CICI), Breast Cancer Survivors (BCS), Quality of Life ( QoL), Risk of Basis (RoB2), Rey Auditory Verbal Learning Test (AVLT), Squire Subjective Memory Questionnaire Scale (SSMQ), Mini-Mental State Examination (MMSE), Color Trails Test (CTT), Verbal Fluency Test (VTT), Index of Well-being (IWB), Center for Epidemiologic Studies Depression (CES-D), psychotic depressed (PD) group, nonpsychotic depressed (NPD) group, \u0026nbsp;MD Anderson Symptom Inventory for Multiple Myeloma (MDASI-MM), MD Anderson Symptom Inventory (MDASI), Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), the Visual Analogue Scale (VAS), \u0026nbsp;Patient\u0026rsquo;s Assessment of Own Functioning Inventory (PAOF)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and Consent to participate\u003c/strong\u003e- This paper is a systematic review and did not require any ethic approval and consent to participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e- All authors consent for this paper to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e \u0026ndash; Because there was no meta-analysis conducted, there is no data sets used of created. All articles included in this review can be access through PubMed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e- There are not competing interests for the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding-\u003c/strong\u003e There was no funding for this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contributions \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPS proposed and defined the definition of \u003cem\u003echemobrai\u003c/em\u003en, definition of modifiable factors and chose a variety of modifiable factors focused on in this systematic review. SPS, and HKS conducted the scoping review, defining the inclusion/exclusion criteria. SPS and HKS uploaded PubMed searches to RAYYANN. SPS and HKS, removed articles based on title and abstract that did not match the inclusion/exclusion criteria. SPS and HKS read the full articles and removed those articles that did not match the inclusion and exclusion criteria. NM and AK conducted a blinded risk basis assessment and then compared their results. For conflicts on risk basis assessment, SPS was the tiebreaker. SPS wrote the abstract, background, objective, methods, result, discussion and conclusion. SPS and NM editting the paper together.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany thanks to Dr. Bijan Najafi, Ph.D., MSc. , Dr. Javad Razjouyan Ph.D., MSc, and Interdisciplinary Consortium on Advance Motion Performance (iCAMP) Lab at Baylor College of Medicine for allowing Saba Parastu Sharafkhaneh to continue this project to William Carey University College of Osteopathic Medicine.\u003c/p\u003e\n\u003cp\u003eMany thanks to Dr. Danielle Fastring Ph.D, MPH\u0026nbsp; for providing mentorship during this project and allowing Saba Parastu Sharafkhaneh to be the principal investigator for the systematic review.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGaman AM, Uzoni A, Popa-Wagner A, Andrei A, Petcu EB. The Role of Oxidative Stress in Etiopathogenesis of Chemotherapy Induced Cognitive Impairment (CICI)-Chemobrain. 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Number 1 / Febr 2022. 2022;26(1):71\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Chemotherapy Induced Cognitive Impairment, Chemobrain, Cancer, Treatment, Modifiable Factors, Psychological Factors, Sleep, Physical Activity, Interventions","lastPublishedDoi":"10.21203/rs.3.rs-4227713/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4227713/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs the prevalence of cancer survivors increases, there have been increased reports of chemotherapy-induced cognitive impairment (CICI). Around 75% of cancer patients experience CICI during or after treatment. From the reported group, up to 35% will have persistent CICI for months to years following their treatments. In this review, the authors focused on modifiable factors (MFs) as variables that can be manipulated to change the impact of CICI on the patient's life. The MFs focused upon psychological factors, sleep, physical activity, and intervention programs. The authors aimed to establish that when certain interventions that address these MFs are added to treatment plans, it may help to decrease the impact of CICI.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch Methods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors used the PubMed database to identify articles to be potentially included in the review. A scoping review was conducted to narrow down the topics in relation to CICI. From here, the authors identified a set of factors deemed MFs. Using the inclusion and exclusion criteria, the authors started with 17,242 papers and narrowed down the review to 46 papers. The RoB2 tool from Cochrane Methods Bias was used to conduct risk basis assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe systematic review established that psychological factors, physical activity, and sleep quality/quantity affect the presence and severity of CICI. Furthermore, interventional programs and exercise can help decrease the effects of CICI. Meta-analysis was not conducted due to varying factors (cancer type, treatment type, and assessments conducted) across included studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCancer patients and survivors reported more severe CICI when depression, anxiety, fatigue, PTSD, decreased sleep quality and quantity were present. The severity of CICI significantly diminished with the use of physical activity programs, psychological programs, and cognitive training programs; however, the use of herbs, supplements, prescribed medication, Tibetan sound meditation, and EGG feedback showed little to no improvement in CICI. The findings suggest that when CICI is diagnosed at earlier stages, and supplementary interventions (medications, exercise programs cognitive behavioral therapy) are incorporated into treatment plans, the impact and severity of CICI can be decreased. This study urges more focus be placed on this aspect of chemotherapy treatment due to the increased prevalence of cancer survivors in the population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003eThere was no funding provided for this systematic review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration: \u003c/strong\u003eThe study protocol was registered on PROSPERO on Aug 18,2022 (CRD42022349831).\u003c/p\u003e","manuscriptTitle":"A Systematic Review Focused On Understanding the Effects of Modifiable Factors in Patients who Suffer from Chemotherapy Induced Cognitive Impairments or “Chemobrain”","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-02 20:39:58","doi":"10.21203/rs.3.rs-4227713/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3d2d298-52a4-49c3-b112-d618dd3d3178","owner":[],"postedDate":"May 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-11-12T03:19:10+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-02 20:39:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4227713","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4227713","identity":"rs-4227713","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}