Florence Joly1, Bénédicte Giffard2, Olivier Rigal3, Michiel B De Ruiter4, Brent J Small5, Martine Dubois6, Johan LeFel3, Sanne B Schagen7, Tim A Ahles8, Jeffrey S Wefel9, Janette L Vardy10, Véronique Pancré11, Marie Lange12, Hélène Castel6. 1. Departments of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France; CHU Côte de Nacre, Caen, France; U1086 INSERM-UCBN Cancers & Préventions, Caen, France. Electronic address: f.joly@baclesse.fr. 2. UMR-S1077, UNICAEN, Normandie Université, Caen, France; U1077 INSERM, Caen, France; Ecole Pratique des Hautes Etudes, UMR-S1077, Caen, France; CHU de Caen, U1077, Caen, France. 3. Service des Soins de Support and Département d'Oncologie Médicale, Centre Henri-Becquerel, Rouen, France. 4. Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; School of Aging Studies, University of South Florida, Tampa, Florida, USA. 5. School of Aging Studies, University of South Florida, Tampa, Florida, USA. 6. INSERM U982, Laboratory of Neuronal and Neuroendocrine Communication and Differentiation, DC2N, Astrocyte and Vascular Niche, Biomedical Research Institute (IRIB), University of Rouen, Mont-Saint-Aignan, France. 7. Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 8. Neurology Service, Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University, New York, New York, USA. 9. Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. 10. University of Sydney, Sydney, and Concord Cancer Centre, Concord Hospital, Concord, New South Wales, Australia. 11. NorthWest Canceropole, CNRS-UMR 8161-Institut de Biologie de Lille, Lille, France. 12. Departments of Clinical Research Unit and Medical Oncology, Centre François Baclesse, Caen, France; U1086 INSERM-UCBN Cancers & Préventions, Caen, France.
Abstract
CONTEXT: Although cognitive impairments have been identified in patients with non-central nervous system cancer, especially breast cancer, the respective roles of cancer and therapies, and the mechanisms involved in cognitive dysfunction remain unclear. OBJECTIVES: To report a state-of-the-art update from the International Cognitive and Cancer Task Force conference held in 2012. METHODS: A report of the meeting and recent new perspectives are presented. RESULTS: Recent clinical data support that non-central nervous system cancer per se may be involved in cognitive dysfunctions associated with inflammation parameters. The role of chemotherapy on cognitive decline was confirmed in colorectal and testicular cancers. Whereas the impact of hormone therapy remains debatable, some studies support a negative impact of targeted therapies on cognition. Regarding interventions, preliminary results of cognitive rehabilitation showed encouraging results. The methodology of future longitudinal studies has to be optimized by a priori end points, the use of validated test batteries, and the inclusion of control groups. Comorbidities and aging are important factors to be taken into account in future studies. Preclinical studies in animal models highlighted the role of cancer itself on cognition and support the possible benefits of prevention/care during chemotherapy. Progress in neuroimaging will help specify neural processes affected by treatments. CONCLUSION: Clinical data and animal models confirmed that chemotherapy induces direct cognitive deficit. The benefits of cognitive rehabilitation are still to be confirmed. Studies evaluating the mechanisms underlying cognitive impairments using advanced neuroimaging techniques integrating the evaluation of genetic factors are ongoing.
CONTEXT: Although cognitive impairments have been identified in patients with non-central nervous system cancer, especially breast cancer, the respective roles of cancer and therapies, and the mechanisms involved in cognitive dysfunction remain unclear. OBJECTIVES: To report a state-of-the-art update from the International Cognitive and Cancer Task Force conference held in 2012. METHODS: A report of the meeting and recent new perspectives are presented. RESULTS: Recent clinical data support that non-central nervous system cancer per se may be involved in cognitive dysfunctions associated with inflammation parameters. The role of chemotherapy on cognitive decline was confirmed in colorectal and testicular cancers. Whereas the impact of hormone therapy remains debatable, some studies support a negative impact of targeted therapies on cognition. Regarding interventions, preliminary results of cognitive rehabilitation showed encouraging results. The methodology of future longitudinal studies has to be optimized by a priori end points, the use of validated test batteries, and the inclusion of control groups. Comorbidities and aging are important factors to be taken into account in future studies. Preclinical studies in animal models highlighted the role of cancer itself on cognition and support the possible benefits of prevention/care during chemotherapy. Progress in neuroimaging will help specify neural processes affected by treatments. CONCLUSION: Clinical data and animal models confirmed that chemotherapy induces direct cognitive deficit. The benefits of cognitive rehabilitation are still to be confirmed. Studies evaluating the mechanisms underlying cognitive impairments using advanced neuroimaging techniques integrating the evaluation of genetic factors are ongoing.
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