Neuropsychological functioning in non-CNS cancer patients

Cancer-related cognitive impairment (CRCI) is a multifaceted condition, influenced by numerous neurobiological mechanisms and individual risk factors. In the non-CNS oncology population, the concept has increasingly received attention over the last few decades. Neurotoxicity of cancer treatment modalities varies, with effects that are protocol- or agent-dependent that additionally interact with patient-specific characteristics (e.g. age, sex-specific endocrine mechanisms, metabolism, brain reserve, etc.), which differently impacts individual cognitive outcomes. Importantly, CRCI encompasses both patient-reported cognitive complaints and objectively measured cognitive impairments, which may not consistently align. Individually tailored neuropsychological follow-up in oncology is therefore important, which should encompass risk profiling, patient-reported, as well as objective cognitive assessments to support psychoeducation and the development of effective interventions.

This review summarizes the historical evolution of CRCI research, biophysiological mechanisms, the clinical presentation, and the array of international guidelines for research and clinical care.

Current findings on interventions are reviewed, and innovative neuroscience-informed rehabilitation approaches are discussed.

While these more personalized interventions might hold promise for CRCI, further research is needed to determine their true efficacy, particularly considering the potential influence of practice effects. Additionally, in-depth, large-scale, transdiagnostic, and multimodal investigations are required to advance understanding of the mechanisms of toxicity, individual risk factors, and effective intervention strategies.