Sage Journals: Discover world-class research

Abstract

Background

Breast cancer is a common malignancy among women worldwide, frequently associated with cancer-related cognitive impairment, which significantly affects quality of life. Non-pharmacological therapies, especially digital health interventions (DHIs), show potential in mitigating cognitive impairment related to cancer through tailored and interactive cognitive training. Nonetheless, current research fails to systematically integrate intervention strategies, behavioral change techniques (BCTs), and their effectiveness.

Objective

This scoping review sought to delineate existing DHIs for cognitive impairment related to cancer in breast cancer patients, emphasizing intervention attributes, efficacy, and the use of behavior change techniques to guide future research and clinical practice.

Methods

Following Arksey and O’Malley's framework, nine databases were systematically searched (inception to February 2025). Inclusion criteria were defined using PICOS (Population, Intervention, Comparison, Outcomes, Study design). Data on intervention characteristics, BCTs, and outcomes were extracted and analyzed via Michie's BCT taxonomy.

Results

Nineteen studies were incorporated. DHIs predominantly employed computerized cognitive training (78.94%), virtual reality (VR) (15.78%), and robotics (5.26%). Prominent BCTs encompassed goal setting (100%), feedback/monitoring (89%), and social support (100%). Eighteen investigations indicated substantial cognitive enhancement, six saw better emotional well-being, and two evidenced an elevated quality of life. Gamification and VR therapies resulted in elevated patient adherence and satisfaction.

Conclusion

DHIs significantly enhance Cognitive Rehabilitation and Cognitive Impairment through cognitive training and multifaceted BCTs. Challenges encompass diverse study designs, insufficient long-term data, and technical obstacles. Future research must include standardized cognitive evaluations, longitudinal investigations, and initiatives to address the digital divide.

Keywords

Breast cancer cancer-related cognitive impairment digital health interventions behavior change techniques scoping review

Introduction

Breast cancer is a malignant neoplasm arising from the epithelial cells of breast tissue. The development is impacted by various elements, including genetics, hormones, and environmental exposures.¹ As per the most recent data from the International Agency for Research on Cancer of the World Health Organization, breast cancer ranks among the most prevalent malignancies worldwide, with around 2.31 million new cases reported in 2022, representing 11.7% of all cancer diagnoses.² In China, breast cancer is the predominant malignancy among women, with around 420,000 new cases documented each year, and there is a tendency towards a younger age of diagnosis.^3,4 Due to advancements in early identification and treatment, the 5-year survival rate for breast cancer patients in China has increased to 82.0%.⁵ Nonetheless, these interventions, especially surgery and radiotherapy, have significant repercussions for patients. Issues like inadequate body image and sexual dysfunction indirectly influence overall quality of life.^6,7 Furthermore, numerous patients encounter the difficulty of enduring sequelae, such as postoperative lymphedema, radiation dermatitis, chemotherapy-induced peripheral neuropathy, cardiovascular toxicity, and osteoporosis.^8,9

Recent research indicates that 17% to 75% of breast cancer patients experience cognitive impairment following therapy, highlighting a substantial concern over their quality of life.¹⁰ Cancer-related cognitive impairment (CRCI) denotes the multifaceted deterioration of cognitive abilities, including attention, memory, and executive function, attributable to either the cancer or its treatments.¹¹ A review¹² indicated that cognitive impairment was observed in 75% of patients during therapy and in 35% of patients 1-year post-treatment completion. CRCI not only impedes daily activities but also diminishes work productivity, with certain patients unable to resume employment.¹³ Furthermore, cognitive impairment can affect social interactions, leading to less participation in social activities and a reduced quality of life.¹⁴

Current methods for cognitive rehabilitation in breast cancer patients encompass pharmaceutical therapies, traditional Chinese medicine rehabilitation, psychological support, physical exercise, and cognitive training.¹⁵ The National Comprehensive Cancer Network advises non-pharmacological approaches as the primary strategy due to the unclear efficacy and possible negative effects of pharmacological treatments, which should be considered only when alternative methods fail.^16,17 Several systematic reviews have shown that,^18–20 Non-pharmacological therapies, including psychological interventions, cognitive training, physical exercise, and lifestyle modifications, are effective in mitigating CRCI.

In recent years, digital health interventions (DHIs), a novel category of non-pharmacological treatment, have surfaced as effective instruments for addressing cognitive impairment in breast cancer patients. DHIs utilize digital technology such as mobile applications, internet platforms, and wearable devices to provide health management and intervention services.²¹ These technologies provide benefits including personalization, flexibility, interactivity, data monitoring, and feedback, thereby augmenting the efficacy of conventional non-pharmacological therapies through intelligent and customized approaches.²² The incorporation of Artificial Intelligence in healthcare is progressively revolutionizing DHIs, facilitating enhanced personalization, real-time data analysis, and adaptive intervention tactics. AI-driven algorithms can evaluate extensive patient data to discern distinct cognitive profiles and customize interventions, advancing from static programs to dynamic and adaptive health care.²³ DHIs have shown considerable promise and efficacy in addressing cognitive impairment related to cancer in breast cancer patients. A study by Anne et al.²⁴ showed that video game cognitive training can improve cognitive functioning, especially subjective cognitive functioning, in breast cancer patients. A systematic evaluation by Wang et al.²⁵ demonstrated that online cognitive interventions have a positive impact on Subjective Cognitive Impairment in cancer survivors, especially breast cancer patients. Nonetheless, the existing research on the utilization of Digital Health treatments (DHIs) in this domain is fragmented and lacks comprehensive summarization and compilation, with all aforementioned studies deficient in additional analysis to discern the successful components of the treatments.

Behavioral change techniques (BCTs) are discernible, reproducible, and integral components of an intervention aimed at modifying or directing behavior.²⁶ These strategies serve as the essential components of an intervention that can directly affect an individual's behavioral patterns to get enhanced health results. Examining the function of BCTs in interventions is essential as it elucidates the active components of an intervention, hence enhancing the design and efficacy of the intervention.²⁷ BCTs are extensively utilized in the domain of DHIs. DHIs employ digital technology, including mobile applications and wearable devices, to facilitate health management and promote behavioral change in individuals.^28,29 Self-monitoring functionalities offered by mobile applications enable users to document and monitor their health metrics, including blood pressure, blood glucose, and physical activity, in real time.^30,31 This self-monitoring device enables users to comprehend their behavioral patterns more effectively, facilitating more precise behavioral modifications. Moreover, DHIs can deliver prompt incentive and assistance via push notifications, reminders, and tailored feedback to improve user engagement and adherence.³²

Despite numerous studies rigorously assessing non-pharmacological therapies for cognitive rehabilitation in breast cancer patients, there is an absence of thorough explanations regarding the characteristics, efficacy, and behavior change techniques employed in these programs. Systematic reviews and meta-analyses generally aggregate previous research but do not furnish direct, first-hand information regarding the specific BCTs utilized. A scoping review is a methodical approach of summarizing and mapping the available literature on a certain issue, providing a comprehensive overview of the field.³³ This scoping review aimed to systematically explore the landscape of DHIs for CRCI in breast cancer patients. Specifically, guided by Arksey and O'Malley's framework, the research aimed to address the following three structured research questions: (1) To explore the characteristics and general intervention strategies of DHIs for CRCI in breast cancer patients. (2) To analyze the specific techniques, procedures, and content elements utilized in these DHIs, as well as BCTs incorporated within them. (3) To evaluate outcome indicators and the effectiveness of intervention strategies. This review is not registered as PROSPERO does not accept scoping reviews.

Methods

This study followed the methodological framework for scoping reviews proposed by Arksey and O'Malley,³⁴ which includes the following steps: (1) identifying the research question, (2) conducting a comprehensive search for relevant studies, (3) selecting the studies, (4) extracting the data, and (5) organizing, summarizing, and reporting the results.

