Cognitive Impairment in Adults with Cancer (PDQ®): Supportive care - Patient Information [NCI]

General Information About Cognitive Problems in Cancer Survivors

Cognition problems can change the way you think and learn.

Cognition is the process of how you learn, remember, and become aware of what is around you.

This process includes being able to do the following:

• Focus on important information, thoughts, and actions.
• Pay attention to a task or activity for a long period of time.
• Predict what may happen, plan, and solve problems.
• Learn quickly.
• Have a sense of where objects are around you.
• Understand and communicate by speaking and writing.
• Learn and remember new information.

When your cognition changes, you may have problems with daily tasks.

This summary is about cognitive changes that occur in people with cancer and cancer survivors.

Memory loss and thinking problems are common in people with cancer and cancer survivors.

Your thought process may change, and it may be hard for you to focus and remember things the same way as you did before your cancer treatment.

Talk to your doctor about memory loss and thinking problems you have during or after treatment.

Signs of Cognitive Problems

Signs of cognitive problems include trouble learning or remembering.

Other conditions may also cause cognitive problems. Talk to your doctor if you have memory loss or are unable to do the following:

• Focus on what you are doing.
• Complete tasks.
• Understand what people are saying.
• Remember names and common words.
• Recognize familiar objects.
• Follow instructions.
• Manage your money well. For example, you may have trouble paying bills or balancing your checkbook.

You may also notice the following changes:

• Disorganized behavior or thinking.
• Loss of interest.
• Problems making sense of the world around you.

Cancer treatments or other diseases may cause cognitive problems.

Factors that cause cognitive problems in people with cancer and cancer survivors include the following:

• Older age.
• Being weak or frail.
• Cancer treatments, such as chemotherapy or radiation therapy, or other medications, and their side effects.
• Being postmenopausal.
• Distress, such as anxiety or depression.
• Symptoms, such as pain, fatigue, or trouble sleeping.
• Other diseases or conditions.
• Using alcohol or other substances that change your mental state.
• The stage of the cancer (the size of the tumor, and whether it has spread to the lymph nodes or other parts of the body).
• Higher levels of certain proteins in the blood.

The cognitive effects of endocrine therapy were studied in breast cancer survivors. Patients who received 5 years of treatment with exemestane were compared with those who received 2.5 years of tamoxifen followed by 2.5 years of exemestane, and with healthy participants. Findings suggested that tamoxifen may have more adverse cognitive effects than exemestane. More studies are needed to confirm these results.

Your doctor will examine you to better understand your cognitive problems.

Your doctor will ask about your health history and usual daily activities to find out a cause of your cognitive problems. Your doctor will also do an exam to check for signs of disease.

Treatment of Cognitive Problems

Treatment of cognitive problems may include activities that help your attention, memory, and thinking.

Cognitive rehabilitation

The goal of cognitive rehabilitation is to improve your memory and the way you think, organize, and make decisions. Cognitive rehabilitation involves the following:

• Learning ways to take in new information and perform new tasks or behaviors.
• Staying organized by using tools, such as calendars or electronic diaries.
• Doing activities over and over, usually on a computer, that become more challenging over time.

Movement therapy

Movement therapy or exercises, such as tai chi, qigong, or yoga, may improve the way you think and focus.

Attention restoration

Activities that restore attention may help you stay focused on what is around you. These activities may include walking, gardening, bird-watching, and caring for pets.

Meditation

Meditation may help improve cognitive function. Meditation is a mind–body practice in which a person focuses his or her attention on something, such as an object, word, phrase, or breathing. This will help keep you from being distracted or having stressful thoughts or feelings. Mindfulness-based stress reduction is a type of meditation that focuses on bringing attention and awareness to each moment.

Certain drugs are being studied to treat cognitive problems.

Several drugs have been studied to treat cognitive problems in people who have or who have had cancer, such as psychostimulants and erythropoietin -stimulating agents, but results are mixed. More research is needed.

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about expert-reviewed information summary about causes and management of cognitive impairment in people with cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Supportive and Palliative Care Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

Permission to Use This Summary

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The best way to cite this PDQ summary is:

PDQ® Supportive and Palliative Care Editorial Board. PDQ Cognitive Impairment in Adults with Cancer. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/side-effects/memory/cognitive-impairment-pdq. Accessed <MM/DD/YYYY>.

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The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.

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Last Revised: 2024-05-13

If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.