Improving cognitive impairment in cancer survivors

Prof Dr Anne Rogiers is a psychiatrist working in the CHU Brugmann in Brussels. During ESMO 2024, Prof Rogiers discussed the issue of cognitive impairment in cancer survivors and explained how this complication can be countered using integrative neurocognitive remediation therapy (INCRT)

Brain metastases and the use of radiotherapy or chemotherapy can induce structural neuronal damage in cancer patients. Furthermore, immune related adverse events that affect the endocrine function and the central nervous system can further exacerbate this. In this respect, pilot studies indicate that 32% to 41% of metastatic melanoma survivors suffer from objective cognitive deficits. Building further on these findings, Prof Rogiers and colleagues evaluated the cognitive function of melanoma survivors who received immunotherapy. Of the 68 survivors that were included in this study, 43 (68%) proved to have an overall cognitive impairment. Interestingly, however, only a minority of these patients (12%) had cognitive complaints. Of note, the presence of brain metastases did not predict for neurocognitive impairment, with 46% of patients with brain metastases being free of cognitive impairment.

Neurological studies have shown that it is possible to improve the neurocognitive function, even if there is structural damage. This formed the basis for Prof Rogiers to evaluate the impact of INCRT on the neurocognition of cancer survivors. Within the context of a multidisciplinary integrative neurocognitive remediation clinic, cancer survivors receive a combination of neurocognitive remediation (e.g., strategy training, drilling), adaptive physiotherapy and cognitive behavior training. To get a clearer view on the efficacy of this cognitive remediation program, a prospective study was set up. By August 2024, 26 cancer survivors had entered the study of whom 23 had completed the program. Interestingly, a comparison of the neuropsychological test results before and after INCRT indicated a clear improvement in overall cognitive functioning, memory composite and executive composite. Furthermore, all patients in the study improved in at least one daily function, such as household tasks, social interactions, administration, hobbies or reading.

As such, these findings indicate that cognitive impairment is common among cancer survivors who received immunotherapy. However, this impairment can in part be countered with INCRT. These findings are of particular relevance given the ever-increasing number of cancer survivors due to the introduction of more effective anticancer therapies.