Jamie Myers, PhD, RN, AOCNS, FAAN, University of Kansas, Kansas City, discusses the feasibility of using a mobile digital application, MindCap, to assess the cognitive function of cancer survivors.

These data were first presented at the annual Oncology Nursing Society (ONS) Congress.

Transcript:

Hi, I am Dr Jamie Myers. I am a nurse scientist and a research associate professor at the University of Kansas School of Nursing in Kansas City. And I'd like to share with you some results from a study that we did that was entitled, investigation of a Mobile Digital Application, which is called MindCap, to objectively Assess Cognitive Function for Cancer Survivors. The reason why we were interested in doing this study, as many of you I'm sure are aware, is cancer- and cancer treatment-related cognitive impairment is extremely prevalent for the survivors that we care for. In fact, up to 75% will experience some cognitive changes at some point during their cancer journey. And also unfortunately, about 30% of people will have persistent issues that can actually last several years. So we're pretty passionate about doing something positive to know how best to assess this for people and also what we can do to mitigate it. 

One of our challenges is how to assess it because the standard neurocognitive tests aren't always as sensitive to the mild forms of cognitive impairment that these patients experience. And we're particularly interested in the cognitive domains that are most commonly affected by cancer and cancer treatment, such as short-term memory, attention and concentration, something called executive function, which is being able to get all the way through the steps to execute a task without becoming distracted or having other issues with focus, and then processing speed is probably the other biggest cognitive domain. 

We were part of a small working group that was sponsored by the National Cancer Institute and were listening to speakers that had done a small business innovation research project that was funded by the NCI to look at forming a digital application to assess these types of cognitive function for cancer survivors. They put together a digital adaptation of some of the more standard neurocognitive tests that we have, which they refer to as MindCap in general, but Nova Scan for looking at continuous memory, also, they refer to that as the numbers test. And looking at something called logical reasoning, which they refer to as the symbols test for short, and then what we would traditionally call trail making test A and B. They put all of these together into a digital app, which we wanted to test, and we were actually conducting a parent study that was funded by the Oncology Nursing Foundation for individuals with stage 1 through 3 solid tumors or non-central nervous system, Hodgkin or non-Hodgkin lymphoma. And we decided to do a sub-study to incorporate the use of this digital app for objective cognitive assessment as a part of the research that we were already conducting. 

What this is like for the participant is they, we instruct them on how to download MindCap on their phone or we lent them a study tablet if they needed one. They then go through a practice phase where they learn how to do these tests with being able to get through them twice without errors that they're considered to have been trained. The bigger ask is then we ask them to do these tests, which take about 15 minutes, 3 times a day for the period of time that the app takes to determine what their normal is. They're kind of establishing their baseline and then that prevents a practice effect later that can skew the research results. Once that's done and they get the green light, then they shift into what's called the monitoring phase. And for that, while they're in the parent study, we asked them to do the mind cap testing 3 times a week, and they're asked to do it at the same time each day at a time when they're not going to be interrupted. 

I should share that the parent study was looking at a cognitive rehabilitation intervention, which is called Emerging from the Haze, and it was developed by a colleague of mine at Cedars-Sinai Medical Center, Dr Arash Asher. And it provides patients with a toolbox of strategies that they can experience during participation in the program to see what works best for them to improve their cognitive function. 

Cutting down to the chase for the results, we had really good uptake by the participants. We had 93 people in the parent study, and our goal was to enroll 60 of them in the sub-study to look at MindCap. We enrolled 57, so we were pretty happy with that. 87% got through the practice phase, 63% got through the normal phase or finding their baseline. And then we had about 54% who got through all of the monitoring phases with enough frequency that they could be included in the analyses. 

By and large, the mean age was around 50. They had about 16 years of education. They were on an average about 21 months out from having finished chemotherapy. Primarily they were females with breast cancer, but we were excited that we also had folks that had colorectal or had a neck or lung, GYN or lymphoma. We were largely Caucasian, but we did have 8% Hispanic or lith. So we were excited about that.

