Comorbid symptoms in cancer patients and caring for the caregiver

Patients living with cancer often experience significant neuropsychological symptoms throughout their illness trajectories, stemming either from the cancer itself or from antineoplastic therapies. In many cases, these neuropsychological effects, including impacts on cognition, are the result of various comorbid symptoms patients with cancer frequently face. These comorbid symptoms include: 1) fatigue and sleep disturbance, 2) mood symptoms, 3) peripheral neuropathy and neuropathic pain, and 4) symptoms related to endocrine and nutritional dysfunction. This review discusses the putative pathophysiological mechanisms connecting each of these comorbid symptoms to cognitive dysfunction in patients with cancer, along with a review of recommendations for evaluating and managing these symptoms. The review highlights the influence of concomitant medication use on cognition with a survey of the most common medication classes that could have cognitive implications. Finally, this review concludes with a discussion of caregiver distress, a frequently neglected component of cancer care that may be especially pertinent in cases in which patient cognition is impaired.