Abstract
Background
Interventions for cancer-related cognitive impairments have been increasingly investigated in recent years. Still, few cancer survivors have access to these interventions. Digital and other remote formats are examples of alternatives to traditional face-to-face delivery of interventions that may facilitate access. However, there is limited knowledge about cancer survivors’ attitudes toward these. In this study study we aimed explore cancer survivors’ perspectives regarding the delivery formats of interventions targeting cognitive impairments.
Methods
A cross-sectional survey was conducted with 724 participants recruited digitally through social media platforms and e-mail outreach via Norwegian cancer societies and healthcare organizations. Descriptive statistical analyses were performed to summarize the data. Ordinal regression analyses were used to assess the relationship between background characteristics and outcomes.
Results
The strongest expressed interest was written self-management interventions (70.8%), followed by face-to-face courses (52.5%), oral self-management interventions (50.2%), e-mail communication with healthcare professionals (45.2%), and digital courses (39.0%). The most frequently reported needs included having relatives and friends receive information (25.9%), talking to other cancer survivors (24.6%), and receiving support from relatives and friends (24.6%). Additional needs included adapted tasks at work or school (23.3%), and support from employers or teachers (19.0%). Notably, 27.6% of the participants reported frequent need for cognitive enhancement interventions several months after completing cancer treatment. Characteristics related to age, gender, education, cancer diagnosis, and received treatment were associated with various perceived needs for interventions, delivery formats, social needs, and timing for interventions.
Conclusions
The study underlines a clear need for acceptable and accessible interventions targeting cancer-related cognitive impairments. The strong preference for written self-management interventions and asynchronous formats, such as e-mail communication with healthcare professionals, highlights the potential for scalable approaches that merit further exploration. Involving the social network of cancer survivors may strengthen their coping capacity and improve outcomes of cognitive challenges. Importantly, the optimal timing for cognitive enhancement interventions, appears to be after the completion of cancer treatment when survivors are transitioning to everyday life and are more likely to become aware of cognitive challenges. Tailoring interventions according to demographic and clinical background might be relevant as there are differences in perspectives and needs regarding interventions targeting cognitive impairments.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-025-13981-2.
Keywords: Cancer survivors, Self-management, Cognitive remediation, Cancer-related cognitive impairment, Survey
Background
Cognitive impairments among cancer survivors have been documented for over three decades [1, 2], affecting up to 75% of survivors’ [3]. These impairments typically involve difficulties with attention, memory, and executive functioning. In daily life, such challenges may manifest difficulties with reading, maintaining focus on tasks, recalling words, details from conversations, and keeping track of appointments [4, 5]. Cognitive impairments are associated with reduced occupational and social functioning [6–8], increased symptoms of depression and anxiety [9, 10], and emotional distress, including feelings of embarrassment, frustration, and sadness [11]. Addressing cancer-related cognitive impairments is therefore of importance.
Several studies have demonstrated the efficacy of interventions targeting cancer related cognitive impairments that involved psychoeducation, cognitive training, and compensatory strategies [12]. Nevertheless, such interventions are rarely offered to cancer survivors [4, 13, 14]. This gap has been highlighted in an expert statement calling for research to identify barriers and facilitators to the implementation of cognitive enhancement interventions in survivorship care [15]. One key barrier involves challenges in service delivery, particularly the limited availability of healthcare professional resources to administer these interventions [16]. Additionally, reliance on time-consuming neuropsychological assessments and face-to-face interventions may hinder scalability and accessibility. These limitations underscore the need for innovative service delivery models that reduce dependence on healthcare personnel and improve access to support for cancer survivors experiencing cognitive impairments.