Review question

The specific research questions addressed in this review are: (1) What are the intervention strategies for CRCI in breast cancer patients, and what are their general characteristics? (2) What techniques, procedures, and content elements are used in DHIs? Which BCTs are incorporated? (3) What outcome indicators are used, and what is the effectiveness of these intervention strategies?

Eligibility criteria

The study utilized inclusion and exclusion criteria based on the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework.³⁵ Inclusion criteria: (1) Population: Research focused on patients aged 18 or older diagnosed with breast cancer, who had received chemotherapy, radiation, hormone therapy, and/or surgery, and who were evaluated for chemotherapy-related cognitive impairments or shown signs of cognitive deterioration. (2) Intervention: DHIs designed to enhance cognitive impairments in breast cancer patients. This includes, but is not restricted to, cognitive training software, online psychoeducational courses, telemedicine consultations, mobile health applications, and similar resources. (3) Comparison: The control group may consist of standard treatments and care, or alternative non-DHIs such as classic psychoeducation or in-person cognitive training. (4) Outcome: Research must use at least one metric pertaining to overall cognitive functioning, specific cognitive domains (e.g. memory, attention, executive functioning, language ability), or objective neuropsychological evaluations, as primary or secondary outcome measures. (5) Study Design: The included study types comprise randomized controlled trials, experimental studies, feasibility studies, and mixed-method studies. Exclusion criteria: (1) Literature not accessible in full text; (2) Literature published multiple times; (3) Studies that offer merely a cursory overview of the intervention, precluding the identification and coding of behavior change techniques in later phases.

Data sources and search strategy

The system searched nine databases, including PubMed, CINAHL, Web of Science, ProQuest, Cochrane Library, Embase, PsycINFO, China National Knowledge Infrastructure, Wan fang Data. The search utilized a combination of subject phrases, keywords, and Boolean operators, together with citation analysis, undertaken from the library's inception until 9 February 2025. To augment the thoroughness of our research, gray literature was systematically searched via specialized databases and platforms. ProQuest, as an extensive database, was employed to obtain pertinent doctoral and master's theses. In a similar manner, Chinese doctorate and master's theses were retrieved from the China National Knowledge Infrastructure database, a principal repository for academic dissertations in China. The searches for gray literature utilized analogous keywords and Boolean operators as those applied to peer-reviewed journal articles, concentrating on terms associated with “Breast Neoplasm,” “Cognitive Dysfunctions,” “chemotherapy-related cognitive impairment,” and “digital health intervention” (as outlined in Table 1).

Table 1.

Search strategies and search terms.

Key concepts	Search terms
Breast neoplasm	breast neoplasm OR breast neoplasms OR breast carcinoma OR breast carcinomas OR breast malignan* OR breast tumor OR breast tumors OR breast tumour OR breast tumours OR breast cancer OR breast cancers OR mammary cancer OR mammary cancers
Cognitive dysfunctions	Cognitive Dysfunctions OR Cognitive Disorder OR Cognitive Impairments OR Cognitive Decline
Chemotherapy-related cognitive impairment	CRCI OR Chemotherapy Related Cognitive Impairment OR Chemotherapy- Related Cognitive Impairments OR Chemotherapy-Induced Cognitive Dysfunction OR Chemotherapy Induced Cognitive Dysfunction OR Chemo-Fog OR Chemo Fog OR Chemotherapy-Induced Cognitive Impairments OR Chemotherapy Induced Cognitive Impairments OR Chemotherapy-Induced Cognitive Impairment OR Chemotherapy Induced Cognitive Impairment OR Chemotherapy-Related Cognitive Dysfunction OR Chemotherapy Related Cognitive Dysfunction OR chemotherapy related cognitive Dysfunction OR Chemo brain
Digital health intervention	Telemedicine OR mobile health OR ehealth OR mhealth OR telehealth OR internet OR online OR application OR App OR platform OR WeChat OR web OR digital virtual OR virtual reality OR cyber OR computer OR mobile OR smartphone OR phone OR Virtual Medicine

CRCI: cancer-related cognitive impairment.

Study selection

The acquired material was loaded into EndNote reference management software. Two researchers, both proficient in evidence-based nursing, independently evaluated the studies according to the established inclusion and exclusion criteria. This procedure entailed examining the titles and abstracts, thereafter acquiring and further evaluating the complete texts of pertinent papers. Disputes were settled through collaborative dialogue or adjudicated by an impartial third researcher.

The data extraction for the included studies was conducted independently by two researchers, with any differences addressed and resolved through the participation of a third researcher. A self-created form was utilized to gather general study information, encompassing: authors, country of origin, study design, sample size, components of the DHI (including techniques, procedures, and content elements), control group interventions, intervention duration, cognitive functioning assessment tools, and intervention outcomes. The cognitive function assessment tools are summarized in Table 2. A detailed description of the cognitive assessment tool is included as a separate comprehensive table in Supplementary File 1. The extracted data are summarized in Table 3.

Table 2.

Tools for measuring cognitive function.

Category			Cognitive function assessment tools
1. Objective Cognitive Function Assessment Tools	1.1 Comprehensive Neuropsychological Assessment Scales	1.1.1. Integrated Neuropsychological Assessment Battery	Neuropsychological Assessment Battery (NAB)³⁶ NIH Toolbox Cognitive Battery (NIHTB-CB)³⁷ CNS Vital Signs^®³⁸
		1.1.2 General Cognitive Screening Tools	Montreal Cognitive Assessment (MoCA)^38–41
	1.2 Specific Cognitive Domain Assessment Tools	1.2.1 Memory Function	1.2.1.1 Verbal Learning and Memory	Hopkins Verbal Learning Test (HVLT)³⁶Rey Auditory Verbal Learning Test (RAVLT)⁴² California Verbal Learning Test (CVLT)⁴³ Selective Reminding Task (SRT)^44,45Verbal Learning Memory Test (VLMT)^36,46 Auditory Consonant Trigrams (ACT) Test⁴⁷
			1.2.1.2 Visuospatial Memory	Rey-Osterrieth Complex Figure (ROCF)⁴⁶ Corsi Block-Tapping Test (CBTT)⁴²Brief Visuospatial Memory Test, Revised (BVMT-R)⁴³
		1.2.2 Attention and Working Memory	1.2.2.1 Attention Span and Sustained Attention	Digit Span Task^42,44–46Paced Auditory Serial Addition Test (PASAT)⁴⁸Brief Test of Attention (BTA)^44,45
			1.2.2.2 Selective Attention and Inhibitory Control	Stroop Colour and Word Test (SCWT)⁴²
		1.2.3 Executive Function	Trail Making Test (TMT)^{42,45,47,49,50}
		1.2.4 Processing Speed	Digit Symbol Substitution Test (DSST)⁴²Symbol Digit Modalities Test (SDMT)⁴³
		1.2.5 Language Function	Verbal Fluency Test⁴²
		1.2.6 Visuospatial Function	Rey-Osterrieth Complex Figure (ROCF)⁴⁶
2. Subjective Cognitive Function Assessment Tools	2.1 Patient Self- Reported Tools	Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog)^{37,38,42–46,49–53}Cognitive Failures Questionnaire (CFQ)^24,48PROMIS Applied Cognition ⁵¹

Table 3.

Overview of included studies.

