Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Florence Joly, Centre Francois Baclesse, France
- Second opponent: Associate Professor Kathrin Kirchheiner, Medical University of Vienna, Austria
- Third member and chair of the evaluation committee: Professor Peter Fedorcsak, University of Oslo
Chair of the Defence
Professor II Marie Ellstrøm Engh, University of Oslo
Principal Supervisor
Professor II Kristina Lindemann, University of Oslo
Summary
This thesis investigates cancer-related cognitive impairment (CRCI) after cervical cancer treatment and evaluates digital cognitive interventions as a potential therapy. It asks: (1) how prevalent are subjective CRCI complaints and how do they relate to fatigue, anxiety, and depression; (2) how do complaints correspond to objectively measured impairment; and (3) are digital interventions feasible and acceptable for cervical cancer survivors with CRCI?
The cohort included 254 cervical cancer survivors treated with curative intent (chemoradiotherapy or surgery) at Oslo University Hospital between 2000 and 2018. Self-reported cognition and associated symptoms were assessed via questionnaires (Paper I). A subgroup of 65 survivors underwent comprehensive neuropsychological testing, compared with normative data and 74 age-matched healthy controls (Paper II). Finally, in a randomized pilot study, 35 survivors received either digitally delivered Goal Management Training or computerized cognitive training over six weeks (Paper III).
Overall, 42.5% reported significant CRCI, particularly among those treated with chemoradiotherapy, where symptoms strongly co-occurred with fatigue, anxiety, and depression. Neuropsychological testing showed that about one-third of survivors with subjective complaints also displayed measurable deficits compared to healthy controls. This suggests that subjective and objective measures tap different aspects of cognition. Both digital interventions were feasible, well-accepted, and showed improvements in memory, attention, and self-reported executive function.
In conclusion, CRCI is a common, persistent late effect in cervical cancer survivors. Systematic assessment of subjective complaints should be integrated into follow-up care, and if needed, supplemented with neuropsychological assessment. Digital cognitive interventions show promise as targeted supportive care strategies, warranting further evaluation in larger randomized controlled trials.
Additional information
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