In the field of mental health, interventions delivered digitally have demonstrated efficacy comparable to those delivered face-to-face, while also enabling healthcare professionals to reach a larger number of patients [17]. Research further supports the effect of remote therapist guidance delivered via digital messaging, video, or telephone [18]. Interventions delivered as self-management represent another method for providing healthcare with minimal healthcare professional involvement [19]. These interventions typically involve educational components aimed at enhancing individuals’ skills to monitor symptoms and solving health related challenges [20]. Several interventions delivered as self-management have been shown to improve quality of life among cancer survivors [21]. Moreover, these self-management interventions have successfully been incorporated into stepped care models, where patients first receive low-intensity interventions before progressing to more resource-intensive treatments if needed [22].
Involving the social network of cancer survivors might also be a promising approach. Cancer survivors have identified support from peers, relatives, and employers as valuable in managing cognitive impairments [23, 24]. Conversely, a lack of acknowledgement from their social network has been shown to increase distress [7, 25]. However, cancer survivors report that their social networks often have limited knowledge about cognitive impairments and therefore do not provide adequate support [7]. Enhancing awareness through targeted education may improve both the knowledge and emotional support provided by their social network. Indeed, interventions involving education and skill training for carers of individuals with breast cancer have been shown to improve quality of life and family relationships [26].
An important consideration in the implementation of cognitive enhancement interventions is timing. For many cancer survivors, cognitive impairments persist long after the cancer treatment has ended, with some individuals reporting symptoms even 20 years post-treatment [27]. However, others experience gradual improvement over time [28]. Several studies have investigated the effects of cognitive enhancement interventions administered six to twelve months after the cancer treatment [29–31]. Introducing interventions during this later phase may help avoid unnecessary and costly interventions for those who recover spontaneously. In contrast, other studies have focused on early interventions, aiming to support cancer survivors in regaining functioning and resuming daily activities more rapidly [32]. Currently, there is no consensus on the optimal timing in the cancer survivorship trajectory for receiving cognitive enhancement interventions.
Overall, the burden of cancer related cognitive impairments is high and several formats for delivering interventions show promise. However, there is limited knowledge regarding cancer survivors’ attitudes towards these various approaches.
The aim of this study was to explore cancer survivors’ perspectives regarding the delivery formats of interventions targeting cognitive impairments. Spesifically, the study adressed the following research questions:
What are cancer survivors’ attitudes toward different delivery formats of interventions targeting cognitive impairments?
What type of support does cancer survivors need from their social network in managing cognitive impairments?
When in the survivorship trajectory do cancer survivors perceive a need for cognitive enhancement interventions?
Methods
Study design
This study employed a quantitative approach using a cross-sectional survey design.
Setting and procedures
Participants were self-recruited digitally across Norway through social media and e-mails from Norwegian cancer patient societies and healthcare organizations. Recruitment took place between October 16th and November 7th, 2023. Inclusion criteria for participation were: (a) aged 18 years or more, and (b) having received treatment for cancer.
Variables
The survey (Supplementary file 1) was developed specifically for this study in collaboration with researchers, clinical psychologists, cancer nurses, and political scientists, in addition to users from the Norwegian Cancer Society.
Demographic and clinical variables included age, gender, civil status, educational level, and occupational status, cancer diagnosis, and cancer treatments.
Cognitive impairments were measured using the statement “The cancer disease or treatment has had a negative impact on my…” followed by three items: (1) ability to concentrate; (2) ability to remember the names of other people; (3) ability to perform multiple tasks. In addition, negative impact of cognitive impairments was measured using the same statement followed by (1) work/school; (2) mental health. Participant responded to these statements using a six-point scale: Don’t know; Never; Rarely; Sometimes; Often; Very often.
Attitudes towards service delivery formats were measured using the statement: “To cope with cognitive impairments after cancer and cancer treatment, I am interested in…”, followed by eight items: (1) written self-management interventions; (2) oral self-management interventions; (3) courses with psychical attendance; (4) digital courses; (5) e-mail communication with healthcare professionals; (6) video communication with healthcare professionals; (7) telephone calls from healthcare professionals; (8) chatting with healthcare professionals. Participant responded to these using a six-point scale: Don’t know; Strongly disagree; Disagree; Neither agree nor disagree; Agree; Strongly agree.
