“Is My Brain Ever Going to Work Fully Again?”: Challenges and Needs of Cancer Survivors with Persistent Cancer-Related Cognitive Impairment

Abstract

Many cancer survivors experience cognitive impairments that impact memory, concentration, speed of information processing, and decision making. These impairments, collectively known as cancer-related cognitive impairments (CRCIs), are a key domain of unmet needs and can significantly impact a cancer survivor’s identity and quality of life. However, there are no purpose-built, multi-domain, needs assessment tools specifically for CRCI. The development of such tools requires an in-depth understanding of cancer survivors’ CRCI-specific challenges and associated needs. This study explored the challenges and associated needs of cancer survivors with persistent CRCI. An in-depth qualitative design using semi-structured interviews with (a) cancer survivors with perceived CRCI (n = 32) and (b) oncology health professionals (n = 19) was utilised. A reflexive thematic analysis of the interviews resulted in five overarching themes: (1) executing regular activities, (2) relational difficulties, (3) occupational functioning, (4) psychological distress, and (5) social functioning, as well as an additional informational needs domain. Ultimately, CRCI was found to directly produce a range of challenges that negatively, and persistently, impact cancer survivors’ quality of life. Cancer survivors were also found to have a range of needs associated with these challenges. This research should be used to inform future challenges and needs assessment tools as well as treatment and supportive care priority areas directly relating to CRCI.

Cancer-related cognitive impairment as a key contributor to psychopathology in cancer survivors: implications for prevention, treatment and supportive care

“…These impairments affect diverse cognitive domains, including memory, reasoning, decision-making, speed of processing, and concentration [ 25 , 26 ]. The onset of these impairments can occur during cancer development, or become noticeable during the treatment or the post-treatment phase, and can last up to 20 years post-treatment and following cancer elimination [ 26 – 28 ]. Various psychosocial and biological accounts exist regarding the development of CRCI, and a range of supportive and treatment options have been, and continue to be, developed.…”

“…Various psychosocial and biological accounts exist regarding the development of CRCI, and a range of supportive and treatment options have been, and continue to be, developed. However, ultimately CRCI has been shown to have significant effects on an individual’s daily life, relationships, occupational functioning, and social functioning [ 27 , 28 ].…”

“…As there is not a strong relationship between subjective and objective assessments of cognition [ 29 , 30 ], it is possible that these proposed relationships between cognition and psychopathology might be established using one assessment approach, but not the other. While cross-sectional research suggests that both objective and subjective measures of cognition show significant relationships with mental health in cancer survivors [ 28 , 29 ], future research should use both subjective and objective measures when testing this proposed model, as this may inform future risk identification methodologies. Should a functional bidirectional relationship be established, it is imperative to develop an understanding of the specific domains and levels within cognition and psychopathology that are implicated, as well as how the cognitive processes intersect with other transdiagnostic domains.…”

“…Subsequently, this knowledge can be used to inform risk identification, prevention, treatment, and supportive care approaches. Finally, these theoretical associations may underscore the imperative of the assessment of CRCI-related needs and the provision of optimal supportive care, which may reduce the risk of psychopathology development and persistence in cancer survivors [ 27 , 28 ].…”

Effectiveness of Non-Pharmacological Interventions to Improve Cognition in Cancer: A Protocol for an Overview of Systematic Reviews

“…A significant proportion of cancer survivors, defined as anyone who has had a cancer diagnosis, experience cognitive impairments that can impact their ability to think quickly, clearly, make decisions and perform daily actions [1-3]. This is commonly called cancer-related cognitive impairment (CRCI) [1].…”