Cognitive impairment and chemotherapy: a brief overview

Vitali, Milena; Ripamonti, Carla; Roila, Fausto; Proto, Claudia; Signorelli, Diego; Imbimbo, Martina; Corrao, Giulia; Brissa, Angela; Gallucci, Rosaria; Braud, Filippo de; Garassino, Marina Chiara; Russo, Giuseppe Lo

doi:10.1016/j.critrevonc.2017.08.001

Cited by 59 publications

(50 citation statements)

References 91 publications

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“…The findings of decreased attention/concentration, memory, and processing speed after chemotherapy are in concordance with previous longitudinal studies (Mandelblatt et al, ; Vitali, Ripamonti, Roila, et al, ). Additionally, this study found older patients receiving chemotherapy to be more vulnerable with regard to processing speed.…”

Section: Discussionsupporting

confidence: 92%

Age‐dependent brain volume and neuropsychological changes after chemotherapy in breast cancer patients

Blommaert

Schroyen

Vandenbulcke

et al. 2019

Human Brain Mapping

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This study investigated volumetric brain changes and cognitive performance in premenopausal and postmenopausal patients treated for early‐stage breast cancer. Participants underwent elaborate neurocognitive assessments (neuropsychological testing, cognitive failure questionnaire, and high‐resolution T1‐weighted structural MRI) before and after chemotherapy. Volumetric brain changes were estimated, using longitudinal deformation‐based morphometry, and correlated with cognitive changes. In total, 180 women participated in this study, of whom 72 patients with breast cancer had received adjuvant chemotherapy (C+), 49 patients did not receive chemotherapy (C−), and 59 healthy controls (HC). The population was categorized into two age groups: A young group who were premenopausal and younger than 52 years at baseline (n = 55C+/32C−/41HC), and an older group who were postmenopausal and older than 60 years (n = 17C+/17C−/18HC). Cognitive impairment occurred after chemotherapy in both young and older patients, although older patients showed more decline in processing speed (Trail making test b). White matter volume expansion was observed after chemotherapy, only significantly present in the younger subgroup of patients. In patients not treated with chemotherapy, diffuse gray and white matter volume reduction was observed. Less white matter expansion concurred with more cognitive decline (r > .349, p < .05). In conclusion, we found age‐dependent cognitive decline and white matter volume changes in patients with breast cancer after chemotherapy, which could possibly be linked to neuroinflammatory processes. White matter expansion after chemotherapy, more pronounced in premenopausal patients, correlated with less cognitive decline. This suggests such expansion to be age‐dependent, possibly caused by a protective response in the younger brain to chemotherapy‐induced neurotoxicity.

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Section: Discussionsupporting

confidence: 92%

Age‐dependent brain volume and neuropsychological changes after chemotherapy in breast cancer patients

Blommaert

Schroyen

Vandenbulcke

et al. 2019

Human Brain Mapping

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show abstract

“…As patients with an advanced tumor stage often receive (neo)adjuvant treatment, results of chemotherapy and disease stage are probably related to one another [26]. Similar to earlier findings, cognitive functioning remained impaired for ovarian cancer patients after chemotherapy caused by long-term toxicity, while improvements were described in patients who did not receive chemotherapy [27].…”