Needs related to social support in managing cognitive impairments were assessed using the statement: “To cope with cognitive impairments after cancer and cancer treatment, I have needed…”, followed by five items: (1) To talk with others experiencing cognitive impairments; (2) relatives/friends receiving information; (3) support from relatives/friends; (4) support from employer or teacher; (5) adapted work or school tasks. Participant responded to these statements using a six-point scale: Don’t know; Never; Rarely; Sometimes; Often; Very often.
Perceived needs regarding timing of interventions were assessed using the statement: “I have needed interventions for cognitive impairment…”, followed by four time points: (1) before cancer treatment; (2) during cancer treatment; (3) immediately after cancer treatment; or (4) six to twelve months after cancer treatment. Participant responded to these statements using a six-point scale: Don’t know; Never; Rarely; Sometimes; Often; Very often.
Analyses
Statistical analyses were performed in SPSS version 30. Descriptive statistics were conducted to calculate the frequency of participants’ responses. Ordinal regression analyses were used to investigate the relationship between the participants’ characteristics and outcomes. The following participant characteristics were included in the model: age, gender, education, cancer diagnosis, and cancer treatment as described in Table 1. Separate analyses were conducted for each item in the outcome variables, in addition to analyses for cognitive impairments, negative impact, and need for interventions. To perform the ordinal regression analyses, responses marked as ‘I don’t know’ were excluded. Statistical significance was determined at a p-value of 0.05. The Nagelkerke R² was used as to assess the explained variance of the models.
Table 1.
Demographic and clinical characteristics of the participants
| Variables | All participants (N = 724) |
|---|---|
| Age | |
| 18–29 years | 21 (2.9%) |
| 30–39 years | 64 (8.8%) |
| 40–49 years | 174 (24.0%) |
| 50–59 years | 234 (32.3%) |
| > 60 years | 231 (31.9%) |
| Gender | |
| Female | 649 (89.6%) |
| Male | 75 (10.4%) |
| Education | |
| Higher education | 443 (61.3%) |
| No higher education | 280 (38.7%) |
| Employment | |
| Employed | 303 (42.0%) |
| Not employed | 419 (58.0%) |
| Cancer type | |
| Breast | 367 (49.3%) |
| Gynecological | 144 (19.9%) |
| Stomach/bowl | 66 (9.1%) |
| Lymphoma | 43 (5.9%) |
| Leukemia | 32 (4.4%) |
| Prostate | 26 (3.6%) |
| Lung | 16 (2.2%) |
| Skin | 16 (2.2%) |
| Brain | 9 (1.2%) |
| Other | 145 (20.0%) |
| Treatment | |
| Chemotherapy | 571 (80.4%) |
| Surgery | 548 (77.2%) |
| Radiation | 455 (64.1%) |
| Hormone therapy | 242 (34.1%) |
| Immunotherapy | 46 (6.5%) |
| Other | 99 (13.9%) |
Ethics
The study was approved by the Regional Committee for Medical Research Ethics of Western Norway (619504) and procedures complied with the data protection regulations at Haukeland University Hospital. Informed consent was provided from all participants before they responded to the survey. The study was conducted in accordance with the Helsinki Declaration of Ethical Research.
Results
A total of 724 individuals consented to participate in the survey, of whom 84% responded to all survey items. Participant characteristics are presented in Table 1 and reported cognitive impairments are presented in Table 2.
Table 2.
