Cancer is a disease that affects around 433,000 new people each year in France. It is the leading cause of death in men and the second in women. This disease endangers the lives of patients and for this reason the main objective of medicine has been to prolong their lives as much as possible.
Thanks to medical advances, a growing number of patients can now survive cancer. This success has pushed research to focus not only on survival, but also on patients' long-term quality of life.
Disorders due to cancer and treatments
This can in fact be affected after the end of the treatments. On the one hand, because the person has experienced a traumatic event, but also because the treatments can lead to long-term physiological disorders, as illustrated by studies on breast cancer.
The disorders may vary depending on the type of cancer, the treatment received, the age of the patients and individual comorbidities. Several studies have focused more specifically on breast cancer, which is one of the most studied due to its high frequency and high survival rate compared to other cancers.
In France, there were 61,214 new cases of breast cancer in mainland France in 2023. Fortunately, the survival rate continues to increase (it is currently 88% at 5 years). Research is further exploring ways to improve the quality of life of cancer survivors.
Discomfort that can last after the illness
Once a life is saved, several consequences occur, some more well known than others. People who have had cancer may feel guilty about having survived and fear of recurrence. Furthermore, the most direct and obvious side effects of cancer treatments are beginning to disappear, such as fatigue, chronic pain, hair loss, and skin and nail problems.
However, there is some discomfort that can remain and continue. People who have had cancer may, for example, experience difficulty concentrating, not being able to finish the page of a book, forgetting what they were going to buy at the supermarket, driving a car and forgetting their way, or even losing or replace words when they speak.
The relatives of these people can also make these observations and report forgetfulness or lack of attention. These problems can persist after treatment for years. Studies have noted the presence of disorders up to 10 years after the end of treatments. Some patients say they feel like they are losing their minds, going crazy. Some mention memory and executive problems. The discomfort produced by these symptoms can even lead to social isolation.
And chemobrain or “cognitive fog” with social consequences
Damage linked to anticancer treatments, also known as chemobrain or “cognitive fog”, are considered mild. But they can impact the quality of life of patients.
First, because these cognitive disorders can affect performance in daily tasks. Second, because it can undermine confidence in one's own cognitive abilities, which can lead to putting aside certain activities for fear of not being able to do them. Third, because people who have had cancer begin to hide the difficulties they encounter, which can lead them to escape from the professional environment and to social isolation.
In breast cancer, for example, far from being the fruit of patients' imagination, these attacks have been objectified using neuropsychological tests and neuroimaging studies.
Neuropsychological tests revealed impairment of verbal memory, flexibility and working memory. Neuroimaging revealed a reduction in brain gray matter and total brain volume. (On distingue two categories of tissues in the brain : gray matter and white matter, gray matter being notably responsible for cognitive functions such as reading, calculation, attention, memory, etc. Editor's note).
Several hypotheses are put forward to explain the origin of these attacks. Some researchers consider that they arise from inflammatory processes triggered by anticancer treatments. Other than treatments modify the permeability of the blood-brain barrier, a structure that has the function of protecting the brain against harmful agents, which would lead to the passage of substances that normally are retained by this barrier.
What support is offered?
Today, these disorders are increasingly known, and different treatments are offered to patients. Physical activity and, what we call, cognitive remediation are among the best-known treatments.
Cognitive remediation is used in mental health. We are now also experimenting with this approach to combat cognitive disorders following oncological treatments.
This treatment uses personalized exercises to address different cognitive processes such as memory, attention and executive functions. Advances in digital technology such as apps and software make it easier to carry out cognitive exercises at home, allowing detailed monitoring of progress, as well as the possibility for neuropsychologists to set up personalized monitoring.
This approach is based on neuroplasticity, that is, the brain's ability to reorganize itself and form new connections, which is essential for recovering and improving cognitive functions. These innovations aim at the recovery of affected abilities, which offers hope and significantly improves the quality of life of those affected.
Although cognitive remediation is an option that seems effective, there is still a way to go to best adapt it to patients' needs. Traditionally, this type of therapy is expensive and is typically delivered face-to-face. Today, in the field of neuropsychology, innovative methods of cognitive remediation are proposed, some through the use of software, applications, videoconferencing and virtual reality.
Current innovations offer significant hope for ultimately improving the quality of life of people affected by the cognitive after-effects of anticancer treatments. Evaluating the effectiveness of these remediation programs is today a priority issue for studies in cognitive psychology.
