A meta-analysis of cognitive impairment following adult cancer chemotherapy.

Abstract

Objective: Chemotherapy-induced cognitive impairments are reported by many cancer survivors. Research to date has not provided a clear description of their nature, extent, mechanisms, and duration. To investigate the impairments and factors that could influence their identification and severity, the present meta-analysis brings together research on this topic in adult cancer patients. Method: Our random-model meta-analysis includes 44 studies investigating the cognitive performance of adults treated with chemotherapy for non-central nervous system malignancies, primarily breast and testicular cancer. We conducted several subgroup analyses to identify the level of cognitive impairments in longitudinal and cross-sectional studies. We also pursued several multilevel model regressions to investigate the impact of methodological (study quality) and clinical moderators (diagnosis, age, time since treatment) on the observed effect sizes. Results: Cognitive impairments were found in cross-sectional studies in immediate free recall, delayed memory, verbal memory, delayed recognition memory, selective attention, and attention capacity. Surprisingly, prior to chemotherapy, patients performed better than matched controls. In longitudinal studies, patients’ performance increased from baseline to follow-up, an effect that was stronger in patients than controls. None of the chosen moderators influenced the magnitude of estimated summary effect sizes. Conclusions: The likelihood to identify impairments rests on the type of design employed, as memory and attention impairments are only detected in cross-sectional studies. We discuss the lack of significant impact of moderators on the effect sizes despite the heterogeneity of results, while providing recommendations toward decreasing the heterogeneity in future studies.

A systemic literature review of neuroimaging studies in women with breast cancer treated with adjuvant chemotherapy

“…A recent metaanalysis [2] showed a decrease in capacity of attention and selective attention as well as in immediate and delayed verbal recall in patients treated with chemotherapy compared to healthy persons. Changes observed during neuropsychological testing are corroborated by the results of neuroimaging studies carried out in the recent years [3–18].…”

Neurocognitive function of lymphoma patients after treatment with chemotherapy

“…Cognitive sequelae of chemotherapy have been demonstrated by objective and validated neuropsychological tests [3,6] with incidences ranging from 19% to 78% across different studies [3]. Cognitive domains that were most likely to be affected included learning, memory, processing speed and executive function.…”

The effect of hypnotherapy on the quality of life in women with breast cancer

“…Cognitive alterations are among the most common symptoms related to cancer (Janelsins et al, 2011). Evaluations of overall cognitive functioning as well as immediate free recall, delayed memory, verbal memory, selective attention, attention span, and abstract reasoning indicate deterioration during and after breast cancer-treatment-related procedures (Lindner et al, 2014;Biglia et al, 2012;Vearncombe et al, 2009;Ando-Tanabe et al, 2014). Härtl et al, (2010) found out that after a mastectomy and with the passage of time, all QLQ-C30 functioning scales improve, except cognitive functioning.…”