Overview of reported cognitive impairments
| The cancer disease or treatment has had a negative impact on my… | Don’t know | Never | Rarely | Sometimes | Often | Very often |
|---|---|---|---|---|---|---|
| Ability to concentrate |
4 (0.6%) |
15 (2.2%) |
28 (4.2%) |
145 (21.5%) |
217 (32.2%) |
265 (39.3%) |
| Ability to remember the names of other people |
6 (0.9%) |
21 (3.1%) |
69 (10.3%) |
163 (24.4%) |
203 (30.4%) |
205 (30.7%) |
| Ability to perform multiple tasks |
10 (1.5%) |
25 (3.7%) |
64 (9.6%) |
171 (25.6%) |
212 (31.8%) |
185 (27.7%) |
| Functioning at work/ school |
124 (19.0%) |
30 (4.6%) |
33 (5.1%) |
115 (17.7%) |
111 (17.1%) |
238 (36.6%) |
| Mental health |
8 (1.2%) |
40 (6.1%) |
81 (12.4%) |
196 (30.1%) |
166 (25.5%) |
160 (24.6%) |
Note. Number of participants responses to each item ranged from n = 651–674
Ordinal regression analysis showed that higher age (p < .001), being male (p = .017), and having higher education (p = .035) were associated with less frequent difficulties with concentration. More frequent problems remembering names were related to being diagnosed with lymphoma (p = .024), while less problems were related to higher education (p = .018). Higher age (p.<0.001) and higher education (p = .014) were associated with fewer problems performing multiple tasks, while being diagnosed with stomach/bowl cancer was related to more frequent problems (p = .026). None of the other background variables were related to outcomes. Explained variance in the model that included background variables and ability to concentrate was R² = 0.125, the explained variance in the model involving ability to remember other people’s names was R² = 0.039, and R² = 0.093 for ability to perform multiple tasks.
More frequently experiencing negative impact on work and school performance were related to being female (p = .008), or diagnosed with lymphoma (p = .013), or stomach/bowl cancer (p = .002), while a negative association were found for higher age (p < .001). Frequently experiencing that cognitive impairment had a negative impact on mental health was related to being female (p = .016), while there were a negative association with higher age (p < .014), and higher education (p < .001). Explained variance for the model including background variables and negative impact on work and school performance was R² = 153, and R² = 0.132 for negative impact on mental health.
Need for interventions
In the sample, 127 participants (23.1%) reported to never having needed interventions targeting cognitive impairments, whereas 113 (20.5%) and 155 (28.2%) of the participants reported often or very often having needed such interventions. Ordinal regression analysis showed that a more frequent need for interventions was related to being female (p = .048), whereas a less frequent need was associated to higher age (p < .001). None of the other background variables were related to outcomes. The explained variance of the model testing the relationship between background variables and need for interventions was R² = 0.088.
Attitudes towards various delivery formats of interventions targeting cognitive impairments
The delivery format most participants reported interest in, indicated by responses of “Strongly agree”, was written self-management interventions, followed by face-to-face courses, oral self-management interventions, e-mail communication with healthcare professionals, and digital courses. The delivery format most participants “Strongly disagreed” being interested in were chatting with healthcare professionals and phone calls from healthcare professionals. Participants’ responses to the various service delivery formats are presented in Table 3.
Table 3.
Participants’ attitude towards delivery formats for interventions targeting cancer-related cognitive impairments
| To cope with cognitive impairments after cancer and cancer treatment, I am interested in receiving… | Don’t know | Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly agree |
|---|---|---|---|---|---|---|
| Written self-management interventions |
6 (1.0%) |
24 (3.9%) |
21 (3.4%) |
30 (4.9%) |
98 (16.0%) |
435 (70.8%) |
| Face-to-face courses |
29 (4.7%) |
