Cancer-Related Cognitive Impairment

Cancer-related cognitive impairment is a condition of decreased cognitive function in a person with cancer.  It encompasses the older term “chemo-brain”, which referenced cognitive symptoms specifically as a result of chemotherapy. Many people recover, but others may continue to experience cancer-related cognitive impairment for years after their cancer treatment was completed.

Cancer-related cognitive impairment can occur prior to cancer treatment, during treatment, or after treatment. It has been studied the most in people with breast cancer, but it can occur in many other types of cancer.  A main mechanism for cancer-related cognitive impairment is thought to be systemic inflammation (from the cancer itself, chemotherapy, radiation therapy, and/or cancer surgery) that leads to neuroinflammation, which results in neurotoxicity. Endocrine therapy’s hormonal effects can also cause cancer-related cognitive impairment. Accelerated brain aging is another potential mechanism for cancer-related cognitive impairment.

Cancer-related cognitive impairment is common but often under-recognized and under-addressed. Cancer survivors with residual cancer-related cognitive impairment may simultaneously feel grateful for the treatment that led to survivorship, and also resentful for how that treatment damaged their cognitive function and quality of life. These complex emotions can further contribute to stress and worsen cognitive difficulties.

There is no FDA approved treatment for cancer-related cognitive impairment. A person with cancer who develops cognitive dysfunction should undergo a comprehensive evaluation to assess for cancer-related cognitive impairment, as well as conditions that may mimic cancer-related cognitive impairment but that could be treatable, such as metastatic spread of cancer to the nervous system or a paraneoplastic syndrome affecting the nervous system.

References and Resources

  3. Van Dyk, K, & Ganz, PA. (2021). Cancer-Related Cognitive Impairment in Patients With a History of Breast Cancer. JAMA, 326(17), 1736-1737. doi:10.1001/jama.2021.13309

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