This article summarizes recent findings regarding cognitive problems and decline in patients previously treated with chemotherapy. It gives a comprehensive overview of results from neuropsychological, imaging and animal studies. It also proposes investigating post-chemotherapy mental decline in the context of the normal aging process.
In long term cancer survivors, mental function decline seems to occur at a faster rate than what is expected as part of the normal aging process. The factors involved in this accelerated decline have not yet been identified.
It is hypothesized that:
- The cancer’s biology (e.g. the body’s inflammatory response) influences cognitive performance and may promote accelerated aging.
- Common factors may exist between cognitive decline and the development of cancer (e.g. a person’s genetic makeup)
Supporting evidence exists for both hypotheses in the literature, as well as for using the process of normal aging (and its milestones) as model and tools for explaining the cognitive changes.
Several studies found that 20% to 30% of patients with breast cancer have lower than expected cognitive performance based on age and education in the pretreatment assessment. This doesn’t seem to be related to psychological factors (e.g. depression or anxiety), fatigue or surgical factors.
The article reports positive results for various treatments aimed at slowing down mental decline. Modafinil (Provigil) has been shown to improve memory and attention and to reduce fatigue. Cognitive behavioral therapy (CBT) and cognitive training, physical exercise and even dietary interventions have been shown to yield positive results for the prevention of cognitive decline in cancer survivors. The authors also recommend developing “models of aging” that will help identify factors responsible for mental decline in cancer patients.
The development of new strategies to deal with cognitive impairment in chemotherapy-treated patients requires further studies in order to discover the exact mechanisms of decline.
Published By :
Journal of clinical oncology
Date :
Oct 20, 2012
