Cancer-related cognitive impairment in adolescents and young adults with cancer: a scoping review

Cancer-related cognitive impairment (CRCI) is a frequent and clinically meaningful consequence of cancer, yet current evidence is largely derived from older adult populations. Adolescents and young adults (AYAs) may be particularly vulnerable due to ongoing neurodevelopment, high cognitive demands, and cancer-related biological and psychosocial stressors. This review is timely given the growing interest in biological mechanisms and preventive models of CRCI, alongside the persistent lack of AYA-specific syntheses addressing cognitive trajectories, mechanisms, and optimal intervention timing.

Approximately 25-30% of AYAs experience CRCI, most commonly affecting attention, processing speed, executive functioning, and working memory. Cognitive alterations may be detectable prior to treatment initiation and can persist across the cancer trajectory. Emerging AYA-specific evidence implicates biological mechanisms such as systemic inflammation and altered neuroplasticity, including changes in brain-derived neurotrophic factor (BDNF). A consistent dissociation between subjective cognitive complaints and objective performance is observed, underscoring the functional impact of subtle inefficiencies in academic and early professional contexts. While non-pharmacological interventions show promise in the general CRCI literature, early and AYA-specific preventive interventions remain scarce.

CRCI in AYAs should be conceptualized as a dynamic, biologically grounded process embedded within ongoing neurodevelopment. Early, developmentally sensitive, and multimodal interventions may represent a key opportunity to preserve long-term cognitive, functional, and psychosocial outcomes in this vulnerable population.