Neurological Complications

Since the birth of oncology as a distinct medical discipline, oncologists have considered myelosuppression and its attendant problems to be the dose-limiting and most important toxicities of radiation and chemotherapy. Within the last decade, however, the availability of colony-stimulating factors, and dramatic improvements in transfusion medicine, antibiotic therapy, and supportive care have made the bone marrow more robust. Today, a strong case can be made that the nervous system has replaced the bone marrow as the most important dose-limiting end organ for cancer therapy. Similarly, for the growing number of cancer survivors, the nervous system rather than the hematopoietic system more frequently affects the quality of survival and the economic productivity of survivors. At the same time, longer survival, more effective systemic therapies, and the relative inaccessibility of the nervous system to these therapies has resulted in a steady increase in the frequency of direct nervous system involvement by non-nervous system cancer.

All components of the central and peripheral nervous system are susceptible to injury by cancer therapy. Among the most prominent targets are the brain (resulting in cognitive impairment, neuroendocrine dysfunction, depression, anxiety, and social disintegration) and the peripheral nerves (resulting in neuropathy). The brain, spinal epidural space and leptomeninges are all common nervous system targets for metastatic spread of tumor and subsequent neurologic compromise.

The guiding purpose of the Neurologic Complications Study Group is to raise awareness within the healthcare community and among patients and advocacy groups about the frequency, importance, and complexity of these problems. To accomplish this goal, the group initiates and supports collaborative research designed to expand our knowledge of the nature, treatment, and prevention of neurologic complications. This group also serves as a resource for information about these problems and develops evidence-based guidelines. Because these issues have only recently garnered attention from the academic community, research on their characteristics, risk factors, and frequency is limited.

The study group was formed to focus on the following objectives:

• To develop reliable assessment tools
• To assess internationally potential variation in the significance of neurological complications
• To survey members’ opinions and needs regarding neurological complications
• To contribute program content to MASCC meetings and practical resources to the MASCC website

Because these problems are important to all patients with cancer, a multidisciplinary approach is essential. In particular, this study group promotes close collaboration with the Psychosocial and the Survivorship Study Groups.