No.	First Author Country Year	Study design	Sample size	Digital components of intervention			Comparison group	Duration	Tools for measuring Cognitive function	Effectiveness of intervention
No.	First Author Country Year	Study design	Sample size	Technique	Procedure	Content element	Comparison group	Duration	Tools for measuring Cognitive function	Effectiveness of intervention
1	Robert⁴³American2016	RCT	47	Computer	Tandbergcentric (CBT)1700 MXP	Cognitive Behavioral	supportivetherapy	8 weeks	CVLT	1. Improvementsin cognitivefunction,anxiety, fatigueand quality oflife
						Therapy	supportivetherapy		FACT-Cog
						1. Education			SDMT
						2. Self-awareness training
						3. Stress management and
						self-regulation
						4. Cognitive compensation				2. High patientsatisfaction
						strategy training (memory,				2. High patientsatisfaction
						language skills, attention,
						executive ability)
2	Jamie⁵¹	Feasibility	61	Computer	Tandbergcentric1700 MXP	Six sessions in total	—	6 weeks	FACT-Cog	Significantimprovementsin cognitivefunction,anxiety, fatigueand loneliness.
	American					Week 1: Program			PROMIS
	2020	Study				Introduction and Overview			Applied
						Week 2: Stress			Cognition
						Management and
						Relaxation Techniques
						Week 3: Emotion
						Management and
						Cognitive Strategies
						Week 4: Attention
						Training
						Week 5: Memory
						Enhancement Strategies
						Week 6: Problem Solving
						and Social Support
						Interventions cover
						attention, memory, and executive training
3	Ángela⁴⁹Spanish2022	RCT	98	Computer	NeuroNation^©	1. Cognitive training	routine care	12 weeks	TMT	Improvement incognitivefunctioning
						(attention, memory, daily			FACT-Cog
						living skills training)
						2. Adaptive training:
						including stress
						management, relaxation
						techniques, problem
						solving training, energy
						conservation and time
						Management3. Homework
4	Alyssa³⁷Canada2023	Mixedresearch	18	Computer	Zoom	1. Yoga program includes	routine care	8 weeks	NIHTB-CB	Improvement incognitivefunctioning
					NeuroNati	breathing exercises,			FACT-Cog
					on^©	meditation, asana practice
						and relaxation techniques
						2. Interventions cover
						attention, memory,
						language, executive
5	Jamie⁵⁰American2022	FeasibilityStudy	30	Computer	—	Functioning trainingCombining motor and	wait - list	4 weeks	TMT	Improvement incognitivefunctioning
						game-based cognitive	control		FACT-Cog
						training:
						1. Exercise
						2. Cognitive games
						including short-term
						memory and simple
						arithmetic
						Interventions cover:
						processing speed,
						executive functioning,
						short-term memory
6	Diane⁴⁴American2023	RCT	35	Computer	BrainHQ	1. Computerized cognitive	1. Global	10 weeks	TMT	Improvement incognitivefunctioning
						training: including	Cognitive		SRT
						chronological order	Stimulating		Digit Span Task
						judgment, discrimination,	based		BTA
						spatial matching,	Games:		FACT-Cog
						command following, and	including
						narrative memory tasks.	crossword
						2. Interventions covered:	puzzles,
						memory, executive	Sudoku
						functioning, attention	2. Interventio
							ns cover:
							attention,
							memory,
							executive
							functioning,
							speed of
							information processing
7	Anne²⁴Belgium2020	RCT	46	Computer	Aquasnap	Video Game Cognitive	routine care	6 months	CFQ	Positive effects
					（MyCQ	Training				on cognitive
					™）	Targets five cognitive				functioning,
						domains:				especially
						Attention, Working				improvements
						Memory, SituationalMemory, ExecutiveFunctioning				in subjective cognitive functioning
8	Jennifer⁴⁵American2023	FeasibilityStudy	21	Computer	—	1. Cognitive games include	routine care	6 weeks	TMT	Improvement inboth cognitivefunctioning andemotional state
						Short Term Memory and			SRT
						Simple Arithmetic.			Digit Span Task
						2. Training tasks: including			BTA
						Memory Ball Recall,			FACT-Cog
						Ultimate Word Master
						(UWM), and Neurogrow.
						involves training in
						attention, working
						memory, situational
						memory, executive functioning, and more!
9	Damholdt⁴⁸Denmark2016	RCT	157	Computer	Happy	Web-based cognitive	wait - list	6 weeks	PASAT	Training had apositive effecton memory andconcentration,but nosignificantsubjectivecognitivefunctionimprovements were found.
					neuron	training + telephone	control		CFQ
					Pro^©	support
						1. The cognitive training
						program covers six
						cognitive domains:
						Attention, Memory,
						Working Memory
						2. Each task is designed as
						a computer game
10	Karl⁴⁶Germany2024	RCT	40	Computer	NeuroNati	Network cognitive	—	14 weeks	ROCF	1. significantimprovement inoverallcognitive andexecutivefunctioning
					on	training:			Digit Span Task
						1. Training tasks are			VLMT
						designed in the form of			FACT-Cog
						games
						2. The training consists of
						16 tasks, covering working				2. no significantimprovementwas seen inquality of life,depression and fatigue.
						memory



11	Giulia³⁸France2021	FeasibilityStudy	20	Computer	HappyNeu	1. Cyber-adaptive physical	—	12 weeks	MoCA	—
					ron ^®	activity (warm-up, muscle			CNS Vital
					Mooven^®	strengthening activities,			Signs^®
						stretching)			FACT-Cog
						2. Cyber Cognitive
						Stimulation (training
						attention, memory,
						executive function,
						language, visuospatial skills)
12	Giulia⁵²France2024	Feasibility	55	Computer	HappyNeu	Digital Cognitive	—	60	FACT-Cog	1. Software hasusability
					ron	Stimulation Training		minutes		1. Software hasusability
		Study			PRESCO	training covers Attention,				2. Patientcompliance ishigh
						memory, executive
						function, language, logic, visuospatial ability, etc.
13	Yang³⁹China2023	RCT	104	VR	Homebrewprogram	Cognitive rehabilitation	routine care	8 weeks	MoCA	1. Cognitivefunctionimprovement
					Homebrewprogram	training includes:
						1. Executive training: tasks
						such as rowing a boat,				2. Improvementof daily livingskills
						playing ping-pong, cutting
						a cake, etc. with an avatar
						2. Attention training: tasks				3. Improved self-managementefficacy
						such as virtual mazes,
						vehicle lane changing,
						crossroads, etc.				4. Highercompliance
						3. Memory training:				4. Highercompliance
						through auditory, visual,
						logical, numerical, motor
						and associative memory training.
14	Chen⁴⁰China2019	RCT	80	VR	Homebrewprogram	Virtual Cognitive	routine care	8 weeks	MoCA	1. Cognitivefunctionimprovement
					Homebrewprogram	Rehabilitation Training
						System
						1. The training program				2. Improvementof daily livingskills
						includes memory training,
						motor memory, auditory
						memory, logical memory,				3. Improved self-managementefficacy
						visual memory, digital
						memory and associative
						memory.				4. Highercompliance
						2. Each module enhances				4. Highercompliance
						the patient's cognitive
						function through virtual
						scenes and game tasks.
						3. Training difficulty
						ranges from simple to difficult
15	Yang⁴¹China2021	RCT	96	VR	Homebrewprogram	Virtual Cognitive	Routine	8 weeks	MoCA	1. Cognitivefunctionimprovement
					Homebrewprogram	Rehabilitation Training	cognitive
						1. Training content:	interventions
						including memory				2. Improvementof daily livingskills
						training, motor memory,
						logical memory, auditory
						memory, visual memory,				3. Improved self-managementefficacy
						numerical memory and
						associative memory.
						2. The training is				4. Highercompliance
						conducted through virtual				4. Highercompliance
						scenes and virtual objects,
						using somatosensory
						interactive equipment.
						3. Training difficulty
						ranges from simple to difficult
16	Noelia⁴⁷Spanish2017	RCT	81	Computer	e-CUIDATE	Internet customized	routine care	8 weeks	TMT	Improvement incognitivefunctioning
						exercise program:			ACT
						including warm-up,
						aerobic and resistance exercise, relaxation
17	Lyn⁵³American2015	RCT	118	Computer	Zoom	1. Live Delivery	routine care	5 weeks	FACT-Cog	Significantimprovementsin health-relatedquality of life,fatiguecognitivefunctioning,mental health,psychologicaldistress andsleep quality were observed.
						Telemedicine Delivery
						2. All content includes:
						educational component,
						interactive component,
						home exercises
						3. Training of attention,
						memory, executive
						function


