Online cognitive assessment: Implementation of the Amsterdam Cognition Scan in clinical trials, observational studies and clinical practice.

The ACS is at present used in various clinical trials, such as the SUBITO study on the efficacy of high-dose chemotherapy for high-risk BRCA1-like breast cancer, and the SONIA trial on the efficacy of endocrine therapy plus CDK4/6 in first or second line for hormone positive advanced breast cancer. We monitor cognition using the ACS in the NADINA trial, a multicenter phase 3 trial comparing NeoADjuvant Ipilimumab + Nivolumab versus standard Adjuvant nivolumab in macroscopic stage III melanoma. The ACS will also be part of the Direct-II trial; this study has the aim to test the capacity of short term fasting using a fasting-mimicking-diet (FMD) during neoadjuvant chemotherapy in patients with breast cancer to improve the pathological response rate, improve quality of life including cognition and to interrogate the effect of FMD on local tumor immunity.

At the NKI (and at many other hospitals) routine assessment of health-related quality of life outcomes is part of daily clinical practice. We currently explore the embedding of online cognitive testing within this structure for those patients at risk for cognitive problems.