The impact of chemotherapy on frontal lobe executive functioning in adolescents and young adults diagnosed and treated for blood cancers: a systematic review

Abstract

Abstract Background Cancer-related cognitive impairment (CRCI), often termed “chemobrain,” is a recognised effect of cancer therapy. However, most research has focused on older adults with solid tumours, leaving the neurocognitive consequences of chemotherapy in adolescents and young adults (AYAs) with blood cancers poorly understood. Because executive functions (EF)—including working memory, inhibition, flexibility, planning, and processing speed—continue to mature into early adulthood, this group may be particularly vulnerable to neurotoxicity. Methods Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, PsycINFO, Embase (including Embase Classic), MEDLINE, and Scopus. Eligible studies included participants aged 16–25 years at diagnosis of a haematological malignancy who had received chemotherapy and were assessed for EF outcomes using validated measures. Methodological quality was appraised with an adapted Newcastle–Ottawa Scale (NOS). Results Twelve studies met inclusion criteria. Evidence indicated consistent vulnerability in working memory and processing speed, with less consistent findings for inhibition, flexibility, and planning. Heterogeneous methods, small samples, and frequent reliance on self-report limited comparability. High-quality, controlled studies employing objective tests reported measurable EF deficits following chemotherapy. Conclusions Chemotherapy may compromise EF in AYAs with blood cancers, though the evidence base remains methodologically limited. Standardised EF assessment, longitudinal research with baseline data, and integration of cognitive monitoring into survivorship care are recommended.