COGNITIVE REHABILITATION IN CANCER SURVIVORS: EVIDENCE-BASED APPROACHES AND EMERGING TRENDS

Abstract

Cognitive decline is a prominent complication among individuals with cancer and is referred to as cancer related cognitive impairment (CRCI). It includes deficits in attention, memory, executive function, and processing speed, which may arise before, during, or after cancer treatment. CRCI is increasingly recognized as a significant survivorship issue, affecting approximately 20–30% of patients with non-central nervous system (CNS) malignancies following therapy. Studies among the breast cancer populations estimate the prevalence of cognitive impairment at 21–34% based on neuropsychological test batteries and up to 44% when measured through self-report. The mechanisms of CRCI are multifactorial, involving direct neurotoxic effects of chemotherapy and radiotherapy, endocrine changes, systemic inflammation, fatigue, sleep disturbances, and psychological distress. Computer-based cognitive exercises such as CogMed, BrainHQ, or Lumosity, other than Cognitive Behavioral Therapy (CBT), physical exercises affecting the brain derived neurotrophic factor (BDNF), sleep and fatigue management, mindfulness-based interventions are amongst the most common intervention methods for controlling cognitive decline in these population. While pharmacological approaches have given inconsistent or moderate results, nonpharmacological strategies especially cognitive-behavioural therapy (CBT) have emerged as promising interventions for improving perceived cognition and overall quality of life.