Beyond survival: a cross-sectional analysis of guideline recommendations for cognitive, sexual, and psychological problems in adult cancer survivors

As the number of cancer survivors increases globally, greater attention is being directed toward life after cancer. Beneath the surface of remission lies a cluster of silent struggles: cognitive impairments, sexual dysfunction, and psychological distress. The aim was to summarize current recommendations for adult cancer survivors suffering from cognitive impairment, sexual health, and psychological problems. A systematic search of PubMed, the Cochrane Library, and major professional society websites was conducted on 16 January 2025. Guidelines published in English from 1 January 2000 to 31 December 2024 were included if they addressed cognitive, sexual, or psychological issues in adult cancer survivors. Two reviewers independently appraised guideline quality using Appraisal of Guidelines for Research and Evaluation II criteria and extracted recommendations, which were then standardized using the Grading of Recommendations Assessment, Development, and Evaluation framework. Of 523 guidelines screened, 13 guidelines from 7 professional societies met inclusion criteria. Twelve (92.3%) were of moderate quality; one (7.7%) was low quality. Guidelines frequently emphasize addressing long-term survivorship as a different set of challenges, requiring recognition of psychosocial needs. Many guidelines recommended the use of validated tools for assessing cognitive, sexual, and psychological issues. Non-pharmacologic interventions such as education, physical activity, coping strategies, cognitive rehabilitation, and cognitive behavioral therapy were commonly recommended, although evidence levels varied considerably. Multidisciplinary approaches were recommended for survivors with conditions affecting daily life and Quality of Life (QoL). Pharmacologic recommendations were mainly directed toward specific treatment-related complications. PDE5 inhibitors and vaginal estrogens were recommended for survivors experiencing sexual dysfunction, whereas osteoporosis treatment, including bisphosphonates and DEXA monitoring, was recommended for survivors undergoing long-term endocrine therapies or considered at high risk for osteoporosis. Cognitive, sexual, and psychological concerns should be proactively screened and managed in cancer survivors. Non-pharmacologic, patient-centered interventions should be prioritized, with individualized care and shared decision-making.