Neuropsychological functioning in non-CNS cancer patients.

Abstract

Introduction: Cancer-related cognitive impairment (CRCI) is a multifaceted condition, influenced by numerous neurobiological mechanisms and individual risk factors. In the non-CNS oncology population, the concept has increasingly received attention over the last few decades. Neurotoxicity of cancer treatment modalities varies, with effects that are protocol- or agent-dependent that additionally interact with patient-specific characteristics (e.g. age, sex-specific endocrine mechanisms, metabolism, brain reserve, etc.), which differently impacts individual cognitive outcomes. Importantly, CRCI encompasses both patient-reported cognitive complaints and objectively measured cognitive impairments, which may not consistently align. Individually tailored neuropsychological follow-up in oncology is therefore important, which should encompass risk profiling, patient-reported, as well as objective cognitive assessments to support psychoeducation and the development of effective interventions.

Methods: This review summarizes the historical evolution of CRCI research, biophysiological mechanisms, the clinical presentation, and the array of international guidelines for research and clinical care.

Results: Current findings on interventions are reviewed, and innovative neuroscience-informed rehabilitation approaches are discussed.

Conclusion: While these more personalized interventions might hold promise for CRCI, further research is needed to determine their true efficacy, particularly considering the potential influence of practice effects. Additionally, in-depth, large-scale, transdiagnostic, and multimodal investigations are required to advance understanding of the mechanisms of toxicity, individual risk factors, and effective intervention strategies.