Cognitive changes associated with cancer and cancer treatment

摘要

THIS issue of Seminars in Oncology Nursing provides an excellent overview of the complexity inherent in the broad field of cognition and cancer. Brain tumors and cancers with central nervous system involvement represent the most complex cases because the disease directly affects the brain and treatments all target the brain (surgery, cranial radiation, and chemotherapy). Yet, a pattern of initial improvement in cognitive functioning can be seen with certain treatments, only to be followed by worsening early and/or delayed effects associated with radiation with or without chemotherapy. Complexities also have emerged in studying treatment-associated cognitive effects in non-central nervous system cancers, including: 1) cognitive deficits identified in 20% to 25% of breast cancer patients before initiation of adjuvant treatment; 2) recognition of the need to identify factors that increase risk for post-treatment cognitive decline (because only a subgroup of patients appear to experience long-term cognitive change); and 3) imaging studies that suggest that compensatory activation may result in maintenance of performance on neuropsychological tests, thereby complicating the interpretation of performance on neuropsychological tests.