A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer

Jenkins, Valerie; Shilling, Valerie; Deutsch, G.P.; Bloomfield, David; Morris, R.; Allan, Stuart M.; Bishop, Hugh; Hodson, N. J.; Mitra, Sonali; Sadler, Georgia Robins; Shah, Elizabeth; Stein, Robert; Whitehead, S.M.; Winstanley, John

doi:10.1038/sj.bjc.6603029

Cited by 349 publications

(355 citation statements)

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“…However, it remains unclear whether postoperative chemotherapy has an effect on cognitive function since different results have been found. Adjuvant CMF chemotherapy caused late cognitive impairment [44] and subjects treated with high-dose chemotherapy with cyclophosphamide, thiotepa and carboplatin showed a decline in cognitive performance compared with healthy controls [45]; however, it has also been found that postoperative chemotherapy had almost no effect on cognitive function [46]. The tendency seems to be that subjective ratings of memory and concentration decrease after treatment with chemotherapy, and that breast cancer patients treated with chemotherapy also seem to be more likely than controls to perceive themselves as impaired [47].…”

Section: Discussionmentioning

confidence: 99%

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Taira

Shimozuma

Shiroiwa

et al. 2011

Breast Cancer Res Treat

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Provision of social support and rehabilitation for patients with physical, mental and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1 and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression and HRQOL at one month (baseline), 6 months, and 1 and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the Functional Assessment of Cancer Treatment scale-General (FACT-G) and the Breast Cancer subscale (FACT-B). Anxiety and depression were rated using the Hospital Anxiety and Depression Scale (HADS).More than 50% of patients had local problems of "tightness", "arm weakness" and "arm lymphedema", and systemic problems of "reduced energy, fatigue, and general weakness" postoperatively. The HRQOL score significantly improved one year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months and 1 and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.

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Section: Discussionmentioning

confidence: 99%

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Taira

Shimozuma

Shiroiwa

et al. 2011

Breast Cancer Res Treat

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“…This observation is in accordance with the findings of virtually all studies that have reported on the relations between cognitive performance and cognitive complaints. 3,5,7,18,44 Neither chemotherapy-induced menopause nor concomitant darbepoetin a administration had a significant influence on cognitive change.…”

Section: Discussionmentioning

confidence: 99%

“…The results were mixed: Poorer performances were reported among patients who received chemotherapy, 2,3,5,7 although others reported no differences 16,17 ; the latter findings also were supported by a meta-analysis. 21 Two longitudinal studies that provided evidence of chemotherapy effects on cognitive function were limited by their rather small sample sizes (Wefel et 18 did not identify any significant differences in cognitive changes between chemotherapy patients, nonchemotherapy patients, and healthy control individuals. The patients were heterogeneous with regard to the chemotherapy regimens administered, with most patients having received only relatively low-dose combined 5-fluorouracil, epirubicin, and cyclophosphamide treatment.…”

Section: Discussionmentioning

confidence: 99%

“…15 Some doubts regarding the evidence for chemotherapy-induced cognitive impairment have been raised by 3 recently published studies that failed to confirm the adverse effects of chemotherapy on cognitive function. [16][17][18] Meta-analyses also consistently have stated that it depends on the study design whether chemotherapy-related cognitive impairment is observed, with more appropriate designs resulting in less clear evidence or no evidence of chemotherapy-induced cognitive impairment. [19][20][21] Currently, we are conducting a multicenter, prospective study entitled Cognitive Impairment in Therapy of Breast Cancer (COGITO).…”

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confidence: 99%

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Cognitive function during neoadjuvant chemotherapy for breast cancer

