Fatigue, Menopausal Symptoms, and Cognitive Function in Women After Adjuvant Chemotherapy for Breast Cancer: 1- and 2-Year Follow-Up of a Prospective Controlled Study

Fan, Helen G. Mar; Houédé-Tchen, Nadine; Yi, Qilong; Chemerynsky, I.; Downie, Fiona; Sabate, K.; Tannock, Ian F.

doi:10.1200/jco.2005.01.6550

Cited by 231 publications

(162 citation statements)

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“…In cross-sectional studies that used test norms 1 or control groups consisting of healthy participants, 4,6,13 cognitive compromise in the patients may have originated before chemotherapy, like it did in the current study. However, several cross-sectional studies have used control groups consisting of patients with breast cancer who were treated without chemotherapy.…”

Section: Discussionmentioning

confidence: 95%

“…11 Data regarding affected cognitive domains and the duration of cognitive disturbance are far from being congruent. 5,12,13 It remains unknown which cytostatic agents are responsible for cognitive impairment, which characteristics make patients vulnerable, 14 and which biologic mechanisms are involved. 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.…”

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Cognitive function during neoadjuvant chemotherapy for breast cancer

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et al. 2007

Cancer

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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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Section: Discussionmentioning

confidence: 95%

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Cognitive function during neoadjuvant chemotherapy for breast cancer

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et al. 2007

Cancer

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“…Because many patients become longterm survivors, concerns about the medium-and long-term consequences of their treatment regimens have led to multiple quality-of-life (qol) studies that have demonstrated significant emotional, cognitive, and physical deterioration after treatment 2,3 . Those studies showed that symptoms such as muscle stiffness, breast sensitivity, tendency to take naps, and difficulty concentrating were common and associated with poor physical functioning and emotional well-being [3][4][5][6] .…”

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confidence: 99%

Effect of exercise in reducing breast and chest-wall pain in patients with breast cancer: a pilot study

et al. 2012

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Breast or chest-wall pain (bcp) is prevalent in 20%–50% of breast cancer survivors, and it affects quality of life (qol). To determine the feasibility and potential efficacy of an exercise program to improve patient qol and bcp, such a program was offered to breast cancer patients suffering from bcp. The study enrolled 10 breast cancer patients with moderate-to-severe bcp at 3–6 months after completion of all adjuvant treatments. These patients participated in a 12-week comprehensive health improvement program (chip). Intensity was adjusted to reach 65%–85% of the patient’s maximal heart rate. Before the chip and at 1 and 6 months after completion of the chip, qol and pain were measured using questionnaires [European Organisation for Research and Treatment of Cancer Quality of Life core and breast cancer modules (qlq-C30, -BR23) and the McGill Pain Questionnaire short form] completed by the patients. Results were compared with those from case-matched control subjects from another study at McGill University. After the chip, patients reported significant and clinically important improvements in qol and symptoms. At 1 and 6 months post-chip, patients in the study felt, on average, better in overall qol than did historical control subjects. Our study suggests that patients who experience chronic bcp may benefit from an exercise program. A randomized controlled trial is warranted.

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“…Because "chemo-brain" is mainly a subjective phenomenon, it is important to develop techniques to objectively measure neurophysiologic or anatomic changes [223][224][225][226] . Cytokines such as IL-1 and interferons may play a role, according to some animal experiments.…”

Section: Herbsmentioning

confidence: 99%

Chinese Medicine and Biomodulation in Cancer Patients—Part Two

Sagar

Wong

2008

Current Oncology

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Traditional Chinese Medicine (TCM) is a whole system containing therapeutic interventions that individually induce biomodulation at the physiologic, chemical, and molecular levels. The theory of TCM proposes a synergy between specific interventions selected as part of a care plan based on TCM diagnostic theory. Combining TCM with the modern practice of oncology seems, in conjunction with biomedical interventions (surgery, radiotherapy, chemotherapy, and pharmaceuticals), to have potential advantages through the synergy of biomodulation. Biomodulation approaches are broadly categorized as modification of tumour response and reduction of adverse effects; modulation of immunity; prevention of cancer progression; and enhancement of symptom control. Although the database of preclinical studies is rapidly expanding, good-quality clinical trials are notably scarce.Laboratory studies suggest that some herbs increase the effectiveness of conventional chemotherapy without increasing toxicity. A healthy immune system is necessary for control of malignant disease, and the immune suppression associated with cancer contributes to its progression. Many Chinese herbs contain glycoproteins and polysaccharides (among them, constituents of Coriolus versicolor, Ganoderma lucidum, Grifola frondosa, Astragalus membranaceus, Panax ginseng, and various other medicinal mushrooms) that can modulate metastatic potential and the innate immune system. Phytochemicals such as specific polysaccharides have been shown to boost the innate immune system, especially through interaction with Tolllike receptors in mucosa-associated lymphoid tissue. This intervention can potentially improve the effectiveness of new anticancer vaccines. An increase in virusassociated cancers presents a major public health problem that requires novel therapeutic strategies. A number of herbal therapies have both antiviral activity and the ability to promote immunity, possibly inhibiting the initiation and promotion of virus-associated cancers.The mechanisms learned from basic science should be applied to clinical trials both of specific interventions and of whole-system care plans that safely combine the TCM approach with the conventional biomedical model. In Western medicine, the combination of TCM herbs with drug therapies is controversial, given lack of knowledge concerning whether a drug is favourably enhanced or whether adverse effects occur. Using initial data from the preclinical studies, future clinical research needs to evaluate the combinations, some of which are showing favourable synergy.

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Fatigue, Menopausal Symptoms, and Cognitive Function in Women After Adjuvant Chemotherapy for Breast Cancer: 1- and 2-Year Follow-Up of a Prospective Controlled Study

Abstract: Fatigue, menopausal symptoms, and cognitive dysfunction are important adverse effects of chemotherapy that improve in most patients. Hormonal treatment has minimal impact on them.

Cited by 231 publications

References 26 publications

Cognitive function during neoadjuvant chemotherapy for breast cancer

Cognitive function during neoadjuvant chemotherapy for breast cancer

Effect of exercise in reducing breast and chest-wall pain in patients with breast cancer: a pilot study

Chinese Medicine and Biomodulation in Cancer Patients—Part Two

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