The impact of cancer therapy on cognition in the elderly

Abstract

Cancer and cancer therapy-related cognitive impairment (formerly known as chemobrain or chemo-fog) are often described in the literature. In the past, studies have failed to prove the existence of cancer therapy-related cognitive dysfunction. However, more recently, prospective trials have shown that patients undergoing chemotherapy do display impairment in specific cognitive domains. Aging confers an increased risk of developing cancer, as well as cognitive impairment. The Geriatric Oncology clinic of the Segal Cancer Centre, Jewish General Hospital in Montreal was founded in 2006 to address the unique needs of older cancer patients. We will describe two cases of cancer therapy-related cognitive impairment from our Geriatric Oncology clinic. The first case is that of a 75 year old male diagnosed with stage III non-small cell lung carcinoma who complained of forgetfulness since starting carboplatin-paclitaxel. The second case is that of a 65 year old female diagnosed with stage I, estrogen-receptor-positive breast cancer who had undergone lumpectomy followed by adjuvant cyclophosphamide, methotrexate and fluorouracil chemotherapy, radiation therapy and was on exemestane when she was evaluated. We will also briefly review the literature of cancer therapy-related cognitive impairment.

Perforin- and granulysin-mediated cytotoxicity and interleukin 15 play roles in neurocognitive impairment in patients with acute lymphoblastic leukaemia

“…Such deterioration has also been observed in previously cured patients up to 20 years after treatment for malignant disease [4,5]. Patients with impaired cognition have reduced quality of life [6] and significantly shorter overall survival, as has been shown in older adults with acute myelogenous leukaemia [7]. The pathophysiological mechanisms underlying cognitive impairment in patients with leukaemia are likely to be multiple, and are as-yet unexplored.…”

Novel mHealth App to Deliver Geriatric Assessment-Driven Interventions for Older Adults With Cancer: Pilot Feasibility and Usability Study (Preprint)

“…Compared to their younger counterparts, however, older adults have a higher prevalence of comorbidity, disability, and geriatric syndromes, putting them at increased risk of treatment-related toxicities and adverse outcomes [1][2][3][4]. A geriatric assessment (GA) is a compilation of reliable and validated tools to assess important domains, including comorbidity, physical function, cognition psychological health, nutrition, medication review, and social support; each of these domains that are predictors of morbidity and mortality [5].…”

Vers une approche multidisciplinaire optimale du traitement du cancer du sein chez les patientes plus âgées

“…Les adultes plus âgés atteints du cancer qui présentent déjà un déficit cognitif voient également augmenter le risque qu'un dysfonctionnement cognitif s'aggrave durant les traitements contre le cancer (Mandilaras et al, 2013). Les patientes plus âgées atteintes du cancer du sein qui font de la chimiothérapie peuvent souffrir de déficits cognitifs causés par ce traitement (difficultés de mémorisation, d'attention et de concentration, par exemple); c'est ce qu'on appelle le « brouillard de la chimio ».…”