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Neurocognitive sequelae of cancer therapies

The potentially deleterious effects of conventional cancer therapies (e.g. chemotherapy and radiotherapy) on cognitive functioning are well documented. However, there remains a great need to define more effectively the long-term neurocognitive sequelae of cancer treatment and the impact that these sequelae will have on the quality of life. Patients and healthcare providers are now considering these effects as well as the efficacy of therapy during treatment decision-making. Biological therapies, including hormone therapy and immunotherapy, are increasingly offering patients important treatment alternatives, but may be among the most potent in their effects on mental abilities. To date, few systematic efforts have been made to define the changes in cognitive outcomes among recipients of these treatment alternatives. In addition, if the toxic effects of cancer treatment do adversely compromise cognitive domains, it is unknown to what extent these potentially persistent effects will influence adherence to follow-up care. We review earlier investigations of neurocognitive sequelae of both conventional and biological cancer therapies, as well as the common methodological confounds that limit the interpretation of reported changes. The paper will also develop a theoretical framework to describe how neurocognitive impairment may present as a major threat to treatment adherence in cancer patients and survivors.