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Cancer-Related Cognitive Impairment or “Chemobrain:” Emerging Assessments, Treatments, and Targets for Intervention

  • Cancer Rehabilitation (SR Smith, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review is intended to provide a summary of the current literature on cancer-related cognitive impairment (CRCI) to support practitioners and researchers with the evaluation and management of patients with CRCI.

Recent Findings

Known discrepancies between objective findings and perceived cognitive impairment highlight the importance of utilizing both performance-based measures and self-report measures to identify cognitive problems impacting patients’ quality of life and engagement in important roles and activities. Additionally, several potential contributing factors may initiate or exacerbate cognitive problems in patients with cancer, and warrant assessment and treatment to optimize functioning. Regardless of the etiology of CRCI, cognitive rehabilitation, CBT, and mindfulness-based interventions have the most evidence of effectiveness to date in improving perceived and objective CRCI. Many pharmacological therapies appear promising as well, but do not yet have convincing evidence of effectiveness.

Summary

CRCI is highly prevalent, potentially disruptive to patients’ quality of life, and the etiology is likely multifactorial. Further research is needed to fill the gaps of the current literature resulting from methodological challenges and limitations of current measurement tools.

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Recommendations/key points:

• Early identification and treatment of modifiable risk factors for CRCI, such as depression, anxiety, sleep disturbance, pain, and fatigue, may lead to decreased severity of CRCI.

• Recommended in-office screening tools for cognitive impairment include the Montreal Cognitive Assessment, and the Clock Drawing Test (for older populations), though notably, these measures are not specific to CRCI.

• The FACT-Cog PCI Scale is recommended as a patient self-report measure for CRCI.

• Several additional measures are recommended for evaluating factors that likely contribute to CRCI and may be modifiable (see Table 1).

• Future studies should explore the utility of ecological momentary assessment and other innovative means of measuring cognitive performance and contributing factors in patients undergoing cancer treatment.

• Cognitive rehabilitation, cognitive behavioral therapy, exercise, and mindfulness-based interventions may be associated with improvements in both self-perceived and objectively measured cognitive functioning.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, 325 E. Eisenhower Pkwy, Ann Arbor, MI, 48108, USA

    Dominique Chao, Andrew Hale, Anna L. Kratz & Nicolette M. Gabel

  2. Department of Internal Medicine, Hematology/Oncology, University of Michigan, Rogel Cancer Center, Ann Arbor, MI, 48109, USA

    N. Lynn Henry

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  1. Dominique Chao
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Correspondence to Nicolette M. Gabel.

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Conflict of Interest

Dominique Chao, Andrew Hale, Anna L. Kratz, and Nicolette M. Gabel declare no conflict of interest. N. Lynn Henry has received research funding (paid to her institution) from Pfizer to support conduct of a pharmaceutical-sponsored clinical trial.

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Chao, D., Hale, A., Henry, N.L. et al. Cancer-Related Cognitive Impairment or “Chemobrain:” Emerging Assessments, Treatments, and Targets for Intervention. Curr Phys Med Rehabil Rep 9, 108–118 (2021). https://doi.org/10.1007/s40141-021-00319-2

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  • DOI: https://doi.org/10.1007/s40141-021-00319-2

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