Cancer-related cognitive impairments: Which treatment(s)?

Résumé 0

Diagnostic and therapeutic advances in oncology have increased patient survival, but survivors often report cognitive impairments, including problems with memory, executive function, attention, language, and speed of information processing. Estimates of the frequency of these problems vary considerably. This variability arises from differences in the methods used to detect them (subjective complaint or objective test scores) and in the timing of the assessments (during treatment or months to years after the end of treatment). Cognitive changes are mostly subtle, but have a negative impact on quality of life. They can be explained by a range of factors, including non-modifiable predisposing factors, treatment-related factors, and modifiable predisposing factors. Currently, there are no reliable biomarkers to identify which patients are at higher risk of cognitive decline. Clinicians should identify the patient's complaint and its impact on his or her daily life and provide appropriate care, which includes informing the patient about these disorders, their reality, their complexity, and their possible association with other factors. Several types of interventional approaches exist to improve cognitive function: pharmacological, physical exercise, nonspecific behavioral, and cognition-centered behavioral. The latter, which includes cognitive training and cognitive remediation, appear to be the most promising. Cognitive remediation programs (which include a cognitive training component), are increasingly popular, as they aim to improve cognitive skills and optimize adaptive strategies, including training patients to become aware of their deficits and situations in which they risk finding themselves in difficulty (metacognition). Programs should take into account the numerous other factors that can affect cognitive function, such as fatigue and sleep or anxiety-depressive disorders. There is clearly no “one size fits all” rehabilitation solution for cancer-related cognitive impairments, and it is important to adjust the nature and content of each program according to the timing of the patient's complaint and the presence of associated problems.