The cognitive processes of cancer patients in advanced stages: Navigating terminal realities

Cognitive impairment in late-stage cancer is an increasingly seen but underappreciated aspect of terminal care. This review integrates recent findings on the multifactorial etiology and expression of cognitive impairment in terminally ill cancer patients, considering data from neuroimaging, psychopharmacology, theoretical psychology, and palliative medicine. Structural and functional alterations—detected by modalities like CT, MRI, and fMRI—correlate with impairments in executive function, memory, attention, and emotion regulation. These deficits are further influenced by existential distress, cultural background, spiritual thought, and psychological resilience. Therapeutic interventions—ranging from cognitive behavioral therapy and meaning-centered psychotherapy to pharmacologic agents and caregiver-spiritual support—can maintain dignity and foster emotional balance, even in the face of irreversible neurological deterioration. This review article highlights the importance of an integrated, patient-oriented approach to cognitive care in cancer, supporting early identification, interdisciplinary interventions, and culturally sensitive support that respects the patient's mind, identity, and values at the end-of-life.