Cancer-related cognitive impairment (CRCI) is a condition experienced by many cancer patients and can include changes in learning and memory, processing speed, and executive functioning.

Current longitudinal studies suggest up to 30% of patients have evidence of CRCI before any treatment, up to 70% during treatment, and up to 35% after completion of treatment, suggesting the cause is complex and multifactorial. Symptoms may resolve in the months to years following treatment or may be persistent. Severity is typically mild-moderate and may have significant impact on daily functioning, social interactions, return to work, and quality of life.

Potential mechanisms include reduced white matter integrity, oxidative damage, microvasculature change, direct neurotoxicity from chemotherapy, and elevated neuroinflammation. Risk factors may include age, medical conditions affecting vasculature, lower cognitive reserve, genetic factors, psychological factors, and other symptoms (depression, sleep, etc).

The majority of research to date has focused on breast cancer patients; however, there is evidence of CRCI in other cancer populations, and with different types of treatment. Recent research has begun investigating CRCI in patients with head and neck cancer.

Zer, et al (2018) conducted a longitudinal assessment of neurocognitive function in head and neck cancer patients. Formal cognitive assessments and self-report questionnaires were administered at four time intervals, pre- and post-treatment. Results showed no immediate changes after treatment, but progressive decline in neurocognitive function in the two years post-treatment. No consistent pattern emerged between any particular chemotherapy regimen or radiation dose and degree of cognitive impairment.

Bernstein, et al (2020) found evidence of frontal dysfunction symptoms in head and neck cancer survivors two years post-treatment, including apathy, disinhibition, and impairment in executive functioning. Assessments included neuropsychological battery, self-report questionnaire, and family-report questionnaire, revealing objective and subjective cognitive changes.

There is help for patients experiencing persistent CRCI. Speech-language pathologists (SLPs) are experienced in the assessment and treatment of cognitive communication disorders. The outpatient team at VMC can provide individualized treatment to improve functional cognition and quality of life.

Contact and referrals: Rehabilitation Services at Valley Medical Center

425.690.3650 (phone), 425.690.9650 (fax)

References:

Bernstein L, et al. (2020). Frontal Systems Dysfunction in Head & Neck Cancer Survivors. Presentation at the International Cancer and Cognition Task Force (ICCTF), Denver, CO.

Hardy S, Krull K, Wefel J, et al. (2018). Cognitive Changes in Cancer Survivors. American Society of Clinical Oncology Educational Book. 38, 795-806.

Wefel J, Kessler S, Noll, K, et al. (2015). Clinical characteristics, pathophysiology, and management of noncentral nervous system cancer‐related cognitive impairment in adults. American Cancer Society Journals. 65(2), 123-138.

Zer A, Pond GR, Razak ARA, et al. (2018). Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg.144(1), 71–79.