Feasibility, adherence, and patient experiences in a pilot randomized trial of home-based cognitive training intervention for gynecologic cancer-related cognitive impairment.

OBJECTIVE: To evaluate feasibility, adherence, and participant experience of home-based cognitive training for gynecologic cancer survivors with cancer-related cognitive impairment (CRCI). METHODS: This was an open-label pilot randomized mixed-methods trial at a tertiary academic cancer center. Eligible participants were gynecologic cancer survivors with screen-positive cognitive concerns after chemotherapy. Participants were randomized 2:1 to 10 weeks of home-based BrainHQ cognitive training or usual care. Feasibility was completion of baseline and week 10 assessments. Adherence was completion of at least 1200 adjusted BrainHQ minutes, corresponding to 80% of the prescribed dose. Post-intervention mixed-methods interviews were analyzed using inductive thematic text analysis. RESULTS: Among 155 patients screened for subjective CRCI, 88 (57%) screened positive, 64 consented, and 60 were randomized to BrainHQ (n = 40) or usual care (n = 20). Overall, 59 of 60 randomized participants (98%) completed baseline and week 10 assessments, exceeding the prespecified 65% feasibility threshold (p < 0.001). Among participants randomized to BrainHQ, median use was 1442 min (IQR 747-1831), and 22 of 40 (55%) met the prespecified adherence threshold. Ten BrainHQ participants completed interviews. Qualitative themes showed that participants were motivated by cognitive concerns, perceived cognitive and functional value, used routine and accountability to support engagement, and were often interested in continued cognitive training. Barriers included time burden, competing health or life demands, and platform frustration. CONCLUSIONS: Trial procedures were feasible, and adherence to the full prescribed BrainHQ dose was variable. Qualitative findings support refinement of intervention dose, adherence support, and participant-facing materials before a larger efficacy trial. CLINICALTRIALS: GOV: NCT06662435.