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.
