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New Directions in Cancer-Related Cognitive Impairment, Fatigue, and Pain: Symposium

New Directions in Cancer-Related Cognitive Impairment, Fatigue, and Pain: Symposium

SAN DIEGO, California—A symposium at the Oncology
Nursing Society’s 26th Annual Congress addressed the challenges of
managing cancer-related cognitive impairment, fatigue, and pain. Each of
three speakers gave an overview of one of these problems, including
contributing factors and current research, and then discussed new approaches
to symptom management.

Cognitive Impairment

Catherine M. Bender, PhD, RN, assistant professor of
oncology nursing, University of Pittsburgh School of Nursing, reviewed
current knowledge concerning cancer-related cognitive impairment. She
described the components of cognitive function—attention, learning and
memory, psychomotor speed and manual dexterity, visuospatial ability, and
general intelligence.

"These processes are all highly interrelated," Dr.
Bender said. "Thus, a problem with one process may also impact the
functioning of other processes."

In addition, she said, many of these cognitive processes are
multidimensional. "For example," she said, "attention has
multiple related capacities that permit you to be receptive to stimuli in
the environment so that you can select information, concentrate on that
information, inhibit irrelevant information, and thus sustain your
attention."

The cognitive processes most often affected in cancer
patients are attention, learning and short-term memory, and psychomotor
speed and manual dexterity. Problems with these processes have a significant
impact on the cancer patient, she said. They can impair decision-making,
interfere with the patient’s roles in the family and at work, and erode
quality of life.

A long list of direct and indirect factors can contribute to
cognitive impairment. Direct factors are primary or metastatic brain
lesions. Indirect factors include the effects of cancer therapy—virtually
all of which, Dr. Bender said, can affect cognitive function—infections,
fevers, nutritional deficiencies, hematologic abnormalities such as anemia,
and metabolic and endocrine abnormalities such as a decline in reproductive
hormone levels.

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