NeuroTrax Science Team and Glen M. Doniger, PhD
Cognitive impairment is one of the most disruptive and persistent consequences of cancer and its treatment. Across tumor types, including non-central nervous system (non-CNS) cancers, breast cancer, pediatric leukemia, glioma, and glioblastoma multiforme (GBM), patients frequently report changes in attention, executive function, memory, visual spatial perception, and information processing speed. These deficits can interfere with work, independence, and overall health-related quality of life (HRQoL).
In non-CNS cancer survivors, it was found that up to 40% report persistent neuropsychological difficulties years after treatment [1]. Their six-month vocational rehabilitation program did not significantly change objective cognitive scores, yet emotional functioning improved and 67% of participants returned to employment compared to 33% of controls. This underscores a critical point: measurable cognitive change and functional recovery do not always move in parallel; both must be assessed.
Among breast cancer survivors, cognitive concerns affect up to 75% of patients [2]. Objective testing has shown that obesity is associated with poorer information processing speed and higher odds of impairment [2], while moderate-to-vigorous physical activity correlates positively with faster processing speed, particularly in overweight and obese survivors [3]. Further, longer sleep duration in survivors is linked to better verbal functioning [2]. However, randomized trials of weight loss and metformin have not demonstrated broad cognitive improvement, although baseline BMI may modify outcomes in verbal domains [4]. These findings highlight the importance of domain-specific measurement rather than relying on subjective complaints alone.
Long-term survivors of pediatric leukemia similarly demonstrate persistent cognitive and HRQoL deficits, with nearly 28% impaired in at least one neuropsychological domain [5]. In neuro-oncology, cognitive tracking has clarified treatment effects: after resection and stereotactic radiosurgery for brain metastases, global cognitive performance remained stable at three months [6]; after low-grade glioma surgery, postoperative ischemic complications were associated with transient but measurable domain-specific changes [7]. In advanced palliative settings, such as anterior cingulotomy for refractory oncologic pain, significant pain relief occurred without meaningful global cognitive decline when assessed objectively [8]. In GBM, longitudinal neuropsychological testing has demonstrated postoperative cognitive improvement with parallel HRQoL gains [9].
Across these contexts, one conclusion is consistent: oncology care requires precise, longitudinal cognitive measurement. Cancer-related cognitive impairment (“chemo brain”) cannot be reliably monitored by subjective report alone. NeuroTrax provides a standardized, computerized neuropsychological battery capable of quantifying: memory, executive function, attention, information processing speed, visual spatial, and other cognitive domains with age- and education-adjusted norms.
In oncology settings, NeuroTrax is a digital neuromarker that can:
- Establish baseline cognitive function before treatment, facilitating differentiation between pre-existing vulnerability and treatment-related decline.
- Monitor cognitive changes during chemotherapy, radiation, or neurosurgical care, detecting subtle domain-specific shifts that may not appear on brief screening tools.
- Document recovery during survivorship, providing objective data that supports return-to-work decisions, rehabilitation planning, and patient reassurance.
Instead of relying solely on clinical impression, clinicians can track chemo brain with precision, measuring change over time and grounding case management decisions in data rather than perception alone. For patients, this offers clarity, validation, and confidence. For clinicians, it provides actionable insights across the cancer trajectory.
As survivorship becomes more prevalent and quality of life central to oncology care, integrating objective neurocognitive measurement with HRQoL assessment ensures that cognitive health is treated as a measurable, manageable component of comprehensive cancer care.
References:
[1] Bloch A, Sharoni L, Shany-Ur T, Maril S, Margalit D. Feasibility and initial assessment of a holistic neuropsychological day program for vocational rehabilitation following non-central nervous system cancer. Front Psychol. 2025;16:1415038. doi:10.3389/fpsyg.2025.1415038.
[2] Hartman SJ, Marinac CR, Natarajan L, Patterson RE. Lifestyle factors associated with cognitive functioning in breast cancer survivors. Psychooncology. 2015;24(6):669–675. doi:10.1002/pon.3626.
[3] Marinac CR, Godbole S, Kerr J, Natarajan L, Patterson RE, Hartman SJ. Objectively measured physical activity and cognitive functioning in breast cancer survivors. J Cancer Surviv. 2015;9(2):230–238. doi:10.1007/s11764-014-0404-0.
[4] Hartman SJ, Nelson SH, Marinac CR, Natarajan L, Parker BA, Patterson RE. The effects of weight loss and metformin on cognition among breast cancer survivors: Evidence from the Reach for Health study. Psychooncology. 2019;28(8):1640–1646. doi:10.1002/pon.5129.
[5] Chiou SS, Jang RC, Liao YM, Yang P. Health-related quality of life and cognitive outcomes among child and adolescent survivors of leukemia. Support Care Cancer. 2010;18(12):1581–1587. doi:10.1007/s00520-009-0781-5.
[6] Berger A, Strauss I, Ben Moshe S, Corn BW, Limon D, Shtraus N, Shahar T, Kanner AA. Neurocognitive evaluation of brain metastases patients treated with post-resection stereotactic radiosurgery: A prospective single arm clinical trial. J Neurooncol. 2018;140(2):307–315. doi:10.1007/s11060-018-2954-x.
[7] Berger A, Tzarfati G, Costa M, Serafimova M, Korn A, Vendrov I, Alfasi T, Krill D, Aviram D, Ben Moshe S, Kashanian A, Ram Z, Grossman R. Incidence and impact of stroke following surgery for low-grade glioma resection. J Neurosurg. 2019;134(1):153–161. doi:10.3171/2019.10.JNS192301.
[8] Strauss I, Berger A, Ben Moshe S, et al. Double anterior stereotactic cingulotomy for intractable oncological pain. Stereotact Funct Neurosurg. 2017;95(6):400–408. doi:10.1159/000484613.
[9] Morga R, Moskała M, Adamek D, Góral-Półrola J, Herman-Sucharska I, Pąchalska M. Health-related quality of life following neurosurgery on glioblastoma multiforme (GBM). Acta Neuropsychol. 2018;16(3):307–319. doi:10.5604/01.3001.0012.7452.
