How to integrate cognitive rehabilitation into post-cancer care plan

Le cancer est une maladie qui affecte non seulement le corps, mais aussi l'esprit. Les traitements contre le cancer, tels que la chimiothérapie et la radiothérapie, peuvent avoir un impact significatif sur la fonction cognitive d'une personne. Les survivants du cancer peuvent éprouver des difficultés de mémoire, de concentration et de résolution de problèmes, ce qui peut avoir un impact sur leur qualité de vie et leur fonctionnement quotidien. C'est pourquoi la rééducation cognitive post-cancer est si importante. Elle vise à aider les survivants du cancer à retrouver leurs capacités cognitives et à améliorer leur qualité de vie.

The effects of the disease on the brain and cognition

Cancer, as well as associated treatments such as chemotherapy, radiotherapy, and surgery, can have devastating effects on the brain and cognitive functions of patients. Aggressive cancer treatments primarily aim to destroy cancer cells, but they can also damage healthy cells, including those in the brain, thereby disrupting cognitive processes.Chemotherapy is one of the treatments most frequently associated with cognitive alterations. Chemotherapy drugs can cause direct damage to brain cells by disrupting their ability to repair and regenerate. This can affect several aspects of cognition, including short-term memory, concentration, learning ability, and the speed of cognitive processes. Additionally, chemotherapy can cause side effects such as "chemo brain," a phenomenon where patients feel mentally "foggy," having difficulty concentrating or recalling simple information.Radiotherapy treatments, while primarily targeting cancer cells, can also have consequences on the brain. In particular, when radiotherapy is administered near the brain, it can damage healthy brain cells and cause cognitive symptoms both in the short and long term. Radiotherapy can also induce brain inflammation, disrupting neural connections and impairing communication between different regions of the brain, with repercussions on memory, attention, processing speed, and problem-solving ability.The emotional and psychological stress caused by the cancer diagnosis and treatments can also contribute to cognitive function impairment. Depression, anxiety, and uncertainty related to cancer can reduce attentional and memory capacities. Indeed, chronic stress directly affects the brain by altering the levels of certain hormones, such as cortisol, which has a devastating effect on brain structures involved in memory, attention, and decision-making.Cancer survivors may thus experience a variety of cognitive difficulties, including short-term memory problems, concentration disorders, and decreased learning abilities. These cognitive deficits can hinder the performance of daily activities, such as work, social interactions, and managing household tasks, and consequently reduce the overall quality of life of patients.

The benefits of post-cancer cognitive rehabilitation

Post-cancer cognitive rehabilitation represents an essential therapeutic approach for cancer survivors suffering from cognitive deficits. This rehabilitation aims to restore brain functions damaged by the disease and its treatments, thus allowing patients to regain their autonomy and improve their well-being.One of the major benefits of cognitive rehabilitation is that it can help improve memory, attention, and other impaired cognitive skills. For example, specific memory or concentration exercises can stimulate brain capabilities and help strengthen neural connections. These improvements can make daily tasks easier, reduce dependence on others, and increase survivors' confidence in their cognitive abilities.Cognitive rehabilitation also plays a crucial role in restoring the self-esteem of cancer survivors. The cognitive difficulties caused by the disease can lead to a loss of self-confidence, which can affect quality of life. Survivors may feel frustrated, helpless, or unable to fulfill their social or professional roles. Through rehabilitation, they can gradually regain control over their cognition and regain their independence. This recovery can restore their sense of competence and effectiveness, which is essential for a successful reintegration into social and professional life.Moreover, cognitive rehabilitation allows for more effective management of "chemo brain" symptoms and other cognitive side effects. By proactively addressing these symptoms, survivors can better manage their daily lives, improving their overall quality of life. It has also been observed that cognitive rehabilitation enhances the social relationships of cancer survivors, as it helps them communicate better and maintain smoother social interactions.

The different approaches to cognitive rehabilitation

Post-cancer cognitive rehabilitation relies on a variety of approaches aimed at improving the different impaired cognitive functions. These techniques can be grouped into two main categories: cognitive training and compensation strategies.1. Cognitive training
Cognitive training includes specific exercises designed to stimulate and improve particular cognitive functions such as memory, attention, information processing speed, and executive functions (like planning and decision-making). These exercises can be performed in the form of memory games, puzzles, or concentration tasks. Digital tools, such as mobile applications or computer software, are also used to provide targeted training. These tools are designed to stimulate different regions of the brain in an interactive and progressive manner, allowing survivors to work at their own pace.The exercises may include memorization tasks, visual and auditory recognition, games that enhance sustained attention, or activities that promote the organization of information. The goal is to strengthen neural connections and promote neuroplasticity, the process by which the brain reorganizes and creates new connections to compensate for cognitive deficits.2. Compensation strategies
Compensation strategies aim to help cancer survivors bypass their cognitive difficulties by using practical techniques and tools. This may include the use of task lists, electronic reminders, or time management applications to organize daily tasks and help remember important information. Patients may also learn to break complex tasks into simple, manageable steps to avoid feeling overwhelmed.Other strategies include structuring the environment to reduce distractions and improve concentration, such as organizing dedicated workspaces and scheduling time slots for tasks requiring sustained attention. Additionally, survivors may be encouraged to take regular breaks to avoid mental fatigue, which can impair concentration and memory.3. Relaxation techniques and stress management
Relaxation techniques and stress management, such as meditation, yoga, mindfulness, and deep breathing exercises, are also integrated into cognitive rehabilitation. These approaches help reduce anxiety and stress, two factors that can negatively impact cognitive functions. Stress management improves the ability to concentrate and memorize, allowing patients to better cope with the cognitive challenges faced after cancer.4. Multisensory cognitive rehabilitation
Some cognitive rehabilitation approaches incorporate multisensory stimulation to enhance learning and memory. For example, the combined use of visual, auditory, and tactile stimuli during cognitive exercises can promote mental engagement and reactivation of neural networks. These approaches can be particularly useful for survivors who experience difficulties with certain sensory modalities, such as vision or hearing impairments.