18	Maria⁴²Spanish2024	RCT	176	Computer	ICOnnecta’t	ICOnnecta't Platform +	ICOnnecta't	12	RAVLT	1. Improvedcognitivefunctioning
						Cognition Module	program,	months	TMT
						(ICOgnition) includes the	including		Digit Span Task
						following components:	psychosocial		CBTT	2. Reducedemotionaldistress
						Cognitive Screening,	screening,		Verbal Fluency
						Cognitive	psychoeduca		Test
						Psychoeducation, Online	tion,		SCWT	3. Improvedquality of life
						Cognitive Training:	community		DSST	3. Improvedquality of life
						Including Memory,	support and		FACT-Cog	4. Higheradherence
						Attention, and	online group			4. Higheradherence
						Visuospatial Orientation Skills Training	psychotherapy
19	Gregory³⁶American2016	FeasibilityStudy	6	Robotics	BrightArm	1. Virtual rehabilitation	—	8 weeks	HVLT	1. Improved cognitive Function
				VR	Duo	games include: motor			NAB
						training, Emotional and			BVMT-R	2. Pain reduction
						cognitive training				3. Mood Improvement
						2. Training executive				4. Improvement in daily living skills
						function, attention, short-term and delayed memory, working memory				5. High technology acceptance

VR: virtual reality; RCT: randomized controlled trial.

BCTs were classified utilizing the approach established by Michie et al. (version 1), which organizes 93 unique BCTs into 16 categories, so offering a consistent framework for the identification of BCTs in behavior change interventions. The coding was conducted independently by two reviewers (YXC and YZ), with any discrepancies addressed through deliberation with a third reviewer (WYH) until a consensus was achieved. Table 4 delineates the specific BCTs incorporated in the DHI techniques.

Table 4.

BCTs involved in intervention strategies.

Inclusion of literature	Goals and planning	Feedback and monitoring	Social suppo rt	Shaping knowled ge	Natural consequences	Comparison of behavior	Association s	Repetition and substitution	Reward and threat	Regulation	Antecedents
1. Robert⁴³	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	Yes	Yes
2. Jamie⁵¹	Yes	No	Yes	Yes	No	No	No	Yes	No	No	No
3. Ángela⁴⁹	Yes	Yes	Yes	Yes	No	No	No	Yes	No	No	No
4. Alyssa³⁷	Yes	No	Yes	Yes	No	Yes	Yes	Yes	Yes	No	Yes
5. Jamie⁵⁰	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	No
6. Diane⁴⁴	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	No
7. Anne²⁴	Yes	Yes	Yes	Yes	Yes	Yes	No	Yes	No	No	No
8. Jennifer⁴⁵	Yes	Yes	Yes	Yes	No	No	No	Yes	Yes	No	No
9. Damholdt⁴⁸	Yes	Yes	Yes	No	No	No	No	Yes	No	No	No
10. Karl⁴⁶	Yes	Yes	Yes	No	No	Yes	Yes	Yes	Yes	No	Yes
11. Giulia³⁸	Yes	Yes	Yes	No	Yes	No	Yes	Yes	Yes	No	No
12. Giulia⁵²	Yes	Yes	Yes	No	Yes	No	No	No	Yes	No	No
13. Yang³⁹	Yes	Yes	Yes	No	Yes	No	Yes	No	Yes	No	No
14. Chen⁴⁰	Yes	Yes	Yes	No	No	No	Yes	Yes	No	No	No
15. Yang⁴¹	Yes	Yes	Yes	No	No	No	Yes	Yes	No	No	No
16. Noelia⁴⁷	Yes	Yes	Yes	No	Yes	Yes	No	Yes	No	No	No
17. Lyn⁵³	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	No	No	Yes
18. Maria⁴²	Yes	Yes	Yes	Yes	No	No	No	Yes	Yes	No	No
19. Gregory³⁶	Yes	Yes	Yes	No	No	No	No	No	No	No	No

BCT: behavioral change technique.

Results

Selection of sources of evidence

A total of 636 articles were obtained during the initial screening, 21 articles were incorporated from retrospective references, and 545 articles persisted following the removal of duplicates. Following the review of titles and abstracts, 278 articles were excluded; an additional 13 articles were dismissed; 254 articles were eliminated upon full-text evaluation (comprising 51 articles that did not align with the study population, 149 articles lacking cognitive function assessment in the outcome measures, and 35 articles that did not incorporate BCTs in the intervention descriptions); ultimately, 19 articles were selected for inclusion in the final literature review. The process of study selection is illustrated in Figure 1, the study selection diagram.

Figure 1.

Study selection diagram.

Characteristics and results of sources of evidence

A total of 19 papers were included in this study, published between 2015 and 2024. The geographic distribution of the included literature was broad, with seven from the United States,^{36,43–45,50,51,53} three from China,^39–41 three from Spain,^42,47,49 two from France,^38,52 one from Germany,⁴⁶ one from Denmark,⁴⁸ one from Belgium,²⁴ and one from Canada.³⁷ Study types included randomized controlled studies (n = 12),^{24,39–44,46–49,53} feasibility studies (n = 6)^{36,38,45,50–52} and mixed studies (n = 1).³⁷ Study sample sizes ranged from 6 to 176. The study subjects were all breast cancer patients with an age range of 18 years and above.

Types of technologies, applications for digital health interventions

In this study, there were various types of DHI technologies, mainly including computer technology, virtual reality (VR) technology, and robotics, with computer technology being the most common. The length of the intervention ranged from 60 min to 12 months, with most studies ranging from 8 weeks to 12 weeks. ① Fifteen studies^{24,37,38,42–53} (78.94%) used computerized technology for cognitive interventions, with commonly used tools including the Tandberg centric 1700 MXP (2),^43,51 NeuroNation^© (3),^37,46,49 HappyNeuron series (3 items),^38,48,52 Zoom (2 items),^37,53 BrainHQ program (1 item),⁴⁴ Aquasnap (MyCQ™) (1 item),²⁴ e-CUIDATE system (1 item),⁴⁷ and ICOnnecta't program (1 item).⁴² Computerized cognitive training uses computer programs and software to enhance cognitive functioning and usually involves a series of organized, interactive computer tasks designed to improve cognitive domains such as attention, memory, and executive functioning.⁵⁴ The computer technology interventions in this study covered cognitive behavioral therapy, cognitive training, adaptive training, and homework. ② Three studies^39–41 (15.78%) used VR technology for cognitive interventions, and all of them used homemade VR game programs combined with virtual scenarios and somatosensory interactive devices to implement cognitive rehabilitation training. VR technology is a technology that generates a three-dimensional virtual environment that can be interacted with through computer simulation, allowing users to feel like they are in the realm of the real world,⁵⁵ The application of VR in cognitive rehabilitation is to improve and rehabilitate cognitive functions by creating immersive virtual environments that allow users to perform various cognitive training tasks in a virtual scene. The VR technology interventions in this study included a virtual cognitive rehabilitation training system, virtual scenes, and game tasks. ③ One study³⁶ (5.26%) conducted an innovative attempt to combine robotics and VR, using the BrightArm Duo rehabilitation system, which integrates robotic assistance with virtual rehabilitation games for motor and cognitive training. The robot improves user engagement and cognitive recovery through personalized training programs, real-time feedback, and gamified design.