Hermelink

Untch

Lux

et al. 2007

Cancer

310

116

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BACKGROUND.It is believed widely that chemotherapy‐induced cognitive impairment occurs in a subgroup of patients with breast cancer. However, recent reports have provided no evidence that chemotherapy affects cognition. In this study, the authors questioned whether cognitive compromise in patients with breast cancer is attributable to chemotherapy. In addition, the effects of therapy‐induced menopause and of the erythropoiesis‐stimulating factor darbepoetin α on cognitive performance were assessed.METHODS.A battery of neuropsychological tests was used to assess cognitive performance in 101 patients with breast cancer before neoadjuvant chemotherapy (T1) and toward the end of neoadjuvant chemotherapy (T2) with combined epirubicin, paclitaxel, and cyclophosphamide with concomitant darbepoetin α. Repeated‐measures multiple analyses of variance and a reliable‐change approach were used for statistical analyses.RESULTS.At T1, the group means ranged below the test norms in 5 of 12 cognitive tests. At T2, multiple analyses of variance (MANOVA) indicated a significant overall improvement in the test results (P < .001). After correcting for practice effects, cognitive decline predominated in 27% of patients, whereas improvement predominated in 28% of patients. Cognitive performance was not related significantly to self‐reported cognitive problems, anxiety and depression, menopause, or darbepoetin α administration.CONCLUSIONS.Even before chemotherapy, a subgroup of patients with breast cancer showed cognitive compromise that was unrelated to anxiety or depression. During chemotherapy, cognitive function remained stable in most patients, improved in a subgroup, and deteriorated in another subgroup. The deterioration may have been caused by side effects of chemotherapy, but it also may have been related to currently unidentified factors that cause prechemotherapy cognitive compromise. Therapy‐induced menopause and darbepoetin α did not appear to influence cognition. Cancer 2007. © 2007 American Cancer Society.

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“…-El rendimiento objetivo en las pruebas no se relacionó con otras variables como malestar psicológico, calidad de vida y fatiga (22) .…”

Section: Estudios Longitudinalesunclassified

Chemobrain: revisión de estudios que evalúan el deterioro cognitivo de supervivientes de cáncer tratados con quimioterapia

2012

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The problem: Some cancer patients have expressed attention, concentration and memory problems, during and after their treatment with chemotherapy, also called chemobrain. Following these complains, in recent decades, studies about this adverse effect had increased.Development of the topic: this work aims to review and analyze the latest scientific studies investigating the nature and severity of cognitive impairment associated with chemotherapy treatments. Works discussed are drowned from different bibliographical sources, mainly from the PubMed database. Results show that, in recent years, longitudinal studies have increased, chemobrain is being studied above all in samples from women with breast cancer, research in other types of cancer is insufficient. Also, the works include new assessment tools, such as MRI and EEG. Advances are done with animal experiments, in vivo and in vitro. Finally, we found studies on drugs and effective strategies for coping of cognitive impairment. The development of guidelines for its systematic study and recommendations for its approach are still pending.Conclusion: There is not conclusive data on the chemobrain, longitudinal studies should be encouraged, as well as assessing the cognitive impact of certain chemotherapeutic agents in different cancers. The works on cognitive Resumen Planteamiento del problema: Algunos pacientes oncológicos han expresado problemas de atención, concentración y memoria durante y después de los tratamientos con quimioterapia, a los que se ha llamado chemobrain. Como consecuencia de estas manifestaciones, en las últimas décadas los estudios dedicados a indagar este posible efecto adverso se han incrementado.Desarrollo del tema: Este trabajo pretende revisar y analizar los estudios científicos más recientes que investigan la naturaleza y alcance del daño cognitivo asociado a los tratamientos quimioterapéuticos. Los artículos analizados se han extraído de diferentes fuentes bibliográficas, principalmente de la base de datos PubMed. Como resultado de la búsqueda se aprecia que, en los últimos años, se han incremento los estudios de diseño longitudinal; este posible efecto adverso se sigue estudiando sobre todo en muestras de mujeres con cáncer de mama, las investigaciones en otros tipos de cánceres son insuficientes; así mismo, destaca la inclusión de nuevas herramientas de evaluación, como la resonancia magnética y el electroencefalograma, junto con nuevos experimentos realizados con animales, in vivo e in vitro, finalmente se constata la inclusión de algunos estudios sobre fármacos y estrategias eficaces para su afrontamiento. La elaboración de guías para el estudio sistemático y las re-

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A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer

Cited by 349 publications

References 21 publications

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

Cognitive function during neoadjuvant chemotherapy for breast cancer

Chemobrain: revisión de estudios que evalúan el deterioro cognitivo de supervivientes de cáncer tratados con quimioterapia

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