Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

Wefel, Jeffrey S.; Kayl, Anne E.; Meyers, Christina A.

doi:10.1038/sj.bjc.6601772

Cited by 155 publications

(94 citation statements)

References 43 publications

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“…Castellon et al (2004) deemed it necessary to include eight different tests in their study of breast cancer survivors treated with adjuvant chemotherapy and tamoxifen. Wefel et al (2004) used thirteen tests in their study of similar patients. Both could have chosen, in fact, from a vast catalog of test instruments, most of which have found their way into neurotoxicology.…”

Section: Scope Of Neurxotoxic Assessment Cognitive Endpointsmentioning

confidence: 99%

“…Many patients now survive for decades after diagnosis and treatments that often incur disabling neurotoxic effects (Figure 1). Wefel et al (2004) posed the implications in this way: "Cancer is becoming a chronic illness… The number of long-term cancer survivors will continue to increase…current understanding of the cognitive and neurobehavioral effects of these treatments is extremely limited…it is imperative that future investigations use well designed longitudinal methodologies that will assist in defining the relative risks and benefits…" Moreover, with newer treatment methods and chemicals, it has become increasingly apparent that not only is neurotoxicity the major dose-limiting side effect, but that it is appearing in forms not seen earlier (Schiff and Wen, 2006). With 70 million cancer survivors estimated world-wide in 2020, the limitations imposed by neurotoxicity on treatment choices and quality of life should engage the efforts of scientists equipped to study its features in detail.…”

Section: Introductionmentioning

confidence: 99%

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Chemobrain: A translational challenge for neurotoxicology

Weiss

2008

NeuroToxicology

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Neurotoxicity is a frequent accompaniment of cancer chemotherapy, and held by many oncologists to be the major dose-limiting side effect. It appears in many forms, but attracted attention during the past decade primarily because of complaints by patients of impaired cognitive function they have labeled as "chemobrain". Neuropsychological testing confirmed the validity of these complaints and has generated a substantial literature examining different aspects of cognitive impairment in various clinical populations undergoing a variety of treatments. Cognitive impairment is far from the only manifestation of neurotoxicity induced by chemotherapy, however. It alters sensory function and motor function as well. A critical need for patients is a suite of methods that will enable clinicians to trace the onset and progression of neurotoxicity so as to guide and balance decisions about the course of chemotherapy. This commentary describes some of the potential methods and encourages neurotoxicologists to enlist their unique skills in the service of these needs.

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Section: Scope Of Neurxotoxic Assessment Cognitive Endpointsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chemobrain: A translational challenge for neurotoxicology

Weiss

2008

NeuroToxicology

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“…Noticeably, the neurocognitive risk is increased in more than an additive manner when treatments are combined (70). Combination chemotherapy elevated the risk of treatment related deaths respecting single agent HD MTX from 0-3% (31,45,66) to 6-16% (33,42,43,48).…”

Section: Well-established Treatment Optionsmentioning

confidence: 99%

Limited role of surgery in the management of primary central nervous system lymphoma (Review)

Cheng¹,

Zhang²,

Zhang³

et al. 2009

Oncol Rep

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Abstract. Primary central nervous system lymphoma (PCNSL) is a nervous-system-seeking extranodal nonHodgkin's lymphoma whose incidence has increased in both immunocompromised and immunocompetent patients. Corticosteroids are used for symptomatic management but can interfere with pathological diagnosis. The well-established treatments such as radiotherapy, chemotherapy or a combination of both remain the mainstays. Traditionally, the most important role for surgery is to obtain and sample adequate tissue to confirm a diagnosis with stereotactic biopsy. Though no benefit could be demonstrated for debulking surgery, a subset of patients with large space occupying lesions which could be well circumscribed and surgically accessible may benefit from tumor resection. Moreover, surgical procedures to carry out interstitial chemotherapy and/or brachytherapy with or without tumor resection hold promise. Complications such as hydrocephalus could be managed by ventriculoperitoneal shunting. Further application of surgical procedures in the treatment of PCNSL is recommended with caution and strict patient selection criteria, and should be used in combination with radiotherapy and/or chemotherapy.

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“…Radiotherapy can damage the brain, eventually resulting in demyelination that may appear only months later and lead to the development of cognitive impairment. These deficits manifest as any or all of impaired memory; diminished attention; lowered concentration; or functional, behavioural, and psychiatric deficits; and similarities to Alzheimer disease are seen [226][227][228][229] . Receptors for N-methyl-D-aspartate (NMDA) are overactivated, leading to neuronal damage and learning impairment 230 .…”

Section: Herbsmentioning

confidence: 99%

“…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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Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

Cited by 155 publications

References 43 publications

Chemobrain: A translational challenge for neurotoxicology

Chemobrain: A translational challenge for neurotoxicology

Limited role of surgery in the management of primary central nervous system lymphoma (Review)

Chinese Medicine and Biomodulation in Cancer Patients—Part Two

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