Perioperative considerations in patients with chemotherapyinduced cognitive impairment: a narrative review

Patients with cancer may suffer from a decline in their cognitive function after various cancer therapies, including surgery, radiation, and chemotherapy, and in some cases, this decline in cognitive function persists even years after completion of treatment. Chemobrain or chemotherapy-induced cognitive impairment, a well-established clinical syndrome, has become an increasing concern as the number of successfully treated cancer patients has increased significantly. Chemotherapy-induced cognitive impairment can originate from direct neurotoxicity, neuroinflammation, and oxidative stress, resulting in alterations in grey matter volume, white matter integrity, and brain connectivity. Surgery has been associated with exacerbating the inflammatory response associated with chemotherapy and predisposes patients to develop postoperative cognitive dysfunction. As the proportion of patients living longer after these therapies increases, the magnitude of impact and growing concern of post-treatment cognitive dysfunction in these patients has also come to the fore. We review the clinical presentation, potential mechanisms, predisposing factors, diagnostic methods, neuropsychological testing, and imaging findings of chemotherapy-induced cognitive impairment and its intersection with postoperative cognitive dysfunction.

Automated summary

Patients with cancer may experience a decline in cognitive function after cancer therapies, including surgery, radiation, and chemotherapy. Chemotherapy-induced cognitive impairment can result from neurotoxicity, neuroinflammation, and oxidative stress, leading to changes in brain structure and connectivity. Surgery can exacerbate this condition and potentially cause postoperative cognitive dysfunction. As the number of successfully treated cancer patients increases, the impact of cognitive dysfunction after treatment has become a growing concern.