Beyond Survival: A Cross-Sectional Analysis of Guideline Recommendations for Cognitive, Sexual, and Psychological Problems in Cancer Survivors

Background/Objective: As the number of cancer survivors increases globally, so does the spotlight on life after cancer. Beneath the surface of remission lies a cluster of silent struggles: cognitive impairments, fractured sexual health, and unspoken psychological wounds. The aim was to summarize current recommendations for adult cancer survivors suffering from cognitive impairment, sexual health, and psychological problems. Methods: A systematic search of PubMed, the Cochrane Library, and major professional society websites was conducted in January 2025. Guidelines published in English from 2000 to 2024 were included if they addressed cognitive, sexual, or psychological issues in adult cancer survivors. Two reviewers independently appraised guideline quality using AGREE II and extracted recommendations, which were then standardized using the GRADE framework. Results Of 524 guidelines screened, 13 guidelines from 7 professional societies met inclusion criteria. Thirteen (92.2%) were of moderate quality; one (7.8%) was low quality. Guidelines strongly emphasized addressing long-term survivorship as a different set of challenges, requiring recognition of psychosocial needs. Strong recommendations supported 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 universally endorsed. Multidisciplinary approaches were recommended for survivors with conditions affecting daily life and quality of life (Qol). Pharmacologic options included PDE5 inhibitors, vaginal estrogens, and osteoporosis treatment for high-risk patients. Conclusion : 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.