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Mitigating Brain Fog Through Cognitive Training: A 3-Arm RCT in Breast Cancer Survivors

Poster Session F - Tuesday, March 10, 2026, 8:00 – 10:00 am PDT, Fairview/Kitsilano Ballroom

Erin Venza¹ (); ¹The University of Texas at Dallas

One in three breast cancer survivors experience persistent “chemo brain,” with difficulties often undetected by standard cognitive tests. This highlights the need for sensitive metrics and scalable solutions. Intervention studies have largely focused on bottom-up approaches because of their scalability, while strategy-based and psychoeducational models remain less examined. This study moves the field forward by directly comparing these approaches to show how each may support cognitive health and quality of life after breast cancer. This study compared three online interventions: Top-Down (SMART+), Bottom-Up (BrainHQ), and self-directed Psychoeducation. Prior to randomization, participants were stratified by age, time since chemotherapy, education, and degree of cognitive complaint. Female breast cancer survivors (N = 134) completed assessments at pre-, post-, and delayed post-training. The primary outcome was the BrainHealth Index, with associated factor scores of Clarity, Connectedness, and Emotional Balance. Secondary outcomes included processing speed, memory, attention, and self-reported cognitive complaints. Group × time effects emerged only for processing speed: Bottom-Up participants showed strong practice-related gains (p < .001), and Top-Down participants demonstrated delayed improvements on this untrained measure versus Psychoeducation (p = .04). BrainHealth Index gains appeared at post-training for Top-Down and Psychoeducation (p ≤ .01) and at delayed for Bottom-Up (p = .02). Attention and self-report improvements occurred across all groups; memory did not change. Overall, findings reveal distinct yet complementary routes to recovery. Top-Down produced cross-domain improvements, Bottom-Up yielded dose-linked cognitive gains, and Psychoeducation enhanced holistic well-being. Results demonstrate the utility of scalable interventions to mitigate cognitive deficits in cancer survivors.

Topic Area: THINKING: Other