Cognitive Function, Fatigue, and Menopausal Symptoms in Women Receiving Adjuvant Chemotherapy for Breast Cancer

Tchen, N.; Juffs, Helen G.; Downie, Fiona; Yi, Qilong; Hu, Hanxian; Chemerynsky, I.; Clemons, Mark; Crump, Michael; Goss, Paul E.; Warr, David; Tweedale, M.; Tannock, Ian F.

doi:10.1200/jco.2003.01.119

Cited by 345 publications

(245 citation statements)

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“…However, the FACT-F includes a brief 13-item fatigue subscale that is more suitable for use in clinical trials. The FACT-F has been used to evaluate fatigue in patients with a variety of diagnoses receiving various treatments (Table 3) [35][36][37][38][39][40]. In each study, the majority of patients reported some degree of fatigue regardless of diagnosis or treatment modality.…”

Section: Multidimensional Toolsmentioning

confidence: 99%

Assessment of Cancer-Related Fatigue: Implications for Clinical Diagnosis and Treatment

et al. 2007

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Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom experienced by most cancer patients during, and often for considerable periods after, treatment. The recognition of the importance of CRF to patients' psychosocial and cognitive functioning, as well as to their quality of life, has driven the development of a wide range of assessment tools for screening and diagnosis of CRF. Over 20 different measures have been used to assess CRF from either a unidimensional or multidimensional perspective. Unidimensional measures are often single-question scales that generally focus on identifying the occurrence and severity of CRF, whereas multidimensional measures may also examine the effect of CRF across several domains of physical, socio-emotional, and cognitive functioning. This paper provides an overview and critique of measures commonly used to assess CRF. Single-question assessment is the most commonly used and the most useful methodology. Strategies to facilitate reliable assessment of CRF are also discussed. The Oncologist 2007;12(suppl 1):11-21

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Section: Multidimensional Toolsmentioning

confidence: 99%

Assessment of Cancer-Related Fatigue: Implications for Clinical Diagnosis and Treatment

et al. 2007

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“…Impairments in attention, mental flexibility, concentration, visual memory, and speed of information processing are estimated in some studies to occur in 4-75% of breast cancer patients who receive adjuvant chemotherapy and to persist even years after completion of the therapy (Ahles and Saykin 2002;Kingma et al 2001;O'Shaughnessy 2002;Schagen et al 1999Schagen et al , 2001Schagen et al , 2002aSchagen et al , b, 2006Silberfarb et al 1980;Tchen et al 2003;van Dam et al 1998;Wieneke and Dienst 1995). In these studies, the cognitive impairments are attributed to the chemotherapy but not to anxiety, depression, fatigue, self-reported complaints of cognitive dysfunction (Schagen et al 2006;Schagen et al 1999), patient age, or menopausal status (Brezden et al 2000).…”

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Effects of chemotherapeutic agents 5-fluorouracil and methotrexate alone and combined in a mouse model of learning and memory

2008

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Rationale-The concern that adjuvant cancer chemotherapy agents cause cognitive impairment in a significant number of patients has been expressed by patients and healthcare providers, but clinical studies have yielded conflicting results to date.Objective-We directly tested two commonly used chemotherapeutic agents in a mouse model of learning and memory.Materials and methods-In the present study, mice were conditioned to respond for a liquid reinforcer (Ensure solution) in the presence of an audible tone on day 1 as a measure of acquisition and were then required to perform the same response on day 2 as a measure of retrieval and retention. Methotrexate and 5-fluorouracil were administered prior to the day 1 session.Results-Methotrexate (1.0-32 mg/kg) alone failed to alter mean latency acquisition, retrieval, or reinforced response rates. Similar to scopolamine, a known amnesic in this assay, 5-fluorouracil (3-75 mg/kg) failed to alter response rates or acquisition latency on day 1 but significantly altered latency to retrieve a previously learned response on day 2. In combination, 3.2 mg/kg methotrexate plus 75 mg/kg 5-fluorouracil significantly increased day 1 and day 2 acquisition and retrieval latencies without altering responserates or motivation to respond as measured by progressive ratio responding. Conclusion-Takentogether, these data demonstrate that 5-fluorouracil causes increased latencies for retrieval of previously learned behavioral responses and that combination of chemotherapeutic agents may produce greater delays than either agent alone, including when neither agent alone does so.

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“…In 1995, in the first of a series of cross-sectional studies with early breast cancer patients, cognitive impairment was observed after cytostatic treatment in 75% of patients. 1 Although the results of subsequent cross-sectional trials assessing cognitive function during or after chemotherapy [2][3][4][5][6][7] were less dramatic, all of them reported substantial cognitive impairment rates of 16% to 50%, suggesting detrimental cytostatic side effects M.U. and R.K. receive research funding and honoraria from Bristol Myers Squibb and Amgen.…”

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Cognitive function during neoadjuvant chemotherapy for breast cancer

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et al. 2007

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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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Cognitive Function, Fatigue, and Menopausal Symptoms in Women Receiving Adjuvant Chemotherapy for Breast Cancer

Abstract: Adjuvant chemotherapy causes cognitive dysfunction, fatigue, and menopausal symptoms in women with breast cancer. Priority should be given to the study of strategies that might reduce these toxic effects.

Cited by 345 publications

References 38 publications

Assessment of Cancer-Related Fatigue: Implications for Clinical Diagnosis and Treatment

Assessment of Cancer-Related Fatigue: Implications for Clinical Diagnosis and Treatment

Effects of chemotherapeutic agents 5-fluorouracil and methotrexate alone and combined in a mouse model of learning and memory

Cognitive function during neoadjuvant chemotherapy for breast cancer

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