Cognitive Effects of Cancer and Cancer Treatments

Abstract

As the population of cancer survivors has grown into the millions, there has been increasing emphasis on understanding how the late effects of treatment affect survivors' ability to return to work/school, their capacity to function and live independently, and their overall quality of life. This review focuses on cognitive change associated with cancer and cancer treatments. Research in this area has progressed from a pharmacotoxicology perspective to a view of the cognitive change as a complex interaction of aspects of the treatment, vulnerability factors that increase risk for posttreatment cognitive decline, cancer biology, and the biology of aging. Methodological advances include the development of (a) measurement approaches that assess more fine-grained subcomponents of cognition based on cognitive neuroscience and (b) advanced statistical approaches. Conceptual issues that arise from this multidimensional perspective are described in relation to future directions, understanding of mechanisms, and development of innovative interventions.

Keywords: aging; biomarkers; cancer; cancer treatment; chemotherapy; cognition; endocrine therapy; genetics; neuroimaging; radiation therapy.

Figure 1.

Cancer treatment can have a direct effect on cognition and can interact with various risk factors. The factors on the left side of the figure represent predisposing risk factors, whereas the remaining factors (physiological, psychological, allostatic load, and lifestyle) are both predisposing factors and factors that can be modified by treatment.

Figure 2

A cancer treatment can cause an identical change in brain resources; however, the impact on cognitive performance will be lower at a younger age and will increase as the individual moves along the continuum of age-related cognitive changes. Further, the impact on cognitive performance will be lower in an individual with high cognitive reserve and higher in an individual with low cognitive reserve.