Content elements of digital health interventions

The content elements of the DHI focused on six cognitive training domains, as follows: ① 15 studies^{24,37–41,43–45,48,49,51–53} involved attention training: using self-directed training,⁴³ positive thinking meditation,^37,51 task-switching,³⁷ spatial matching,⁴⁴ and temporal order judgment.⁴⁴ This was done in a variety of ways. Common tasks include “concentration” exercises,^49,51 breath control exercises,³⁷ distraction tasks such as “Pay Attention!”,^38,52 “Private Eye!”,^38,52 virtual mazes,^39–41 vehicle lane changing,³⁹ and complex puzzles.⁴² ② Seventeen studies^{24,36–46,48–52} involved memory training, covering short-term memory, long-term memory, and different types of memory tasks, such as verbal repetition,⁴³ visualization strategies,⁴³ mnemonics,⁵¹ imagery,⁵¹ memorization of words, numbers, or images,^36,42,49 and memorization of repetitions of specific yoga poses and sequences.³⁷ ③ Three studies^37,38,52 dealt with language skills training: understanding and following instructions,³⁷ vocabulary tests, vocabulary and language comprehension tasks such as “Split words,”^38,52 “Embroidery,”^38,52 and other communication tasks. ④ Eleven studies^{24,36,38,39,43–45,50–53} dealt with executive skills training: making an organized schedule,⁴³ simple arithmetic,⁵⁰ time-limited crossword puzzles,⁴⁴ and problem-solving and decision-making tasks such as “Towers of Hanoi,”^38,52 “Basketball in New-York,”^38,52 tasks such as rowing a boat, playing ping-pong, and cutting a cake with an avatar,³⁹ interactive exercises,⁵³ and task training such as Breakout 3D³⁶: training executive functions by bouncing a virtual ball. ⑤ Three studies^38,42,52 involved training in visuospatial orientation skills: including training in spatial perception and visual processing tasks such as maze games,⁴² 3D object rotation and puzzle games.⁴² ⑥ One study⁵² involved logic and numeracy training: it included logical reasoning tasks, such as “The Right Count” training task. ⑦ One study⁴⁹ involved daily living skills training: helping patients to manage daily activities more effectively through energy management and time management skills.

Behavioral change techniques used in intervention strategies

The 19 studies included in this scoping review addressed a total of 11 categories of BCTs, as detailed in Table 3. All 19 studies used at least one category of behavior change technique. Seventeen studies^{24,36–50,52,53} used greater than five categories of BCTs. Intervention components used in intervention strategies included goals and plans^24,36–53 (setting specific cognitive training goals) (n = 19), feedback and monitoring^{24,38–41,43–50,52,55} (workbooks, telephone assessments, logs, online platforms to record) (n = 17), social support^24,36–53 (emotional support, informational support) (n = 19), Knowledge Shaping^{24,37,42–45,49–51,53} (instruction on how to conduct cognitive training, problem-solving training) (n = 10), Natural Consequences^{24,39,43,44,47,50,53} (Participants were able to directly perceive an improvement in cognitive functioning through self-reported assessments of cognitive functioning) (n = 9), Behavioral Comparison^{24,37,43,44,46,47,50,53} (role modeling by others) (n = 8), Connection^{37–41,46,53} (linking healthy behaviors to positive emotions and outcomes) (n = 7), Repetition and Substitution^{24,37,38,40,41,43–51,53,55} (diversified activities such as cognitive stimulation combined with physical activity to replace a single activities) (n = 16), Reward^{37–42,45,46,52} (social or material rewards for completing cognitive training tasks) (n = 7), Conditioning⁴³ (relaxation training, stress management, emotion regulation) (n = 1), and Antecedents^37,43,46,53 (environmental changes e.g. community-centered group activities, videoconference interactions) (n = 4).

Measurement tools for cognitive functioning

This scoping review categorizes techniques for assessing cognitive function into two primary groups: objective assessments (neuropsychological tests) and subjective assessments (patient-reported outcomes (PROs)).

Neuropsychological examinations offer standardized and quantitative evaluations of cognitive functioning. These instruments are employed to assess general cognitive functioning and particular cognitive domains. A variety of neuropsychological assessments have been employed to evaluate overall cognitive functioning. The Montreal Cognitive Assessment was employed in four research.^38–41 Other tools for assessing overall cognitive function include the NIH Toolbox Cognitive Battery (n = 1),³⁷ CNS Vital Signs^® (n = 1),³⁸ and Neuropsychological Assessment Battery³⁶ (n = 1).

In addition to the overall assessment, studies have targeted specific cognitive domains. In the area of memory functioning, assessment tools for verbal learning and memory include the Hopkins Verbal Learning Test,³⁶ Rey Auditory Verbal Learning Test,⁴² California Verbal Learning Test⁴³ (each in one study), Selective Reminding Task,^44,45 and Verbal Learning Memory Test^36,46 (both in two studies). The Auditory Consonant Trigrams Test⁴⁷ (n = 1) was also used in this domain. For the assessment of visuospatial memory, Rey-Osterrieth Complex Figure,⁴⁶ the Corsi Block-Tapping Test,⁴² and the Brief Visuospatial Memory Test, Revised⁴³ (each in one study) were used. Executive power was assessed by the Trail Making Test^{42,45,47,49,50} (n = 5), and attention instruments included the Digit Span Task,^42,44–46 the Paced Auditory Serial Addition Test⁴⁸ (n = 1), the Brief Test of Attention^44,45 (n = 2), and the Stroop Colour Word Test⁴² (n = 1). Processing speed was assessed with instruments such as the Digit Symbol Substitution Test⁴² (n = 1) and the Symbol Digit Modalities Test⁴³ (n = 1). In addition, Verbal Fluency Test⁴² (n = 1) and Rey-Osterrieth Complex Figure⁴⁶ (n = 1) were used to assess verbal function and visuospatial function.

Subjective assessments, known as PROs, assess patients’ self- perceived cognitive changes and complaints. In terms of overall cognitive functioning, the most frequently used PRO is the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog),^{37,38,42–46,49–53} which was used in 12 studies. Other PROs include the PROMIS Applied Cognition⁵¹ (n = 1) and the Cognitive Failures Questionnaire^24,48 (n = 2).

Effectiveness of digital health interventions

In 18 studies,^{24,37,39–42,44–47,49–52,55} the results showed that DHIs had a significant improvement in the cognitive functioning of breast cancer patients. Among them, six studies^{36,37,42,43,51,53} also found that DHIs were effective in improving patients’ mood states, and the improvement in mood in turn facilitated the recovery of cognitive functioning, creating a virtuous cycle. In addition, two studies^42,53 showed that breast cancer patients’ quality of life was significantly improved after receiving DHIs. Meanwhile, five studies^39–42,52 found that patients’ satisfaction and compliance with DHIs were high, further demonstrating the feasibility and effectiveness of this intervention program.

Discussion study summary

This study comprehensively analyzes the existing status of DHIs for CRCI among individuals with breast cancer via a scoping review. The findings reveal that DHI techniques include a diverse array of technological methods and content components, integrating modalities such as computer technology, VR, and robotics. These interventions incorporate many BCTs, such as goal setting, feedback monitoring, and social support. The therapies significantly enhanced cognitive impairment in breast cancer patients, especially in the areas of attention, memory, and executive function. Technological Approaches in Digital Health Interventions.

The predominant technologies utilized in DHIs for CRCI in breast cancer patients are computer-based technologies, VR, and robots, with computerized technology representing 78.94% of all interventions. Computerized cognitive training delivers individualized rehabilitation programs using software and interactive challenges, ensuring significant flexibility, repeatability, and real-time progress assessment.⁵⁴ Widely used software systems like HappyNeuron and BrainHQ facilitate the training of attention, memory, and executive functions, employing gamification to enhance patient engagement and therapeutic results.⁵² Moreover, computerized technologies can be incorporated into multi-module, stratified care frameworks. The ICOnnecta't program integrates advanced digital interventions with cognitive modules, resulting in notable cognitive enhancements and decreased healthcare expenditures.⁴² Future research ought to concentrate on investigating the synergistic effects of multidimensional interventions, such as the integration of cognitive training with psychological support or physical rehabilitation, and formulating standardized, tiered intervention protocols customized for patients at various stages of disease.

