Cancer-Related Cognitive Impairment (CRCI), also known as "chemobrain" refers to cognitive changes and difficulty experienced as an effect of chemotherapy agents. In my experience, individuals with cancer who have not received chemotherapy but receive disease-managing interventions that involve hormone deprivation may experience similar symptoms. Other cancer interventions, such as whole-brain radiation may also impact cognition. The pathophysiology of CRCI is currently not well understood however it is thought that there are central neurotoxic properties to certain chemotherapy agents. While it is necessary for chemotherapy agents to reach brain cells to address any microscopic disease that might be present, side effects of these agents can cause mild to severe effects upon cognition in some individuals. These symptoms may spontaneously resolve at the conclusion of treatment or a few months after, ranging to being unremitting for several years. It is similarly not well understood who or why may experience chronic cognitive problems following oncology treatments. These problems can be extremely frustrating for individuals experiencing them, as every aspect of daily functioning can be affected. This may be more pronounced or stressful for individuals with higher cognitive occupational demands.

In my experience, patients experiencing CRCI or "chemobrain" often say that they had no idea that interventions existed to address cognitive and language problems impacting their lives. Many individuals have told me that they were afraid they were beginning to experience dementia or that the problems were progressive in nature. Thus it is likely that CRCI is hugely undertreated, poorly understood, and people living with it are suffering to a greater extent than is necessary. Some individuals experience improvement in underlying function due to cognitive rehabiliation, while others may experience unremitting symptoms but learn effective adaptive or compensatory techniques to function more effectively with the cognitive issues. In either case, hope exists for cognitive and language problems arising from CRCI.

Changes in speech, language, and cognitive functioning occur as a result of the location, size, and other characteristics of the of brain tumor and associated treatments for it, such as surgery, radiation, and chemotherapy. Brain cancer may be primary (e.g., glioblastoma, astrocytoma, oligodroglioma, etc.) or metastatic (e.g., due to the spread of lung cancers); tumors may also be benign (e.g., meningioma) but at some point affected brain tissue before or after treatment. Brain tumors can result in aphasia, motor speech disorders, and right-hemisphere related communication problems (see in-depth explanation under Stroke tab); cognitive problems, amongst other changes in neurological function. Cognitive and communication symptoms can be complex and fluctuate due to swelling, medication effects, changes in disease status, fatigue, and other factors. Furthermore, secondary problems such as stroke can occur during surgery to resect brain tumors.

Individuals living with brain tumors can benefit from communication and cognitive interventions at many points along the course of experiencing this condition. Direct rehabilitation approaches may improve underlying function following tumor resection or radiation treatment. Individuals who are working or who have other high demand communication and cognitive functions during treatment can benefit from working with a speech pathologist to address the ways in which current impairments are impacting their activities through development of strategies, supports, and other approaches. Individuals with progressive or terminal brain cancers can benefit from SLP interventions to maximize communication and cognition through end of life, including providing alternative communication supports and systems to communicate wants, needs, wishes, and to decision making regarding their own care as well as their affairs.