Review article

Cancer-related cognitive impairment: an update on state of the art, detection, and management strategies in cancer survivors

Annals of Oncology · 2019Not a clinical trial; sample size not reported in the abstract

Lange M, Joly F, Vardy J, Ahles T, Dubois M, Tron L, et al. Annals of Oncology. 2019. 30:1925-1940

Study type: Review article
Study name: CRCI
Design: Narrative review based on a PubMed search (from 2012 to March 2019)
Sample size: Not a clinical trial; sample size not reported in the abstract
Source: Annals of Oncology · 2019

In plain words

Some patients have problems with memory, concentration and speed of thinking during or after cancer treatment, especially chemotherapy; these problems have been studied most in patients with breast cancer. The problem is not caused only by chemotherapy, and hormonal and targeted treatments can also play a part. Approaches such as cognitive training and exercise are being studied to help patients cope with these problems. If you have such problems, talk to your doctor.

Key results

Memory, processing speed, attention and executive functions

Cognitive domains most affected after chemotherapy

Evidence mainly from patients with breast cancer

Hormonal therapies and targeted therapies can also cause cognitive deficits

Other cancer treatments

CRCI is not limited to chemotherapy

Age and genetic polymorphisms of apolipoprotein E, catechol-O-methyltransferase (COMT) and BDNF

Predisposing factors

May increase the risk of cognitive impairment

Poorer performance on neuropsychological tests was associated with reduced grey matter volume, less connectivity and less activation after chemotherapy

Imaging findings

Hippocampus-dependent memory and frontal lobe-dependent executive functions were particularly vulnerable to chemotherapy

Animal studies

Including altered neurogenesis, mitochondrial dysfunction or brain cytokine responses

Treatment arms and regimens

1Narrative review

This study is a review and has no treatment group. Dose details in the full text of the paper.

Source of the regimen details: Abstract of the paper

Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.

Study population

Patients treated for non-central nervous system cancers, especially during and after chemotherapy. The evidence comes mainly from studies in patients with breast cancer.

Endpoints

An updated review of clinical, imaging and preclinical evidence on cancer-related cognitive impairment (CRCI) and strategies for its management. No defined primary or secondary endpoint is reported in the abstract.

Safety and side effects

This paper is a review, and no interventional safety data are reported in the abstract.

Clinical significance and place in guidelines

This review shows that cancer-related cognitive impairment is a recognised complication extending beyond chemotherapy and should be considered in the follow-up of cancer survivors. Based on the abstract, studies of cognitive rehabilitation programmes are encouraged, and no definitive evidence is presented for any specific management strategy. The status of formal guideline recommendations should be checked separately.

Limitations

This is a narrative review, and no systematic methodology (such as meta-analysis) is reported in the abstract. The evidence comes mainly from patients with breast cancer, and generalisation to other cancers is limited. Based on the abstract, studies of management strategies (cognitive training and exercise) are still at an early stage.

Original article (DOI)PubMed

This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.