Several candidate mechanisms of CRCI have been proposed, including inflammation and cytokine dysregulation, chemotherapy - induced epigenetic changes, blood — brain barrier disruption, hormone deficiencies, oxidative DNA damage and shortened telomere length, and genetic susceptibility.21 — 26 However, the heterogeneity and design limitations within the emerging body of evidence have led to recommendations for harmonising study methodologies and moving
towards multisite, longitudinal research.3 27 Such
approaches would support the demonstration of
robust relationships between measurable biological processes and cognitive outcomes.