Background: Cancer-related cognitive impairment (CRCI) is a significant concern for individuals with non-central nervous system (non-CNS) cancers, affecting memory, attention, executive functions, and processing speed. Non-pharmacological interventions, including digital cognitive rehabilitation, have shown promise in addressing CRCI. This systematic review investigates the efficacy of digital and computerized cognitive rehabilitation interventions in improving cognitive outcomes in non-CNS cancer patients. Method: A systematic search of the EMBASE, Scopus, and PubMed databases was conducted to identify studies on digital and computerized cognitive rehabilitation for non-CNS cancer patients. Studies were included if they involved computerized and digital cognitive rehabilitation for oncological patients and assessed the efficacy of the intervention. A total of 11 studies were selected, including randomized controlled trials and quasi-experimental designs. The quality of the studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data was synthesized using a narrative descriptive approach, and the results were summarized in a descriptive table. Results: The most frequently assessed cognitive domains included working memory, attention, executive functions, and processing speed. The majority of studies (n = 11) demonstrated significant immediate improvements in cognitive functions, particularly in working memory, executive functions, attention, and processing speed. Short-term follow-up (1–5 months) showed partial maintenance of these improvements, while long-term effects (6 months to 1 year) were more variable. Improvements in episodic memory were less consistent, particularly among breast cancer survivors. Discussion: Digital and computerized cognitive rehabilitation appears to be an effective intervention for CRCI, providing immediate cognitive benefits and some lasting improvements, especially in domains such as memory and attention. However, long-term effects remain variable, and further research is needed to explore the optimal duration of interventions and the potential advantages of personalized rehabilitation approaches.

Objectives: To systematically review the evidence on the effectiveness of patient decision aids (PDAs) for women with early stage breast cancer, focusing on decision-making outcomes, psychological variables, and quality of life. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PUBMED, EMBASE and SCOPUS databases were searched to identify quantitative, qualitative and mixed-methods studies evaluating PDAs designed to support treatment decision-making in women with early stage breast cancer. Eligible studies included randomized controlled trials, quantitative, qualitative and mixed-methods studies. Outcomes of interest included knowledge, decisional conflict, Shared Decision-Making (SDM), anxiety, depression, and quality of life. Special focus has been given to lower Socio-Economic Status (SES) and lower literacy populations. Results: Twenty-six studies (5174 participants) met inclusion criteria. PDAs were associated with reduced decisional conflict (6 of 7 studies), improved satisfaction with the decision or decision-making process (4 studies), and enhanced knowledge (4 of 8 studies showing statistically significant improvement). No consistent adverse effects on anxiety or depression were observed. Ten studies focused on lower SES or low-literacy populations, highlighting the effectiveness of pictorial and simplified PDAs in improving knowledge, SDM, and reducing decisional regret. Qualitative findings indicated high acceptability but identified barriers related to timing and institutional implementation. Conclusions: PDAs for women with early stage breast cancer enhance knowledge and support informed, value-congruent treatment decisions. However, evidence regarding their impact on psychological well-being and long-term quality of life remains inconclusive. Further research should also address institutional implementation policies.

Introduction Early breast cancer (BC) detection enhances survival, with treatment options influenced by cancer stage, pathological characteristics and patient preferences. Patient decision aids (PDAs) promote shared decision-making (SDM), enhancing patients’ engagement, adherence to treatment and satisfaction. However, few PDAs for early-stage BC patients exist in the Italian context. Methods and analysis A first developmental phase will include a systematic review on current PDAs and semistructured interviews with patients and healthcare professionals. Outcomes will be used to develop a first draft of PDA. Following international guidelines, the PDA will be sent to patients to gather first qualitative feedback and subsequently quantitative feedback regarding the attractiveness, usability and comprehensibility of the tool and patients’ health literacy. Once having reached a final version of PDA, a pilot randomised controlled trial study will be implemented: a control group will receive standard care (n=75) and an experimental group (n=75) will receive standard care and the PDA. Depression, anxiety, SDM, quality of life (QoL) and distress levels will be assessed through validated questionnaires in both groups at three different time points. Measures will include attractiveness, usability and comprehensibility of the PDA as well as efficacy measures assessed through evaluation of patients’ levels of anxiety, depression, distress and QoL. Ethics and dissemination This protocol was approved by the ethical committee Comitato Etico Territoriale Lombardia 2 of the Istituto di Ricovero e Cura a Carattere Scientifico European Institute of Oncology (L2-253; approved in November 2024). All participants will be given written and verbal information, and informed consent will be obtained from all participants across all phases of our project. Participation in the study will be fully voluntary. All the methodologies mentioned in this protocol will be carried out according to both national and international declarations, guidelines and regulations compliant with proper ethical research involving human subjects. Results will be published in peer-reviewed journals, through traditional academic pathways. This protocol study has been registered on clinicaltrials.gov in January 2025 (Identifier: NCT06762496). Trial registration number NCT06762496.

Introduction: A diagnosis of early‐stage Breast Cancer (BC) induces significant psychological distress in patients, who are then required to make complex treatment decisions. Evidence‐based tools like Patient Decision Aids (PDAs) have been proposed as tools to support communication and Shared Decision‐Making (SDM). However, their successful use in clinical practice depends also on real‐world consultation dynamics. Existing literature suggests that insufficient attention to contextual and user‐centered factors may limit the relevance and uptake of PDAs. A bottom‐up approach grounded in clinical reality may therefore be essential to inform their design and future integration into care. Aims: This study aimed to explore experiences, unmet needs and expectations of both patients and healthcare professionals involved in early‐stage breast cancer care regarding decision‐making support and standard oncological consultations, in order to identify patient‐ and clinician‐derived design requirements for a future PDA supporting shared treatment decision‐making in early‐stage breast cancer. Methodology: We conducted 52 semi‐structured interviews with 20 patients and 32 HCPs at the European Institute of Oncology in Milan from 10 January 2025 to 30 August 2025. Interviews were transcribed and analyzed using thematic analysis, with coding performed by two independent researchers and discrepancies resolved through independent discussion with two other authors. Results: HCPs highlighted three key themes: variability in patient information needs, misconceptions about treatments (especially chemotherapy and radiotherapy), and the multifactorial nature of treatment decisions. Patients emphasized the importance of trust in physicians, the need for practical information on side effects and coping strategies, and the role of peer support, often found through informal networks or social media. These findings identified preliminary requirements for a future PDA: adaptable information depth and timing; plain‐language responses to common misconceptions; structured values‐clarification prompts; practical preparation and side‐effect‐management information; signposting to vetted psychosocial and peer‐support resources. Conclusions: Findings highlight communication challenges and unmet psychosocial and informational needs within standard oncological consultations for early‐stage breast cancer. By grounding decision support development in the perspectives of both patients and healthcare professionals, this study provides formative, pre‐implementation insights to guide the design of PDAs that are responsive to real‐world clinical contexts and patient experiences. Trial Registration: clinicaltrials.gov , identifier: NCT06762496. Registered 7th January 2025 – https://clinicaltrials.gov/study/NCT06762496