Troubles cognitifs liés au cancer : quelle(s) prise(s) en charge ?

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Les troubles cognitifs liés au cancer du sein et à ses traitements sont fréquents, mais variables selon que l’on s’attache à la plainte ou aux scores obtenus aux tests neuropsychologiques, et selon le timing par rapport au diagnostic et au(x) traitement(s). Ils sont généralement légers, mais ils ont un impact négatif sur la qualité de vie. Les facteurs impliqués sont multiples (prédisposant modifiables, non modifiables, liés au traitement) et ces troubles restent globalement sous-diagnostiqués. Des recommandations sont proposées pour mieux spécifier la plainte cognitive, objectiver les troubles et apporter une solution de prise en charge adaptée. Plusieurs types d’approches interventionnelles sont expérimentés pour améliorer le fonctionnement cognitif : interventions pharmacologiques ; exercices physiques ; interventions comportementales aspécifiques ; interventions comportementales centrées sur la cognition. Ces dernières semblent les plus prometteuses. Il semble crucial de poursuivre l’élaboration et le développement de programmes de remédiation cognitive adaptés, ciblant de façon spécifique les fonctions cognitives altérées, mais promouvant également les aspects de métacognition et la mise en place de stratégies compensatoires efficaces, tout en tenant compte des multiples facteurs associés potentiels comme la fatigue, les troubles du sommeil ou anxiodépressifs. La prise en compte du timing dans le parcours de soins et des symptômes associés permettrait également de moduler de façon pertinente la nature et le contenu des propositions thérapeutiques.

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