51 (8.3%) |
29 (4.7%) |
60 (9.8%) |
121 (19.8%) |
321 (52.5%) |
| Oral self-management interventions |
17 (2.8%) |
51 (8.3%) |
39 (6.4%) |
56 (9.2%) |
142 (23.2%) |
307 (50.2%) |
| E-mail communication with healthcare professionals |
26 (4.3%) |
52 (8.5%) |
48 (7.9%) |
78 (12.8%) |
130 (21.3%) |
276 (45.2%) |
| Digital courses |
34 (5.6%) |
69 (11.3%) |
50 (8.2%) |
80 (13.1%) |
140 (22.9%) |
238 (39.0%) |
| Video communication with healthcare professionals |
44 (7.2%) |
68 (11.1%) |
55 (9.0%) |
95 (15.6%) |
128 (21.0%) |
220 (36.1%) |
| Phone calls from healthcare professionals |
41 (6.7%) |
92 (15.1%) |
69 (11.3%) |
106 (17.4%) |
118 (19.3%) |
184 (30.2%) |
| Chatting with healthcare professionals |
48 (7.9%) |
97 (15.9%) |
74 (12.2%) |
106 (17.4%) |
129 (21.2%) |
155 (25.5%) |
Note. Number of participants responses to each item ranged from n = 609–614
Relationship between participant characteristics and delivery formats
An ordinal regression analysis examined the association between attitudes toward written self-help interventions and participant characteristics. Results indicated that lower interest in these formats was associated with older age (p = .006), diagnosis of lymphoma (p = .012), and brain tumour (p = .044). The explained variance of the model testing the relationship between background variables and attitudes towards self-management interventions was R² = 0.060. Interest in face-to-face courses was associated with being female (p = .023) and having received hormone treatment (p = .010), whereas breast cancer diagnosis was related to lower interest (p = .032). The explained variance of the model was R² = 0.040. Analysis showed that lower interest in oral self-management interventions was associated with a diagnosis of breast cancer (p = .002), stomach/bowel cancer (p = .011), and leukaemia (p = .026), whereas higher interest was associated with received hormone treatments (p = .042). The model testing the relationship between interest in oral self-management interventions and background variables had an explained variance of R² = 0.063. Lower interest in digital interventions was related to increased age (p = .004) and being diagnosed with lymphoma (p = .046). Explained variance in the model was R² = 0.058. Interest for e-mail communication was related to being female (p < .001), while less interest was associated with being diagnosed with breast cancer (p = .005). The explained variance in the model testing the relationship between interest in e-mail communication and background variables was R² = 0.074. Lower interest for video conference communication was associated with higher age (p < .001). Explained variance in model was R² = 0.066. Interest in telephone communication was associated with having received hormone therapy (p = .004), while less interest was related to higher age (p = .018). The model testing the relationship between interest in telephone communication and background variables had an explained variance of R² = 0.063. There was found an association between interest in chatting with healthcare professionals and being female (p = .017), while there was a negative relationship with higher age (p < .001) and having received radiation therapy (p = .033). The explained variance in model testing the relationship between interest in chatting with healthcare professionals and background variables was R² = 0.080. None of the other background variables were related to outcomes.
Needs from social network in managing cognitive impairments
Participants’ needs related to social support from their network are presented in Table 4. The most frequently endorsed needs, indicated by responses of “Very often” were relatives and friends receiving information, talking to other cancer survivors experiencing cognitive impairments, and receiving support from relatives and friends, followed by adapted work or school tasks, and support from employer or teacher. The need that received the highest number of “Strongly disagree” responses were adapted tasks at work or school, followed by support from employer or teacher. These two needs also had the highest frequency of “Don’t know” responses.
Table 4.