Virtual reality and robotics in cognitive rehabilitation

VR provides an immersive training environment that markedly enhances cognitive function and daily life skills in breast cancer patients. Research indicates that VR therapies significantly enhance visuospatial abilities, attention, and memory, hence increasing cognitive functions and self-management skills.^39,40 Additionally, the use of robotics, such as the BrightArm Duo system, has expanded intervention dimensions by incorporating real-time feedback and personalized training.³⁶ The BrightArm Duo system aims to rehabilitate upper limb motor function while concurrently providing cognitive training and emotional support via gamified tasks and VR environments.⁵⁶ Future research should investigate the amalgamation of cognitive and affective therapies in rehabilitation to improve patient experiences and outcomes.

Content elements of digital health interventions

DHIs focus on six essential cognitive domains: attention, memory, executive functions, language, logic and numeracy, and visuospatial orientation. These domains are trained in a variety of ways, such as attention training through visual tracking tasks to improve concentration,⁴⁹ and memory training through memory games and repetitive exercises to enhance memory capacity and efficiency.^24,48 In executive training, the combination of gamified design (e.g. “Towers of Hanoi”) and social interaction (Zoom group tasks)^38,52 significantly improves long-term adherence and treatment outcomes. This design methodology not only augmented the enjoyment of the tasks but also elevated the patients’ sense of belonging and participation through social interactions, so enhancing the overall therapy experience. The DHI significantly enhanced attention, memory, and executive function, offering patients an effective and sustainable treatment plan via Internet-based cognitive behavioral therapy, gamified design, and real-time feedback mechanisms. Future study should investigate the customization of personalized DHIs to align with the distinct needs and contexts of patients. For instance, creating more specialized training modules and task designs for patients of varying age demographics or disease classifications.

Behavior change techniques in digital health interventions

This analysis thoroughly analyzed the BCTs employed in DHIs for cognitive rehabilitation in breast cancer patients. The findings suggest that intervention strategies employ a diverse array of multidimensional methodologies to enhance cognitive function. “Goal setting and planning” evolved as a fundamental method, assisting patients in elucidating intervention aims and augmenting adherence through the establishment of specific cognitive goals (e.g. enhancing attention or memory). This corresponds with prior research indicating that goal-oriented interventions can significantly enhance self-efficacy.⁴² Furthermore, “feedback and monitoring” facilitates real-time data tracking via workbooks and online platform records, enabling patients to dynamically modify training intensity. Research has also demonstrated that these strategies can improve behavioral maintenance through instant feedback.^38,52 Social support, as a prevalent method, alleviates patients’ psychological stress via emotional and informational assistance (e.g. group interactions, therapist guidance), potentially enhancing cognitive symptoms and underscoring the significance of psychosocial factors in CRCI interventions.⁴² Significantly, procedures like “knowledge shaping” (n = 10) and “behavioral comparison” (n = 8) may assist patients in developing adaptive strategies through cognitive training instruction and role modeling.⁵⁷ Conversely, “Repetition and Substitution” amalgamates many therapies, including cognitive stimulation and physical activity, or amplifies the efficacy of interventions via neuroplasticity mechanisms.^58,59 In contrast, the low utilization of “conditioning” and “antecedent” techniques suggests the need to further explore the mechanisms and scenarios of relaxation training and environmental adjustment in CRCI.⁶⁰ Despite the fact that most of the existing studies used comprehensive BCTs, extrinsic motivators such as “rewards” (n = 7) were less frequently used, which may limit long-term behavioral maintenance.^21,61 Future research should investigate methods to enhance long-term patient engagement and adherence via extrinsic motivators (e.g. incentives), while employing digital platforms to deliver real-time feedback and facilitate dynamic adjustments in training intensity may significantly improve intervention efficacy. Augmented emotional and informational support (e.g. group engagement, therapist advice) can mitigate patients’ psychological stress and indirectly enhance cognitive symptoms.

Challenges and future directions

While current research has shown the substantial impact of DHIs on enhancing cognitive impairment in breast cancer patients, numerous problems and limits persist. Cognitive functioning is frequently neglected, mostly due to the absence of defined protocols, inadequate awareness of cognitive effects among healthcare providers, limitations in resources and time, and the unavailability of suitable assessment instruments.⁴² Secondly, while research indicates that older breast cancer patients exhibit greater acceptance and compliance with digital cognitive stimuli, variations among distinct patient demographics may influence the acceptance rate.⁵² In the future, it is essential to create more intuitive interfaces (e.g. streamlined operating procedures) and assess the efficacy of long-term incentives. Simultaneously, technical obstacles (e.g. device compatibility, financial constraints) must be resolved to mitigate the digital divide.⁶² Moreover, despite the convenience and cost-effectiveness of DHIs, patients may encounter issues with device and network access or a lack of familiarity with digital tools, thereby constraining the generalizability of the intervention. The constraints of assessment instruments and the intricate influence of several factors (e.g. chemotherapy, endocrine therapy, psychological condition, etc.) on cognitive performance pose problems for intervention development.^63–65 While short-term impacts have been evidenced, long-term effects require further validation, and the majority of existing studies have concentrated on short-term observations, missing longitudinal research extending five years or beyond. Moreover, extensive investigations of DHIs remain constrained by resources and financing, thus restricting the scope and depth of the studies, thereby impacting the comprehensiveness and trustworthiness of the findings. Future research must address these challenges by enhancing intervention programs, increasing sample numbers, and investigating long-term impacts to improve the efficacy and generalizability of therapies.

In contemplating the future advancement of DHIs for breast cancer patients, several critical directions warrant attention. Initially, the design of tailored interventions is crucial for enhancing outcomes. Patients with breast cancer exhibit varying forms of cognitive impairment, making it essential to tailor interventions according to their cognitive function and specific requirements. Employing artificial intelligence and big data analytics to monitor patients’ cognitive alterations in real time and adapt intervention tactics accordingly can enhance the precision and efficacy of therapies. The creation and execution of DHIs necessitate interdisciplinary cooperation. Interdisciplinary collaboration among medicine, nursing, psychology, and computer science, particularly in data collecting, analysis, and privacy protection, will establish a more robust foundation for future interventions. Consequently, interdisciplinary collaboration will be essential for the effective implementation of DHIs. Third, while current research has offered initial indications that DHIs can enhance cognitive function, the precise pathways are not fully elucidated. Future research should concentrate on boosting cognitive ability through the stimulation of neuroplasticity and the optimization of brain network coordination, thereby elucidating its biological foundations and offering theoretical support for intervention strategies. The long-term consequences of DHIs and patient satisfaction are critical factors that must not be overlooked. Notwithstanding the substantial immediate results of the intervention, the patients’ acceptance and happiness, along with the sustainability of the long-term impacts, remain critical inquiries that require urgent exploration in forthcoming investigations. Consequently, longitudinal follow-up studies and patient feedback will be essential to refine the intervention program and augment its practical applicability.

Strengths and limitations

This study, unlike other systematic studies, further demonstrates the capacity of DHIs to include various BCTs. Conventional non-pharmacological interventions (e.g. psychoeducation, fitness programs), while demonstrated to be successful, do not possess the personalized and data-informed attributes of DHIs. This paper is the inaugural systematic summary of the application model of BCTs, addressing the research gap in CRCI management. The review indicated that DHIs markedly enhanced cognitive functioning, especially in the areas of attention, memory, and executive functioning. Moreover, research has highlighted the beneficial effects of DHIs on emotional well-being and overall quality of life, with numerous studies indicating elevated patient satisfaction and adherence to DHIs. Nonetheless, limits in research persist. The significant heterogeneity among the included studies, characterized by substantial variations in sample size and intervention duration, may compromise the generalizability of the findings. Additionally, the absence of long-term follow-up data, particularly regarding the validation of effects beyond 1 year, constrains the evaluation of the enduring impacts of DHIs. Moreover, technological obstacles (e.g. device compatibility, financial constraints) and variations among patient demographics (e.g. age, digital literacy) may have resulted in disparate rates of intervention adoption, while insufficient descriptions of BCTs in certain trials exacerbated the challenges of coding and analysis. The variety of cognitive function testing techniques and the intricate influence of confounding variables (e.g. chemotherapy, psychological condition) may undermine the trustworthiness of the results.

