Assessment and Management of Cancer-Related Cognitive Impairment

Cancer-related cognitive impairment (CRCI) is common and multifactorial in nature with the cancer itself, various treatment modalities, as well as socioenvironmental, biobehavioral, and lifestyle factors all potentially contributing to cognitive impairment in cancer survivors. Estimates of CRCI prevalence vary widely depending on cancer type and the cognitive assessment tools used, but range from 25% to 75%. CRCI typically affects memory, processing speed, attention, and executive function. Diagnosis can be challenging because of a poor association between self-reported cognitive symptoms and performance on standardized neuropsychological assessment. Patient-reported outcome measures are used to assess cognitive symptoms. A comprehensive interview and history-taking by a psychologist or neuropsychologist identifies additional cognitive risk factors and comorbidities, combined with standardized neuropsychological testing, with results compared with normative data. This process evaluates cognitive skills and impairments, including specific affected cognitive domains. Based on the results and the individual concerns of the cancer survivor, tailored management strategies for cognitive impairments can be developed, including advice and support for returning to study or work. There is still inconsistent evidence for the use of pharmacologic agents for CRCI. Education about CRCI and compensatory and supportive strategies may be helpful. Brain training programs have been shown to assist with cognitive symptoms, with variable results for objective cognitive function. Cognitive rehabilitation studies (computer-based training and/or compensatory strategy training) report some improvements in certain studies on some objective cognitive measures, generally memory, as well as improvements in cognitive symptoms. Tai Chi and Qigong have also been found helpful for cognitive symptoms. Lifestyle changes, including a healthy diet, regular exercise, stress management, and addressing sleep disturbances, should be considered.