A Meta-Analysis of the Neuropsychological Effects of Adjuvant Chemotherapy Treatment in Women Treated for Breast Cancer

Abstract

Given the improvement in mortality rates associated with breast cancer, the importance of understanding the long-term neuropsychological consequences of chemotherapy is becoming increasingly vital. This study applies meta-analytic techniques to the scant literature on the relationship between contemporary adjuvant chemotherapy treatment for breast cancer and cognitive dysfunction as examined through neuropsychological indices. Seven studies (involving more than 300 participants) were selected from over 200 potential articles, based on three inclusion criteria: presence of breast cancer, administration of chemotherapy treatment, and use of neuropsychological tests. From these, nine treatment-control comparisons were used to generate 129 Hedge's d effect sizes across the cognitive domains of simple attention, working memory short- and long-term memory, speed of processing, language, spatial abilities, and motor function. Small to medium cumulative effect sizes, showing diminished cognitive function for chemotherapy treatment groups compared to control groups, were obtained for each of the eight cognitive domains. Overall, these results suggest that women who undergo adjuvant chemotherapy as treatment for breast cancer may experience subtle yet consequential cognitive decline.

Neuropsychological functioning in postmenopausal breast cancer patients treated with tamoxifen or exemestane after AC-chemotherapy: Cross-sectional findings from the neuropsychological TEAM-side study

“…The present, cross-sectional study was conducted among patients of 13 Dutch community hospitals who received ACchemotherapy before the start of hormonal therapy. Inclusion criteria for the TEAM-trial were: (1) histologically/cytologically confirmed adenocarcinoma of the breast followed by intended curative surgery; (2) Exclusion criteria were: (1) palliative treatment, inflammatory breast cancer, positive supraclavicular nodes or ulceration/infiltration of local skin metastasis; (2) evidence of distant metastases; (3) previous adjuvant hormonal treatment; (4) uncontrolled cardiac disease; (5) psychiatric disorders preventing proper informed consent; (6) concomitant malignancies or other significant malignancies within the past 5 years; (7) or other serious illnesses; (8) HRT use not stopped at least 4 weeks prior to randomization; (9) bilateral tumor; (10) neo-adjuvant chemotherapy. For the current neuropsychological side study additional inclusion criteria were: (1) free of CNS disease; (2) no signs of dementia according to a dementia screenings tool (7 minutes screen) [14]; (3) being fluent in Dutch; and (4) use of the originally assigned hormonal agent for at least six months.…”

“…A recent meta-analysis using seven cross-sectional studies suggests small to medium cumulative effect-sizes across eight cognitive domains, with lower cognitive functioning for breast cancer (BC) patients compared to healthy controls [1]. In recent years, several prospective longitudinal studies are published, of which most, but not all, found subtle negative influences of chemotherapy on cognitive functioning in a subset of patients [2].…”

Computerized Finger Tapping Task in Adult Unipolar Depressed Patients and Healthy Subjects: Influence of Age, Gender, Education, and Hand Dominance

“…Psychomotor performance in depressed subjects may be further influenced by other factors, such as hospitalization status/duration, severity, subtype and duration of depression, and medication (Bashir et al, 2013). Many studies have addressed specifically effects of medication on psychomotor speed (Aldenkamp et al, 2002;Bashir et al, 2013;Stewart et al, 2006). First-line medication for depression often includes substances (e.g., fluoxetine, venlafaxine, and paroxetine) liable to affect cognitive and function performance (Bashir et al, 2013).…”

“…Therefore, recently, in an attempt to overcome such limitations, several computerized versions have emerged, which are able to measure the response time more precisely, requiring less time to administer, and generating instant scoring (Wilken et al, 2003). The FTT is now part of several recent batteries, such as the Computerized Neurocognitive Battery (Coleman, Moberg, Ragland, & Gur, 1997;Gur et al, 2010), the Automated Neuropsychological Assessment Metrics-ANAM 4tm Reeves, Winter, Bleiberg, & Kane, 2007;Wilken et al, 2003), the FePsy (Aldenkamp et al, 2002;Stewart et al, 2006), and the Neurotrax TM Mindstreams TM (Dwolatzky et al, , 2004Schweiger et al, 2003).…”

“…Several researchers have utilized it to assess psychomotor effects of some drugs, like antiepileptics (Aldenkamp, Van Meel, Baker, Brooks, & Hendriks, 2002), chemotherapy (Stewart, Bielajew, Collins, Parkinson, & Tomiak, 2006), and antidepressants (Bashir et al, 2013). Furthermore, many find it resourceful to detect fake symptoms in forensic contexts (Arnold et al, 2005;Hubel et al, 2013a;Rohling et al, 2002), having also been used to study the relationship between manual dexterity and performance, in order to draw inferences about the functional integrity of the two cerebral hemispheres (Hervé, Mazoyer, Crivello, Perchey, & Tzourio-Mazoyer, 2005;Peters, 1980;Schmidt, Oliveira, Krahe, & Filgueiras, 2000;Strauss et al, 2006).…”