Conclusion

DHIs present a viable strategy for addressing Cognitive Impairment related to Cancer in breast cancer patients. This scoping study indicates that DHIs, utilizing technologies such computerized cognitive training, VR, and robots, can markedly enhance cognitive performance, emotional well-being, and overall quality of life. By incorporating diverse BCTs, these therapies foster patient involvement and adherence, hence augmenting their overall efficacy. Nonetheless, obstacles including the absence of standardized evaluation instruments, study variability, and insufficient long-term data persist. Future study ought to concentrate on creating standardized cognitive evaluation instruments, examining long-term impacts, and tackling the digital divide to enhance accessibility. It is essential to investigate personalized, interdisciplinary strategies that integrate cognitive training, psychological support, and physical rehabilitation to enhance the efficacy of DHIs for breast cancer patients.

Supplemental Material

sj-docx-1-dhj-10.1177_20552076251358297 - Supplemental material for Digital health interventions for cancer-related cognitive impairment in breast cancer patients: A scoping review

Supplemental material, sj-docx-1-dhj-10.1177_20552076251358297 for Digital health interventions for cancer-related cognitive impairment in breast cancer patients: A scoping review by Ying-Xiang Chen, You Zhou, Xiao-Lan Zhang, Wen-yan He, Qin Ye and Min Xu in DIGITAL HEALTH

Supplemental Material

sj-pdf-2-dhj-10.1177_20552076251358297 - Supplemental material for Digital health interventions for cancer-related cognitive impairment in breast cancer patients: A scoping review

Supplemental material, sj-pdf-2-dhj-10.1177_20552076251358297 for Digital health interventions for cancer-related cognitive impairment in breast cancer patients: A scoping review by Ying-Xiang Chen, You Zhou, Xiao-Lan Zhang, Wen-yan He, Qin Ye and Min Xu in DIGITAL HEALTH

Footnotes

Acknowledgment

The author thanked all.

ORCID iD

Ying-Xiang Chen

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Zhejiang Province Science and Technology Plan Project (Grant Number: 2023C03165).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Credit author statement

All authors were involved in the conceptualization and design of the study. YXC was responsible for the study design, developing the literature search strategy, literature search, data extraction and writing the first draft. YZ was responsible for the literature search, data extraction and writing part of the first draft.MX, XLZ, WYH, and QY were responsible for providing their expertise, making suggestions and critically revising the first draft.

Supplemental material

Supplemental material for this article is available online.

References

Kuchenbaecker

Hopper

Barnes

, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. Jama 2017; 317: 2402–2416.

. Epidemiologic trends and prevention and control insights of breast cancer globally and in China: an interpretation of the global cancer statistics report 2018–2022. Chin Basic Clin J Gen Surg 2024; 31: 796–802.

Janelsins

Kesler

Ahles

, et al. Prevalence, mechanisms, and management of cancer-related cognitive impairment. Int Rev Psychiatry 2014; 26: 102–113.

McDonald

Clark

Tchou

, et al. Clinical diagnosis and management of breast cancer. J Nucl Med 2016; 57: 9s–16s.

Tao

Gandomkar

, et al. Incidence, mortality, survival, and disease burden of breast cancer in China compared to other developed countries. Asia Pac J Clin Oncol 2023; 19: 645–654.

Bishop

. The Consequences of Self-Objectification: Investigating the Impact of Body Image on Female Sexual Functioning (BA). Muncie, IN: Ball state University, 2015.

Sebri

Durosini

Pravettoni

. How to address the body after breast cancer? A proposal for a psychological intervention focused on body compassion. Front Psychol 2022; 13: 1085837.

Ramseier

Ferreira

Leventhal

. Dermatologic toxicities associated with radiation therapy in women with breast cancer. Int J Womens Dermatol 2020; 6: 349–356.

Cathcart-Rake

Tevaarwerk

Haddad

, et al. Advances in the care of breast cancer survivors. Br Med J 2023; 382: e071565.

10.

Ahles

Root

Ryan

. Cancer- and cancer treatment-associated cognitive change: an update on the state of the science. J Clin Oncol 2012; 30: 3675–3686.

11.

Oliva

Giustiniani

Danesin

, et al. Cognitive impairment following breast cancer treatments: an umbrella review. Oncologist 2024; 29: e848–e863.

12.

Janelsins

Kohli

Mohile

, et al. An update on cancer- and chemotherapy-related cognitive dysfunction: current status. Semin Oncol 2011; 38: 431–438.

13.

Semendric

Pollock

Haller

, et al. “Chemobrain” in childhood cancer survivors-the impact on social, academic, and daily living skills: a qualitative systematic review. Support Care Cancer 2023; 31: 532.

14.

Bray

Dhillon

Vardy

. Systematic review of self-reported cognitive function in cancer patients following chemotherapy treatment. J Cancer Surviv 2018; 12: 537–559.

15.

Merceur

Reilly

Bonan

, et al.

A systematic review of rehabilitation programs for cognitive impairment related to breast cancer: different programs at different times?

Ann Phys Rehabil Med 2024; 67: 101832.

16.

Denlinger

Sanft

Moslehi

, et al. NCCN Guidelines insights: survivorship, version 2.2020. J Natl Compr Canc Netw 2020; 18: 1016–1023.

17.

Chan

McCarthy

Devenish

, et al. Systematic review of pharmacologic and non-pharmacologic interventions to manage cognitive alterations after chemotherapy for breast cancer. Eur J Cancer 2015; 51: 437–450.

18.

Liu

Chen

, et al. Effectiveness of nonpharmacologic interventions for chemotherapy-related cognitive impairment in breast cancer patients: a systematic review and network meta-analysis. Cancer Nurs 2023; 46: E305–e319.

19.

Park

Jung

Lee

, et al. Impact of nonpharmacological interventions on cognitive impairment in women with breast cancer: a systematic review and meta-analysis. Asia Pac J Oncol Nurs 2023; 10: 100212.

20.

Mackenzie

Marshall

. Effective non-pharmacological interventions for cancer related cognitive impairment in adults (excluding central nervous system or head and neck cancer): systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58: 258–270.

21.

Liu

Sun

, et al. Mapping the landscape of digital health intervention strategies: 25-year synthesis. J Med Internet Res 2025; 27: e59027.

22.

Kirsch

Kunte

, et al. Digital health platforms for breast cancer care: A scoping review. J Clin Med 2024; 13: 1937.

23.

Triberti

Durosini

La Torre

, et al. Artificial intelligence in healthcare practice: how to tackle the “Human” challenge. In: Lim

C-P

Chen

Y-W

Vaidya

, et al. (eds) Handbook of artificial intelligence in healthcare: vol 2: practicalities and prospects. Cham: Springer International Publishing, 2022, pp.43–60.

24.

Bellens

Roelant

Sabbe

, et al. A video-game based cognitive training for breast cancer survivors with cognitive impairment: a prospective randomized pilot trial. Breast 2020; 53: 23–32.

25.

Wang

Zhang

, et al. Web-based cognitive interventions on subjective cognitive impairment in cancer survivors: a systemic review. Int J Nurs Sci 2024; 11: 429–438.

26.

Michie

Richardson

Johnston

, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013; 46: 81–95.

27.

Carey

Connell

Johnston

, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med 2019; 53: 693–707.

28.

Gooch

Jarvis

Stockley

. Behavior change approaches in digital technology-based physical rehabilitation interventions following stroke: scoping review. J Med Internet Res 2024; 26: e48725.

