Dr. Martin Harutyunyan
Cancer related cognitive impairment remains one of the most challenging and clinically meaningful issues in survivorship care. Many individuals living with and beyond cancer continue to experience changes in thinking and daily cognitive performance long after treatment ends. These difficulties affect independence, functioning, and quality of life, yet structured and scalable interventions have been limited. This makes the recent work around cognitive rehabilitation especially important because it offers a multidimensional and evidence based approach to a problem that has long lacked accessible solutions.
In this episode of MASCC’s Supportive Care Digest, Dr. Martin Harutyunyan, medical oncologist, palliative care specialist, and Director of OncoDaily LA, reviews the randomized pilot of Emerging From the Haze, published in the Oncology Nursing Forum. Developed by experts in oncology rehabilitation, neuropsychology, and survivorship care at Cedars Sinai Medical Center and the University of Kansas Cancer Center, Emerging From the Haze is a standardized cognitive rehabilitation program designed for cancer survivors experiencing cognitive challenges after treatment.
The program integrates neuroplasticity education, stress physiology, sleep and exercise guidance, nutrition, cognitive strategies, pacing, problem solving, and the role of loneliness in cognitive well being. Earlier work demonstrated that this approach can improve perceived cognitive function and can be delivered through telehealth. The recent pilot evaluated whether the program could be delivered fully virtually in both live and prerecorded formats while maintaining feasibility and clinical benefit.
The study enrolled survivors of solid tumors and lymphoma who reported cognitive concerns after completing chemotherapy. Participants were randomized to virtual live delivery, virtual prerecorded delivery, or waitlist control. The ten week program covered core elements of cognitive rehabilitation, and assessments were conducted at baseline, at program completion, and four weeks later. Outcomes included perceived cognitive function, physical activity, sleep quality, mood, loneliness, mindfulness, intention to change behavior, and health related quality of life.
Virtual delivery was feasible with strong recruitment, high retention, and positive satisfaction across both formats. Live delivery produced clear improvement in perceived cognitive abilities immediately after the program. Prerecorded delivery also improved perceived cognitive function and demonstrated additional gains in physical activity, sleep quality, and mental aspects of health related quality of life at follow up.
Both formats reduced loneliness, an important contributor to cognitive symptoms. These findings reinforce the importance of addressing biological and psychosocial factors together when supporting cognitive recovery. The authors of Emerging From the Haze have contributed a meaningful advance in survivorship care by demonstrating that cognitive rehabilitation can be delivered virtually, effectively, and at scale.
A complementary biologic approach known as transcranial photobiomodulation is being evaluated through a randomized and blinded study. This method uses gentle red and near infrared light to support mitochondrial activity, improve cerebral blood flow, and encourage neuroplasticity. The trial aims to determine whether biologic and behavioral approaches can work together to enhance cognitive recovery.
Emerging From the Haze represents a promising step toward accessible and evidence-based cognitive rehabilitation for cancer survivors. As research continues, programs like this may become essential components of comprehensive supportive care, helping individuals navigate cognitive changes with structure, clarity, and meaningful support.