Participants’ needs from their social network
| To cope with cognitive impairments after cancer and cancer treatment, I have needed… | Don’t know | Never | Rarely | Sometimes | Often | Very often |
|---|---|---|---|---|---|---|
| Relatives/friends receiving information |
32 (5.1%) |
85 (13.6%) |
60 (9.6%) |
145 (23.2%) |
142 (22.7%) |
162 (25.9%) |
| To talk with others experiencing cognitive impairments |
36 (5.8%) |
82 (13.1%) |
55 (8.8%) |
140 (22.4%) |
159 (25.4%) |
154 (24.6%) |
| Support from relatives/friends |
28 (4.5%) |
78 (12.5%) |
55 (8.8%) |
151 (24.1%) |
158 (25.2%) |
156 (24.9%) |
| Adapted work/ school tasks |
137 (21.9%) |
120 (19.2%) |
38 (6.1%) |
86 (13.7%) |
99 (15.8%) |
146 (23.3%) |
| Support from employer/teacher |
139 (22.2%) |
112 (17.9%) |
35 (5.6%) |
101 (16.1%) |
120 (19.2%) |
119 (19.0%) |
Note. Number of participants responses to each item was n = 626
Relationship between participant characteristics and social network
Ordinal regression analysis showed that a less frequent need for relatives and friends receiving information was related to higher age (p < .001). The explained variance in model testing the relationship between a need for relatives and friends receiving information and background variables was R² = 0.073. A less frequent need to talk with others experiencing cognitive impairments was associated with older age (p < .001), whereas being female (p = .006) and having received hormone therapy (p = .045) were related to a greater need. The model testing the relationship between needing to talk with others experiencing cognitive impairments and background variables was R² = 0.099. A greater need for receiving support from family and friends were related to being female (p = .003), while a less frequent need was associated with higher age (p < .001). Explained variance in model was R² = 0.121. A lower need for adapted work or school task was related to higher age (p < .001). The model testing the relationship between the need for adapted work or school tasks and background variables was R² = 0.111. Moreover, higher age (p < .001) was associated with a less frequent need for receiving support from employer or teacher, while receiving hormone therapy was related to a more frequent need for support (p < .018). The explained variance of the model that included need for receiving support from employer or teacher and background variables was R² = 0.104. None of the other background variables were related to outcomes.
Attitudes toward the timing of interventions targeting cognitive impairments
The preferred timing for cognitive enhancement interventions, indicated by “Very often” responses, was six to twelve months after cancer treatment, followed by immediately after treatment. The time periods most responded to “Never” needing interventions for cognitive impairments, were before and during cancer treatment. The results for timing of interventions for cognitive impairments are presented in Table 5.
Table 5.
Participants responses to when they needed interventions targeting cancer-related cognitive impairment
| I have needed interventions for cognitive impairments… | Don’t know | Never | Rarely | Sometimes | Often | Very often |
|---|---|---|---|---|---|---|
| Six to twelve months after cancer treatment |
74 (11.6%) |
116 (18.2%) |
42 (6.6%) |
104 (16.3%) |
126 (19.7%) |
176 (27.6%) |
| Immediately after cancer treatment |
53 (8.3%) |
139 (21.8%) |
57 (8.9%) |
137 (21.5%) |
132 (20.7%) |
120 (18.8%) |
| During cancer treatment |
42 (6.6%) |
227 (35.6%) |
87 (13.6%) |
150 (23.5%) |
72 (11.3%) |
60 (9.4%) |
| Before cancer treatment |
19 (3.0%) |
518 (81.2%) |
43 (6.7%) |
35 (5.5%) |
12 (1.9%) |
11 (1.7%) |
Note. Number of participants responses to each item was n = 638
Relationship between participant characteristics and timing of interventions
Ordinal regression analysis indicated that a need to receive interventions before cancer treatment was associated with a brain tumour diagnosis (p = .001) and a lower need was associated with higher education (p = .002). The explained variance of the model testing the relationship between the need for interventions before the cancer treatment and background variables was R² = 0.067. A need for interventions during cancer treatment was positively related to having received hormone therapy (p = .035), whereas a lower need was associated with higher age (p = .008) and higher education (p = .008). The explained variance of this model was R² = 0.063. Lower needs for interventions immediately after cancer treatment were related to higher age (p < .001), higher education (p = .027), and a diagnosis of lung cancer (p = .021). The model testing the relationship between a need for interventions immediately after cancer treatment and background variables had an explained variance of R² = 0.074. Frequently having needed interventions six to twelve months after cancer treatment, was associated with being female (p = .005), while a less frequent need was related to higher age (p < .001). The explained variance of the model testing the relationship between a need for interventions six to twelve months after cancer treatment was R² = 0.102. None of the other background variables were related to outcomes.
Discussion
The findings from this study provides insights into cancer survivors’ attitudes and needs regarding varoius delivery formats for interventions targeting cognitive impairments.
