Prevalence of cognitive impairment following chemotherapy treatment for breast cancer: a systematic review and meta-analysis

Abstract

Breast cancer survival rates have markedly improved. Consequently, survivorship issues have received increased attention. One common sequel of treatment is chemotherapy-induced cognitive impairment (CICI). CICI causes a range of impairments that can have a significant negative impact on quality of life. Knowledge of the prevalence of this condition is required to inform survivorship plans, and ensure adequate resource allocation and support is available for sufferers, hence a systematic review of prevalence data was performed. Medline, Scopus, CINAHL and PSYCHInfo were searched for eligible studies which included prevalence data on CICI, as ascertained though the use of self-report, or neuropsychological tests. Methodological quality of included studies was assessed. Findings were synthesised narratively, with meta-analyses being used to calculate pooled prevalence when impairment was assessed by neuropsychological tests. The review included 52 studies. Time-points considered ranged from the chemotherapy treatment period to greater than 10 years after treatment cessation. Summary prevalence figures (across time-points) using self-report, short cognitive screening tools and neuropsychological test batteries were 44%, 16% and 21–34% respectively (very low GRADE evidence). Synthesised findings demonstrate that 1 in 3 breast cancer survivors may have clinically significant cognitive impairment. Prevalence is higher when self-report based on patient experience is considered. This review highlights a number of study design issues that may have contributed to the low certainty rating of the evidence. Future studies should take a more consistent approach to the criteria used to assess impairment. Larger studies are urgently needed.

Impact of psychosocial, behavioral and lifestyle factors on subjective cognitive complaints and perceived quality of life in a large cohort of Italian breast cancer patients

“…In fact, due to voluntarily enrollment in the study, our subjects' sample might be more aware of cognitive functioning and more cofounding variable might have a key role in explaining incidence of CRCI in our sample. But despite selection bias, our results are coherent with incidence of SCC in BC patients (Schimdt et al, 2016;Whittaker et al, 2022), indicating that CRCI is frequently present in breast oncological patients.…”

“…To date, the majority of CRCI research in patients with non-CNS cancer has involved women with breast cancer (BC), who represents approximately 43% of women cancer survivors in Italy ( Tagliabue et al, 2021 ). However, despite the vast literature regarding CRCI in BC patients, the prevalence estimates of subjective cognitive complaints (SCC) vary considerably between studies, ranging from 12% up to 86% ( Nelson and Suls, 2013 ; Janelsins et al, 2017 ; Whittaker et al, 2022 ). This lack of consensus regarding SCC cognitive decline in BC patients arises primarily due to methodological issues.…”

Cerebral glucose changes after chemotherapy and their relation to long-term cognitive complaints and fatigue

“…In contrast, an earlier study showed that short-term memory complaints are associated with cortical metabolism in cancer patients ( 17 ), not excluding metabolic changes as an acute compensatory mechanism. Moreover, several psychological measures have been shown to be related to cognitive complaints such as depression and anxiety ( 52 , 53 ), which could be interesting for further evaluation in the context of cerebral metabolism. Additionally, while fatigue is one of the most reported side effects of treatment for non-CNS cancer, associations between brain metabolism and fatigue have not yet been examined.…”

Functional changes of the prefrontal cortex, insula, caudate and associated cognitive impairment (chemobrain) in NSCLC patients receiving different chemotherapy regimen

“…CICI occurring during and after chemotherapy has been found to be associated with neuronal damage, impaired mechanisms responsible for repair and remodelling of brain ( 9 ). CICI even persists for a longer period of time with more severe progressive manifestations after discontinuation of chemotherapy ( 10 ). CICI is recently becoming more widely recognized, therefore, early identification, aggressive and prompt medical interventions are required to prevent potentially high morbidity and mortality ( 11 ).…”