Section: Ovarian Cancer Patientssupporting

confidence: 73%

Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis

et al. 2019

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Background: While many cancer survivors experience persistent impairments in health-related quality of life (HRQoL) for extended periods of time, others recover soon after treatment. The aim of this research is to assess changes in health-related quality of life in endometrial and ovarian cancer survivors during two years post initial treatment, and to assess clinical and sociodemographic characteristics associated with those changes. Methods: This prospective population-based cohort study includes longitudinal data of endometrial (N ¼ 221) and ovarian (N ¼ 174) cancer survivors diagnosed between 2011 and 2014. The EORTC QLQ-C30 functioning scales were used to assess HRQoL after initial treatment and after 6, 12 and 24 months. Clinical (stage, treatment and comorbidities) and sociodemographic (age, marital status and socioeconomic status) characteristics were obtained from the Netherlands Cancer Registry and through self-administered questionnaires. Linear mixed models were used to assess changes in HRQoL over time and characteristics associated with these changes. Results: Among both endometrial and ovarian cancer patients, HRQoL improved within the first 6 months after initial treatment. Changes in HRQoL were mainly associated with clinical characteristics including comorbidities, treatment and tumor stage, and to a lesser extent with sociodemographic characteristics such as socioeconomic status. However, these associations varied per tumor type. Endometrial cancer survivors, who received radiotherapy and had no comorbidities, reported greater improvements in some HRQoL scales over time. Ovarian cancer patients who received chemotherapy and with advanced tumor stages reported poorer functioning during treatment. Most functioning domains (global health, physical and role functioning) recovered to levels of patients without chemotherapy or with early-stage disease after 12 months, but cognitive and social functioning remained impaired. Conclusion: Some subgroups of patients, including those with multiple comorbidities, with an advanced tumor stage and who received chemotherapy, may be in need of additional support as they are less likely to show improvements in HRQoL over time.

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“…Another suggestion was that survivors may experience emotional distress in response to the debilitating symptoms of fatigue and cognitive difficulties. It is also possible that the symptoms could have shared antecedents, such as physical inactivity, the increased state of inflammation induced by cancer and its treatments, or a combination of biological and psycho‐social factors that affect the course of the symptoms . As for cognitive difficulties, indications exist showing that this group of symptoms is caused by changes hippocampal and prefrontal brain regions or a decrease in grey matter density caused by chemotherapy agents.…”

Section: Discussionmentioning

confidence: 99%

Stability and change of postchemotherapy symptoms in relation to optimism and subjective stress: A prospective study of breast cancer survivors

et al. 2019

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Objectives: Inconsistent findings were reported about the course of postchemotherapy symptoms; specifically, the effect of changes in optimism and perception of subjective stress on the evolution of symptoms remains understudied. This prospective study aimed (a) to examine the course of postchemotherapy symptoms of emotional distress, fatigue, and cognitive difficulties among breast cancer survivors and (2) to assess the effect of changes in optimism and subjective stress on the trajectory of these symptoms. Methods: Ninety-eight breast cancer survivors, diagnosed at stages I to III, aged 30 to 74, recruited consecutively (response rate 84.7%) completed fatigue, emotional distress, self-reported cognitive difficulties, optimism, and subjective stress questionnaires at three points in time: upon enrollment (1-6 months after completing treatment, Time 1) posttreatment, 6 months (Time 2), and 12 months (Time 3). A linear mixed-effects model was used to analyze the data. Results: Emotional distress decreased between time-points, level of cognitive difficulties remained stable, and a marginal decrease in fatigue was evident. Optimism or subjective stress predicted changes in each of the symptoms (P<.01), except for the effect of optimism on cognitive difficulties (P=.06). The interactions between time and optimism and between time and subjective stress were only significant regarding their effect on emotional distress (P<.05), showing that the strongest effect of these variables was at Time 2. Conclusion:The course of postchemotherapy symptoms shows patterns of stability and change over a 1-year period. Optimism and subjective perceptions of stress were shown to affect the decrease of symptoms. Therefore, these two factors should be specifically targeted in psycho-social interventions.

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Cognitive impairment and chemotherapy: a brief overview

Cited by 59 publications

References 91 publications

Age‐dependent brain volume and neuropsychological changes after chemotherapy in breast cancer patients

Age‐dependent brain volume and neuropsychological changes after chemotherapy in breast cancer patients

Changes in health-related quality of life among gynecologic cancer survivors during the two years after initial treatment: a longitudinal analysis

Stability and change of postchemotherapy symptoms in relation to optimism and subjective stress: A prospective study of breast cancer survivors

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