A majority of the participants reported to have had a need for interventions targeting cognitive impairments. However, higher age was related to a lower need for such interventions. This is in line with previous research reporting that younger cancer survivors experience more cognitive impairments than older survivors [14, 33]. One explanation for these findings might be that younger cancer survivors are in a vulnerable phase related to work or family obligations. Cancer-related cognitive impairment might therefore represent a significant burden on their functioning in daily life. An additional explanation is that older age is associated with reduction in some aspects of cognitive functioning [34], whereby cognitive changes might be attributed to normal aging. Gender was also related to perceived need for interventions targeting cognitive impairments, where women did more frequently report such a need. This is in line with previous studies finding gender differences in attitudes towards psychological interventions, where men are reported to be less likely to acknowledge the benefits of psychological interventions [35]. Another aspect to consider is that there are differences in cognitive functioning between men and women across the lifespan associated with hormonal fluctuations [36], which may further contribute to reductions in cognitive performance beyond the effects of cancer treatment [37].
Several delivery formats for interventions were of interest for the participants. Among the formats were written self-management interventions the most preferred. This preference aligns with previous research demonstrating the efficacy of self-management approaches [38, 39]. Such interventions require minimal involvement from healthcare professionals and are not constrained by geographical distances. These features of self-management interventions address common barriers reported by cancer survivors such as inconvenient scheduling of healthcare appointments and burden of traveling time [23]. Moreover, many cancer survivors experience debilitating fatigue [40], which can make it difficult to schedule physical appointments. This might partly explain their positive attitudes towards self-management interventions. Research has shown that the effect of self-management increases when combined with guidance from healthcare professionals [38]. In the present study, e-mail-based support from healthcare professionals was the most positively rated. Asynchronous formats, such as e-mails, offer greater flexibility by allowing patients and healthcare professionals to communicate without the need to coordinate schedules. In contrast, synchronous formats like telephone or video calls, require both parties to be available simultaneously, which might be more resource intensive. Asynchronous written guidance from healthcare professionals has been successfully implemented in routine mental healthcare in Norway, Sweden, Denmark, Canada, and Australia [41]. This format of receiving therapist support might be relevant and adaptable for supporting cancer survivors experiencing cognitive impairments. Overall, the findings suggest that future research should explore the effectiveness of combining written interventions with asynchronous email support, as these formats were highly endorsed by the participants. However, results from this study also suggests a need for tailoring delivery formats for various groups as older age was associated with lower interest in written self-management interventions, digital formats, video communication, chatting, and telephone communication. A solution might be offering face-to-face or oral self-management options combined with e-mail support.
About half of the participants in this study identified support from relatives, friends, peers, and employers as important for coping with cognitive impairments. This aligns with research showing that cancer survivors experiencing lack of support from their close network report the greatest negative impact of cognitive impairments [25]. Providing education to cancer survivors’ social network might help prevent misunderstandings and reduce frustration. However, there are gender differences seeking for social support, as women is reported to be more likely than men to seek support from friends [42]. Moreover, women are in general found to have higher quality of their social support system [43], indicating that they have more social resources to lean on than men. This may partly explain why women in this study reported a greater need for social support to manage cognitive impairments. Another format to receive support is through peers. Cancer survivors can benefit from sharing experiences, exchanging coping strategies, and offering mutual encouragement [24, 44]. Peer support interventions have been shown to improve psychological empowerment, reduce depression and anxiety, and enhance coping abilities and quality of life [45, 46]. Organizing peer support groups specifically focused on managing cognitive impairments, may therefore be a relevant format for delivering cognitive enhancement interventions. Additionally, some participants reported needing support from their employers. However, over half of the participants were not employed, which might have influenced the relevance of these items. Nevertheless, cognitive health plays an important role in occupational functioning [47], and cancer survivors experiencing cognitive impairments may benefit from adaptations to work tasks [48]. Educating employers about cognitive impairments and appropriate adaptations to occupational tasks, is therefore of importance for enhancing cancer survivors’ performance at work.
