The mechanisms behind chemotherapy-induced cognitive changes remain largely unknown, but several candidate mechanisms have been identified. These include shared genetic risk factors for cancer and cognitive problems, such as low-efficiency efflux pumps, deficits in DNA repair mechanisms, and deregulated immune responses. Chemotherapy's impact on these systems may contribute to cognitive decline in patients. Additionally, genetically modulated reductions in neural repair capacity, neurotransmitter activity, and antioxidant capacity, often associated with reduced estrogen and testosterone levels, might interact with or independently affect cognitive function. Studies have shown that cognitive changes associated with chemotherapy are typically subtle and occur across various cognitive domains, including working memory, executive function, and processing speed. Long-term cognitive changes after chemotherapy persist in only a subset of cancer survivors. Research using imaging techniques has reported structural and functional changes in the brain, such as reduced brain volume and altered white-matter integrity, associated with cognitive dysfunction. The authors suggest that future research should focus on evaluating these candidate mechanisms and their potential interactions, using longitudinal studies and advanced imaging techniques.The mechanisms behind chemotherapy-induced cognitive changes remain largely unknown, but several candidate mechanisms have been identified. These include shared genetic risk factors for cancer and cognitive problems, such as low-efficiency efflux pumps, deficits in DNA repair mechanisms, and deregulated immune responses. Chemotherapy's impact on these systems may contribute to cognitive decline in patients. Additionally, genetically modulated reductions in neural repair capacity, neurotransmitter activity, and antioxidant capacity, often associated with reduced estrogen and testosterone levels, might interact with or independently affect cognitive function. Studies have shown that cognitive changes associated with chemotherapy are typically subtle and occur across various cognitive domains, including working memory, executive function, and processing speed. Long-term cognitive changes after chemotherapy persist in only a subset of cancer survivors. Research using imaging techniques has reported structural and functional changes in the brain, such as reduced brain volume and altered white-matter integrity, associated with cognitive dysfunction. The authors suggest that future research should focus on evaluating these candidate mechanisms and their potential interactions, using longitudinal studies and advanced imaging techniques.