Neuropsychological assessment of cognitive functioning following chemotherapy for breast cancer

Abstract

Cancer patients' complaints of impaired cognition following chemotherapy are fairly common but poorly documented among adult patients. Neuropsychological testing was used to evaluate current cognitive functioning of 28 stage I and II breast cancer patients (ages 28–54) who had completed 3 to 18 months of adjuvant chemotherapy, from 0.5 to 12 months prior to testing. Effects of drug regimen, length of treatment and level of depression on cognitive functioning were examined. Despite estimated high‐normal pre‐morbid intelligence (mean FSIQ 113) patients scored significantly below age‐, education‐, and gender‐corrected test norms in areas of verbal and visual memory, mental flexibility and speed of processing, attention and concentration, visuospatial ability and motor function. Of patients, 75% scored ‐2SDs (moderate impairment) on one or more test measures. Level of cognitive impairment was unrelated to depression, type of chemotherapy and time since treatment, but was positively related to length of chemotherapy treatment. These preliminary findings suggest that cognitive impairment may follow conventional adjuvant chemotherapy treatment and warrant replication with a controlled and more rigorous longitudinal design.

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

“…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).…”

New Insights Into Erythropoietin and Epoetin Alfa: Mechanisms of Action, Target Tissues, and Clinical Applications

“…Recently published studies suggest that cognitive dysfunction is experienced by about 10% of breast cancer survivors who did not receive chemotherapy and by approximately 15%-25% of patients with breast cancer treated with chemotherapy [118][119][120][121][122][123][124]. Data from a pilot trial in patients with breast cancer receiving adjuvant chemotherapy indicate that those receiving QW epoetin alfa experienced less cognitive decline than patients receiving placebo [56].…”

Valoración del funcionamiento cognitivo en mujeres con cáncer de mama antes de iniciar el tratamiento oncológico

“…Desde los años 90 se ha comenzado a prestar una mayor atención a la calidad de vida de los pacientes con cáncer, lo que ha favorecido que surgieran los primeros estudios referentes al efecto que los tratamientos oncológicos sistémicos, especialmente la quimioterapia, tienen sobre el funcionamiento cognitivo del paciente (1)(2) . Estos estudios eran muy rudimentarios en su diseño y su tamaño muestral carecía del suficiente poder estadístico para extraer conclusiones, pero sirvieron para tomar conciencia del tema y despertar el interés de los investigadores.…”

“…Estas pacientes son las que verbalizan más abiertamente en consulta sus quejas y es una de las poblaciones oncológicas en la que se obtienen cifras de supervivencia más elevadas. Así, desde que surgieron los primeros estudios sobre el tema (1,2) ha habido un crecimiento exponencial de las publicaciones, lo que indica un interés creciente por el tema en la actualidad.…”

“…Los primeros estudios (2)(3)(4)(5)(6)(7)(8) eran de carácter transversal y la evaluación del funcionamiento cognitivo se realizaba en un único momento temporal, bien sea durante o tras la administración de la quimioterapia. Este momento era muy variable entre estudios, lo que dificultaba la comparación de los resultados.…”