Our findings indicate that the preferred timing for cognitive enhancement interventions is six to twelve months after cancer treatment. This finding is consistent with the emotional and psychological demands associated with a cancer diagnosis and cancer treatment [49], during which patients may be primarily focused on survival rather than cognitive functioning. Moreover, during treatment, individuals are often less engaged in cognitively demanding activities, such as work or school, which may cause cognitive difficulties to go unnoticed [50]. This finding is further supported by previous research suggesting that pre-existing awareness of cognitive impairments is associated with greater likelihood of experiencing cognitive difficulties after cancer treatment [3]. However, a few participants reported a need for interventions before treatment. This aligns with research indicating that over 30% of cancer survivors experience cognitive impairments prior to treatment [51], which may partly be explained by the cancer itself. In the present study, participants diagnosed with brain tumours reported a more frequent need for interventions. This is likely due to tumours affecting brain regions critical for cognitive functioning. Addressing cognitive impairments might therefore be relevant for these prior to cancer treatment. In contrast, higher education was associated with a lower need for interventions before, during, and immediately after treatment. This finding may be explained by individuals with higher education being better able to compensate for cognitive decline through cognitive reserve. However, they may encounter cognitive difficulties when returning to cognitively demanding work settings. Overall, these results suggest that the optimal timing for delivering interventions targeting cancer-related cognitive impairments may be several months after treatment, when survivors are transitioning back to everyday life.
Strengths and limitations
This study has a large sample size, including cancer survivors with various cancer diagnosis, that improves the strength and reliability of the findings. However, the study also has limitations. The use of a convenience sampling strategy introduces potential bias. Women are generally more likely to participate in research [52]. This might explain the considerable overrepresentation of female participants in this study. The gender imbalance limits the generalizability of the findings. Further exploration of men’s perspectives is warranted, as failing to adequately capture these may result in interventions that are less relevant for this group. This is also reflected in our analyses showing that men differ from women about needing interventions targeting cognitive impairments and have other preferences regarding interventions formats. Approaches that encourage men to engage in psychological interventions might be relevant to explore, as they might still gain benefits from interventions targeting cognitive impairments. Another limitation concerns the use of quantitative data, which does not provide detailed insights into cancer survivors’ attitudes toward delivery approaches or the timing of interventions. Future research should therefore use qualitative designs to explore these aspects in greater depth.
Conclusion
This study demonstrates a need for acceptable and accessible interventions targeting cancer-related cognitive impairments. The finding that most participants preferred written self-management interventions and asynchronous formats, such as e-mail communication with healthcare professionals, points towards scalable approaches that warrants further exploration. Involving societal resources, such as other cancer survivors, relatives, and employers, may strengthen cancer survivors’ capacity to cope with cognitive challenges. The optimal timing for cognitive enhancement interventions appears to be after the completion of cancer treatment, when survivors transitioning to everyday life and are more likely to recognize cognitive challenges. While these insights can inform the development of future intervention strategies, the generalizability of the findings may be limited due to sample biases. Demographic and clinical characteristics are related to differences in interest and needs regarding interventions that should be taken into consideration.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
We would like to thank user representatives from the Norwegian cancer society for their collaboration in developing the survey, in addition to the participants responding to the survey.
Author contributions
S.B.M.: Conceptualization, methodology, recruitment, formal analyses, investigation, data curation, preparations, writing original draft, review and editing. K.G.B.: Formal analyses, writing original draft, preparations, review and editing. R.G.: Conceptualization, data curation, methodology, review and editing. M.A.H.: recruitment, review and editing. R.J.T.S.: methodology, recruitment, review and editing. T.N.: Conceptualization, funding acquisition, methodology, supervision, review and editing.
Funding
S.B.M., K.B.G., R.G. and T.N. were supported by the Norwegian Research Council (NFR: 309264 Centre for research-based innovation on Mobile Mental Health).
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Declarations
Ethical approval and consent to participate
This study was performed in line with the principles of the Declaration of Helsinki. The study was approved by the Regional Committee for Medical Research Ethics of Western Norway (619504). Informed consent was obtained from all individual participants included in the study.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.