29.

Thomas

Curtis

Potts

HWW

, et al. Behavior change techniques within digital interventions for the treatment of eating disorders: systematic review and meta-analysis. JMIR Ment Health 2024; 11: e57577.

30.

Zhou

Huang

, et al. Behavior change techniques used in self-management interventions based on mHealth apps for adults with hypertension: systematic review and meta-analysis of randomized controlled trials. J Med Internet Res 2024; 26: e54978.

31.

Kebede

Liedtke

Möllers

, et al. Characterizing active ingredients of eHealth interventions targeting persons with poorly controlled type 2 diabetes Mellitus using the behavior change techniques taxonomy: scoping review. J Med Internet Res 2017; 19: e348.

32.

Richardson

Jospe

Saleh

, et al. Use of biological feedback as a health behavior change technique in adults: scoping review. J Med Internet Res 2023; 25: e44359.

33.

Colquhoun

Levac

O'Brien

, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol 2014; 67: 1291–1294.

34.

Lockwood

Dos Santos

Pap

. Practical guidance for knowledge synthesis: scoping review methods. Asian Nurs Res (Korean Soc Nurs Sci) 2019; 13: 287–294.

35.

Amir-Behghadami

Janati

. Population, intervention, comparison, outcomes and study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J 2020; 37: 387.

36.

House

Burdea

Grampurohit

, et al. A feasibility study to determine the benefits of upper extremity virtual rehabilitation therapy for coping with chronic pain post-cancer surgery. Br J Pain 2016; 10: 186–197.

37.

Neville

Bernstein

Sabiston

, et al. Feasibility of a remotely-delivered yoga intervention on cognitive function in breast cancer survivors: a mixed-methods study. Front Cogn 2023; 2. DOI: https://doi.org/10.3389/fcogn.2023.1286844.

38.

Binarelli

Lange

Dos Santos

, et al. Multimodal web-based intervention for cancer- related cognitive impairment in breast cancer patients: Cog-Stim feasibility study protocol. Cancers (Basel) 2021; 13: 4868.

39.

Yang

. Application of a virtual reality-based cognitive rehabilitation training model in breast cancer CRCI patients. Gen Pract Nurs 2023; 21: 4340–4344.

40.

Chen

Jin

Zhu

, et al. Application of virtual cognitive rehabilitation training in patients with chemotherapy-related cognitive impairment in breast cancer. Chin J Nurs 2019; 54: 664–668.

41.

Yang

Wang

Wei

, et al. Application of virtual cognitive rehabilitation training in patients with chemotherapy-related cognitive impairment in breast cancer. Qilu Nurs J 2021; 27: 159–162.

42.

Serra-Blasco

Souto-Sampera

Medina

, et al. Cognitive-enhanced eHealth psychosocial stepped intervention for managing breast cancer-related cognitive impairment: protocol for a randomized controlled trial. Digit Health 2024; 10: 20552076241257082.

43.

Ferguson

Sigmon

Pritchard

, et al. A randomized trial of videoconference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfunction. Cancer 2016; 122: 1782–1791.

44.

Von Ah

Crouch

Storey

. Acceptability of computerized cognitive training and global cognitive stimulating-based games delivered remotely: results from a randomized controlled trial to address cancer and cancer-related cognitive impairment in breast cancer survivors. Cancer Med 2023; 12: 12717–12727.

45.

Vega

Newhouse

Conley

, et al. Use of focused computerized cognitive training (Neuroflex) to improve symptoms in women with persistent chemotherapy-related cognitive impairment. Digit Health 2023; 9: 20552076231192754.

46.

Kleinknecht

Bierend

Keim

, et al. Computerized cognitive training improves cognitive function in primary breast cancer survivors. NPJ Breast Cancer 2024; 10: 85.

47.

Galiano-Castillo

Arroyo-Morales

Lozano-Lozano

, et al. Effect of an internet-based telehealth system on functional capacity and cognition in breast cancer survivors: a secondary analysis of a randomized controlled trial. Support Care Cancer 2017; 25: 3551–3559.

48.

Damholdt

Mehlsen

O'Toole

, et al. Web- based cognitive training for breast cancer survivors with cognitive complaints-a randomized controlled trial. Psychooncology 2016; 25: 1293–1300.

49.

González-Santos

Lopez-Garzon

Sánchez-Salado

, et al. A telehealth-based cognitive-adaptive training (e-OTCAT) to prevent cancer and chemotherapy-related cognitive impairment in women with breast cancer: Protocol for a randomized controlled trial. Int J Environ Res Public Health 2022; 19: 7147.

50.

Myers

Pathak

, et al. Combined exercise and game-based cognitive training intervention: Correlative pilot study of neurotrophic and inflammatory biomarkers for women with breast cancer. Cancer Nurs 2022; 10.

51.

Myers

Cook-Wiens

Baynes

, et al. Emerging from the haze: a multicenter, controlled pilot study of a multidimensional, psychoeducation-based cognitive rehabilitation intervention for breast cancer survivors delivered with telehealth conferencing. Arch Phys Med Rehabil 2020; 101: 948–959.

52.

Binarelli

Lange

Santos

, et al. Digital cognitive stimulation in elderly breast cancer patients: the cog-tab-age feasibility study. BMC Complement Med Ther 2024; 24: 209.

53.

Freeman

White

Ratcliff

, et al. A randomized trial comparing live and telemedicine deliveries of an imagery-based behavioral intervention for breast cancer survivors: reducing symptoms and barriers to care. Psychooncology 2015; 24: 910–918.

54.

Hill

Mowszowski

Naismith

, et al. Computerized cognitive training in older adults with mild cognitive impairment or dementia: a systematic review and meta-analysis. Am J Psychiatry 2017; 174: 329–340.

55.

Aliwi

Schot

Carrabba

, et al. The role of immersive virtual reality and augmented reality in medical communication: A scoping review. J Patient Exp 2023; 10. DOI:https://doi.org/10.1177/23743735231171562

56.

, et al. The effectiveness of virtual reality-based interventions in rehabilitation management of breast cancer survivors: systematic review and meta- analysis. JMIR Serious Games 2022; 10: e31395.

57.

Syed Alwi

Mazlan

Mohd Taib

, et al. A Delphi technique toward the development of a cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy. PLoS One 2022; 17: e0277056.

58.

Oldacres

Hegarty

O'Regan

, et al. Interventions promoting cognitive function in patients experiencing cancer related cognitive impairment: a systematic review. Psychooncology 2023; 32: 214–228.

59.

Robertson

Cox-Martin

Basen-Engquist

, et al. Reflective engagement with a digital physical activity intervention among people living with and beyond breast cancer: mixed methods study. JMIR Mhealth Uhealth 2024; 12: e51057.

60.

Eccles

Aboagye

Ali

, et al. Critical research gaps and translational priorities for the successful prevention and treatment of breast cancer. Breast Cancer Res 2013; 15: R92.

61.

Chow

Showalter

Gerber

, et al. Use of mental health apps by patients with breast cancer in the United States: pilot Pre-post study. JMIR Cancer 2020; 6: e16476.

62.

Maggio

De Bartolo

Calabrò

, et al. Computer-assisted cognitive rehabilitation in neurological patients: state-of-art and future perspectives. Front Neurol 2023; 14: 1255319.

63.

Saita

Amano

Kaneko

, et al. A scoping review of cognitive assessment tools and domains for chemotherapy-induced cognitive impairments in cancer survivors. Front Hum Neurosci 2023; 17: 1063674.

64.

Zhou

Zhang

Zhong

, et al. Prevalence and associated factors of chemotherapy-related cognitive impairment in older breast cancer survivors. J Adv Nurs 2024; 80: 484–499.

65.

Crouch

Champion

Von Ah

. Cognitive dysfunction in older breast cancer survivors: an integrative review. Cancer Nurs 2022; 45: E162–e178.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

0.11 MB