Cancer-related cognitive impairment in adult cancer survivors: a clinical practice review for healthcare providers.

PURPOSE: Cancer-related cognitive impairment (CRCI) is a decline in cognitive function associated with cancer and its treatments, affecting approximately 60-75% of individuals with cancer. This review provides an evidence-based overview of the causes, assessment, and management of CRCI across the cancer continuum.

METHODS

A narrative literature review was conducted using peer-reviewed studies, clinical practice guidelines, systematic reviews, and expert consensus recommendations examining CRCI in adult cancer populations. The review focused on the biological and psychosocial contributors to CRCI, methods of assessment and diagnosis, and current evidence supporting pharmacological and non-pharmacological interventions.

RESULTS

CRCI is a multifactorial condition associated with chemotherapy, endocrine therapy, radiotherapy, surgery, psychological distress, and lifestyle factors. Proposed mechanisms include neuroinflammation, oxidative stress, neurotoxicity, hormonal dysregulation, and psychosocial influences such as anxiety, depression, and fatigue. Assessment should incorporate both patient-reported cognitive concerns and objective neuropsychological testing, while also evaluating potentially reversible contributors including sleep disturbances, pain, medication effects, and emotional distress. Current evidence supports non-pharmacological interventions as first-line management, with physical activity and cognitive rehabilitation demonstrating the strongest benefits. Additional strategies including mindfulness-based interventions, psychoeducation, compensatory techniques, and healthy lifestyle modifications may further improve cognitive outcomes. Pharmacological therapies, including psychostimulants and neuroprotective agents, have shown inconsistent results and are not routinely recommended.

CONCLUSION

CRCI is a prevalent and clinically significant survivorship issue that requires greater recognition within oncology care. Routine screening, comprehensive assessment, and individualized management strategies can help mitigate cognitive symptoms and improve functional outcomes. Further research is needed to develop standardized screening tools, establish evidence-based treatment pathways, and improve integration of CRCI care into routine oncology practice.