Strategies for caring for the well cancer survivor

Chemotherapies that are more likely to cause cognitive symptoms include methotrexate, 5-fluorouracil, cyclophosphamide, and hormone antagonists.⁴⁷ More powerful regimens and repetitive chemotherapy regimens tend to cause more cognitive effects.⁴⁷

Cognitive training interventions show evidence of likely benefit,^44,48 leading to recommendations for self-treatment strategies, such as written lists, wordplay, crossword puzzles, jigsaw puzzles, playing a musical instrument, and new hobbies. Small studies suggest a benefit from cognitive behavioral therapy.^44,49 A study of breast cancer survivors showed that yoga led to improvement in patient-reported cognitive dysfunction.⁵⁰ Physical exercise yields cognitive benefit in healthy older adults and is supported by limited evidence in cancer survivors.⁵¹

There is no effective pharmacotherapy for cancer- and cancer chemotherapy-related cognitive dysfunction unless a treatable underlying cause is found.⁴⁴ Symptoms tend to subside with time after completion of chemotherapy, which might be reassuring to patients and families.⁴⁵

Psychiatric problems. The most common psychiatric issues in cancer survivors are anxiety and depression; the prevalence of anxiety is nearly double that of depression.⁵² Anxiety often presents as fear of a recurrence of cancer or a feeling of lack of control over present or future circumstances.⁵³ Screening for anxiety and depression is recommended at each visit, using standardized screening questionnaires.⁵⁴

A small study suggests that psychiatric treatment reduces the risk of early mortality.⁵⁵ Small studies also suggest that mindfulness-based therapy and cognitive behavioral therapy delivered by telehealth offer benefit.⁵⁶ A meta-analysis shows that exercise interventions improve depression and anxiety in breast cancer patients.⁵⁷

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