Cancer- and Cancer Treatment-Associated Cognitive Change: An Update on the State of the Science

Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022
Journal of Clinical Oncology (Impact Factor: 18.43). 09/2012; 30(30):3675-86. DOI: 10.1200/JCO.2012.43.0116
Source: PubMed


Cognitive changes associated with cancer and cancer treatments have become an increasing concern. Using breast cancer as the prototype, we reviewed the research from neuropsychological, imaging, genetic, and animal studies that have examined pre- and post-treatment cognitive change. An impressive body of research supports the contention that a subgroup of patients is vulnerable to post-treatment cognitive problems. We also propose that models of aging may be a useful conceptual framework for guiding research in this area and suggest that a useful perspective may be viewing cognitive change in patients with cancer within the context of factors that influence the trajectory of normal aging.

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    • "During the last decades, treatment-related cognitive dysfunction in noncentral nervous system cancers has received increasing attention. Several studies showed that patients exhibit cognitive dysfunction after cancer treatment, particularly when chemotherapy (CT) was incorporated into their treatment plan [Ahles et al., 2012; Collins et al., 2014; Wefel and Schagen, 2012; Wefel et al., 2015]. Factors contributing to variability in cognitive performance after treatment are not well understood. "
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    ABSTRACT: Objective: Chemotherapy (CT) is associated with adverse effects on cognition. Only few studies have investigated cognition in testicular cancer (TC) patients and studies on very late effects of CT on cognition are absent. Further, brain changes in relation to treatment have not been investigated in TC. The objective of the present study is to compare psychosocial functioning, cognitive performance and brain (micro)structure following surgery and CT for TC, against surgery (S)-only. Methods: Twenty-eight CT (43.1 ± 7.5 y) and 23 S-only (48.2 ± 9.5y) TC survivors on average 14 yr post-treatment were examined using questionnaires, neurocognitive tests, and 3T-MRI [Diffusion Kurtosis Imaging (DKI), T1-weighted and Fluid Attenuated Inversion Recovery]. A multivariate cognitive performance score (Mahalanobis distance) was calculated to indicate the grade of cognitive performance. Kurtosis parameters, gray matter, and white matter (WM) volume were calculated from MRI data. Results: Overall, the CT group showed lower cognitive performance (5.35 ± 1.7) compared with the S-only group (4.4 ± 0.9; P =0.03; d = 0.70). Further, TC patients reported more memory problems after CT. DKI revealed a significantly higher radial kurtosis after CT in several anterior and posterior brain areas (P < 0.05, corrected), but this was unrelated to cognitive performance. Conclusions: This cross-sectional study suggests that men receiving CT for TC are at risk for long-term lower cognitive performance. Although CT affected WM microstructure, this was unrelated to cognitive performance. More extensive, preferably prospective studies are warranted to confirm these results and to provide more insight into the possible mechanisms behind the observed cognitive sequelae after treatment for TC. Hum Brain Mapp, 2015. © 2015 Wiley Periodicals, Inc.
    Human Brain Mapping 08/2015; DOI:10.1002/hbm.22942 · 5.97 Impact Factor
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    • "Thus, a more accurate term to describe the cognitive changes that survivors experience is cancer and cancer-treatment-associated cognitive change (Hurria, Somlo, & Ahles, 2007). Risk factors for cognitive problems after cancer treatment include older age and having lower cognitive reserve (i.e., lower education or IQ), which contributes to the hypothesis that cancer treatments accelerate the aging process (Ahles et al., 2012). "
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    ABSTRACT: The number of individuals living with a history of cancer is estimated at 13.7 million in the United States and is expected to rise with the aging of the population. With expanding attention to the psychosocial and physical consequences of surviving illness, psychological science and evidence-based practice are making important contributions to addressing the pressing needs of cancer survivors. Research is demonstrating that adults diagnosed with cancer evidence generally positive psychosocial adjustment over time; however, a subset is at risk for compromised psychological and physical health stemming from long-term or late effects of cancer and its treatment. In this article, we characterize survivorship after medical treatment completion during the periods of reentry, early survivorship, and long-term survivorship. We describe the major psychosocial and physical sequelae facing adults during those periods, highlight promising posttreatment psychosocial and behavioral interventions, and offer recommendations for future research and evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    American Psychologist 02/2015; 70(2):159-174. DOI:10.1037/a0037875 · 6.87 Impact Factor
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    • "Five meta-analyses have also documented cognitive deficits that survivors experience , suggesting that impairments in memory, attention and concentration, speed of processing, and executive functioning are most common (Anderson-Hanley et al., 2003; Falleti et al., 2005; Jansen et al., 2005; Jim et al., 2012; Stewart et al., 2006). Although results of some prospective studies suggest cognitive impairment may attenuate over time (Jenkins et al., 2006; Tchen et al., 2003; Wefel, Lenzi, Theriault, Davis, & Meyers, 2004), researchers have found that a substantial number of survivors continue to have objectively measured memory deficits for 5, 10, and even as long as 20 years post-treatment (Ahles et al., 2002; Jenkins et al., 2006; Koppelmans et al., 2012; Wefel et al., 2004). "
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    ABSTRACT: Cognitive impairment is a distressing, disruptive, and potentially debilitating symptom that can occur as a direct result of cancer or its treatment. National organizations have identified cognitive impairment as a challenge many survivors face and call for research to address this problem. Despite the priority, research is still relatively limited and questions remain unanswered about prevalence and impact on survivors, as well as coping strategies and effective treatment options available to address this potentially debilitating problem. The purpose of this article is to (a) analyze the prevalence and types of cognitive impairment that commonly affect survivors; (b) delineate the impact that cognitive impairment after cancer and cancer treatment has on self-esteem, social relationships, work ability, and overall quality of life among survivors; and (c) synthesize and appraise commonly used coping strategies used by survivors to address cognitive impairment and evidence-based interventions that may be incorporated into clinical practice. A comprehensive review and synthesis of the literature was conducted. Evidence-based interventions to address cognitive changes after cancer and cancer treatment are limited. However, emerging research has demonstrated that nonpharmacologic treatments, such as cognitive training, are likely to be effective.
    Clinical journal of oncology nursing 02/2015; 19(1):47-56. DOI:10.1188/15.CJON.19-01AP · 0.91 Impact Factor
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