And what we were able to demonstrate for the results in terms of feasibility was that indeed, this test appears to be feasible to do in conjunction with a clinical trial to assess cognitive function. What we expected to see was a median time of less than 5 days to get through the practice phase, and that was achieved. Our median time to that was 3 days. We expected a median time of less than 14 days to find their normal or their baseline, and that actually came in at a meeting of 9 days. And then for the ask for people doing it 3 times a week, the median time for that was just under 3 days a week. It came in at 2.47, so that was excellent. 

Now, we also gathered some qualitative data from people. What did they like best? What did they like least? What would they suggest we change? Well, we found out that they really either loved it or hated it, and the folks who loved it really made comments like they felt it was improving their cognitive ability. It was raising their awareness of their challenges, felt like it was exercising their brain. What people liked the least was the length of time that it took to do particularly the first couple of tests that were part of the Nova Scan and being frustrated that they were being asked to do it at the same time each day, in terms of a pretty narrow window.

Some of our study aims was whether or not the MindCap scores, which would be objective testing, correlated with people's self-report of cognitive function. And we used the PROMISE instruments for that, and indeed we did see correlation between the two. The Spearman's correlations were between 0.46 and 0.53. What we also wanted to see was could we have sensitivity to those domain specific improvements in cognitive function? And indeed, we saw individual level improvements across all the cognitive domains between baseline and week 10, which was the period for which we were assessing them. The biggest improvement seemed to be for verbal ability, visual spatial ability, memory, and processing speed. And at the group level, we did see significant improvement in the self-report of cognitive function. 

What we didn't see, which we were disappointed about, was an intervention effect from the cognitive rehabilitation intervention that we did between groups. We had to combine the two intervention groups so that the sample size was the same as the control group, and we didn't see a between group analysis for either the self-report or the performance on MindCap, but we were really curious about that, and we decided to drill down a little bit because we noticed we had the intervention group and we had folks that were wait list control, meaning they were providing data to us before the experience, the cognitive rehabilitation intervention, everybody in the wait list control group finished the practice phase. Only 5 of the wait list group participants withdrew during the monitoring phase. And actually the mean number of MindCap sessions was significantly higher for those that were in the control group. 

We began to kind of wonder were we seeing a dose effect of the cognitive testing on cognitive function? We did some linear modeling results after the fact to look at whether or not there was a dose effect. And indeed, we did see a significant improvement based on the number of MindCap sessions that people had for both the self-report and for almost all of the cognitive domains. So we drilled down a little bit further and we pooled all of the cognitive domains into one variable, and then we controlled for age and education level, and we still saw a dose effect. 

So long story short, we were limited by our sample size. We had 57 patients. We were largely female Caucasians with breast cancer. We didn't do a head-to-head comparison between the mind cap tests and standard neurocognitive testing, and we lacked racial and ethnic diversity. We felt like we did indeed see feasibility demonstrated for using this app in conjunction with a clinical trial. It was sensitive to improvement in cognitive function. The reason why we even investigated whether there was a potential for a dose effect is the characteristics of doing the MindCap testing, it's really similar to another type of intervention that's under investigation for cancer related cognitive impairment. And that would be computerized cognitive testing in that you're exposing someone to novel stimuli, you're giving them a repetitive exercise or execution of structured tests that are domain specific to these cognitive function challenges. The only difference being computerized, cognitive testing gets progressively more difficult based on what the person's performance level is. 

Going forward, we think we need to continue to do research in this area. It's obviously still a big need for the patients for whom we care and we need better ways to assess it. We need better ways to mitigate it with intervention. We also will want to look carefully about the next study investigating with a larger sample size, that dose effect that I mentioned.

Source:

Myers J, Ramakrishnan S, Scott Holt L, and Asher A. Investigation of a mobile digital application (MindCap) to objectively assess cognitive function for cancer survivors. Presented at the ONS Congress. April 10-13, 2025; Denver, CO.