Prevalence, mechanisms, and management of cancer-related cognitive impairment

Abstract

This review summarizes the current literature on cancer-related cognitive impairment (CRCI) with a focus on prevalence, mechanisms, and possible interventions for CRCI in those who receive adjuvant chemotherapy for non-central nervous system tumors and is primarily focused on breast cancer. CRCI is characterized as deficits in areas of cognition including memory, attention, concentration, and executive function. Development of CRCI can impair quality of life and impact treatment decisions. CRCI is highly prevalent; these problems can be detected in up to 30% of patients prior to chemotherapy; up to 75% of patients report some form of CRCI during treatment, and CRCI is still present in up to 35% of patients many years following completion of treatment. While the trajectory of CRCI is becoming better understood, the mechanisms underlying the development of CRCI are still obscure; however, host characteristics, immune dysfunction, neural toxicity, and genetics may play key roles in the development and trajectory of CRCI. Intervention research is limited, though strategies to maintain function are being studied with promising preliminary findings. This review highlights key research being conducted in these areas, both in patient populations and in animals, which will ultimately result in better understanding and effective treatments for CRCI.

Disrupted brain network functional dynamics and hyper‐correlation of structural and functional connectome topology in patients with breast cancer prior to treatment

“…Therefore, it is likely that disruptions of brain structure and/or function also exist at this early, pretreatment stage of breast cancer. These disruptions may parallel, at least in part, those noted following cancer treatments given that inflammation is a candidate mechanism underlying cancer pathogenesis as well as chemotherapy‐related effects on the brain (Janelsins, Kesler, Ahles, & Morrow, 2014; Patel et al., 2015). …”

Cognitive Complaints in Survivors of Breast Cancer After Chemotherapy Compared With Age-Matched Controls: An Analysis From a Nationwide, Multicenter, Prospective Longitudinal Study

“…1 CRCI can be related to disease, surgery, chemotherapy, radiation, hormone therapy, and immunotherapy. [2][3][4][5] CRCI negatively impacts quality of life (QOL).…”

“…[6][7][8][9] Although several studies have assessed CRCI in cancer populations via objective neuropsychological testing and self-report assessments, the majority of these studies have relied on small sample sizes, included heterogeneous disease and treatment groups, included patients from academic medical centers, lacked pretreatment chemotherapy assessments, and used normative control data. 1,7,8 Assessing the patient's perspective is an important aspect of CRCI, particularly because some neuropsychological tests cannot detect CRCI complaints. Patient-reported outcomes (PROs) are ideal because of the lack of practice effects and clinical adaptability.…”

Toward a National Initiative in Cancer Rehabilitation: Recommendations From a Subject Matter Expert Group

“…98 Recent research has proposed a mobile cognitive assessment battery for assessment of cancer-related cognitive changes. 99,100 There is a need to better integrate cognitive assessment for the cancer population. 101 Evidence suggests that preexisting cognitive impairment, in many instances mild or subclinical, may be exacerbated during cancer treatment.…”