Denlinger, C.S., Ligibel, J.A., Are, M., Baker, K.S., Demark-Wahnefried, W., Friedman, D.L., . . . National Comprehensive Cancer Network. (2014). Survivorship: Cognitive function [v.1.2014]. Journal of the National Comprehensive Cancer Network, 12, 976–986.
Purpose & Patient Population
PURPOSE: To provide recommendations for the assessment, evaluation, and management of cognitive impairment in survivors of cancer
TYPES OF PATIENTS ADDRESSED: Cancer survivors
Type of Resource/Evidence-Based Process
RESOURCE TYPE: Consensus-based guideline
PROCESS OF DEVELOPMENT: Extent, consistency, and quality of data from articles retrieved in search were used to determine the level of evidence (higher or lower level) and the consensus for recommendations. According to NCCN categories for guidelines, the 2014 Cognitive Function Guidelines are a 2A Category (≥ 85% uniform consensus was reached from lower-level evidence available for the 2014 Cognitive Function Guidelines).
SEARCH STRATEGY:
DATABASES USED: PubMed
KEYWORDS: Neoplasms, cancer, and survivors
INCLUSION CRITERIA: Human, English, clinical trial phases 2–3, practice guideline, randomized, controlled trial, meta-analysis, systematic reviews, and validation studies
Phase of Care and Clinical Applications
PHASE OF CARE: Late effects and survivorship
APPLICATIONS: Pediatrics and elder care
Results Provided in the Reference
A uniform NCCN consensus determined that recommendations were appropriate (NCCN Category of Evidence and Consensus = 2A).
Guidelines & Recommendations
Nonpharmacologic interventions were recommended as first-line therapies whenever possible. These included specific neuropsychological recommendations based on formal evaluation, cognitive behavioral therapy, self-management and coping strategies, discontinuing or limiting medications that may contribute to cognitive dysfunction, managing medical comorbidities, relaxation, stress management, exercise, occupational therapy strategies, patient and family education and counseling, and managing distress, pain, sleep disturbances, and fatigue.
Pharmacologic interventions were recommended as the last line of therapy. These included the use of stimulants (methylphenidate or modafinil).
Limitations
Some interventions that may be useful to improve or maintain cognitive function might not be included in these guidelines because this manuscript did not detail search strategies, inclusions and exclusions, or the number of articles included in the recommendations.
Nursing Implications
The NCCN cognitive function algorithm aids healthcare professionals considering the assessment and treatment of cancer-related cognitive function. Nonpharmacologic interventions should be recommended to oncology survivors experiencing cognitive issues. Pharmacologic interventions may be considered when medical conditions permit and potential contributing factors are ruled out or managed.
