Cognitive Sequelae of Intensive Treatment for Hematological Malignancies

With more active treatments becoming available, cancer is increasingly becoming a more chronic illness. The side-effects of cancer treatment, including potential neurotoxic effects are a major concern. The number of long-term cancer survivors will further increase in the near future, as will the number of survivors with cognitive and neurobehavioral impairment. Both chemotherapy and cranial irradiation may induce cognitive impairment.1 Research on cognitive functioning following cancer treatment started in the early 1980s,2 but still there is a paucity of systematic prospective, longitudinal and large-scale studies using objective psychometric measures. Up till recently, most clinical trials investigating new treatment approaches focused on survival, time to tumor progression, physical side-effects and its impact on quality of life (QOL), rather than on potential cognitive side-effects. This thesis reports on the cognitive sequelae of intensive treatment for hematological malignancies. The central aim of this thesis was to examine the prevalence and the characteristics of cognitive impairment in patients treated with or undergoing bone marrow or hematopoietic stem cell transplantation (HSCT), and in patients treated for primary central nervous system lymphoma (PCNSL). Additional goals were to study the relationship between cognitive functioning and subjective cognitive complaints, general QOL-related issues, and psychological functioning. This chapter presents and discusses the main findings, the limitations of the studies and recommendations for future research.