Date Presented 04/22/2023

Breast cancer survivors may have cognitive deficits with lower quality of life (QOL) and decreased participation in activities. Computer-assisted cognitive therapy can improve function, and the addition of music to improve focus and concentration can further improve memory and QOL.

Primary Author and Speaker: Theresa M. Smith

Contributing Authors: Wanyi Wang

PURPOSE: Over 3.8 million women breast cancer survivors (BCS) live in the United States. Many experience long-term cognitive deficits that can result in a lower quality of life (QOL) and decreased participation in everyday activities. Computer-assisted cognitive therapy (CACT) can improve function. We compared effects of a CACT program to one enhanced with music to improve focus and concentration (CACT +A) and queried 'What are the effects of a computer-assisted cognitive training program compared to a computer-assisted cognitive training program enhanced with music on memory, cognition, quality of life, and participation in everyday activities perceived by BCS?'

DESIGN: Mixed methods were employed to reach a greater depth of understanding and achieve corroboration of findings. Participants were recruited from 3 breast cancer support groups and one 1 Facebook group.

METHOD: Researchers used the forward digit span to measure working memory; the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) for cognitive function; the 41 item QOL -Cancer Survivors (QOL-CS) for QOL, and the Model of Human Occupation Screening Tool (MOHOST) to determine the extent to which motivation, pattern of occupation, communication and interaction skills, process skills, and environment factors facilitate or restrict participant’s engagement in everyday activities. Qualitative data were collected with an open-ended question interview exploring any changes in participant’s memory, cognition, QOL, and participation in everyday activities.

RESULTS: Twenty-five BCS, ages 31 to 72 years participated. The CACT group demonstrated significantly improved pre to post-test scores for working memory, QOL, and 3 subscales of the MOHOST. The CACT+A group had significant improvement for 4 FACT-Cog subscales and the total score. Five themes emerged from the interview: Cognitive skill, Strategy learned, No change, QOL factors, and Participation in everyday activities. The CACT+A group expressed experiencing a larger ratio of improvements, most notably for memory and QOL.

CONCLUSION: Impact Statement CACT+A is an auspicious intervention option for BCS and convenient to participate in at home. Further research is needed on best practice for BCS with cognitive deficits.


Smith, T. M., & Ratcliff, K. A. (2019). Comparison of two computer-assisted cognitive rehabilitation program outcomes: A pilot study. Korean Journal of Occupational Therapy, 27(3), 147–158.

Smith, T. M., & Wang, W. (2021). Comparison of a standard computer-assisted cognitive training program to a music enhanced program: A mixed methods study. Cancer Reports. 2021;4:e1325.

Creswell, J. W., & Plano Clarke, V. L. (2011). Designing and conducting mixed methods research (2nd ed.). Sage.