Two different sides of ‘chemobrain’: determinants and nondeterminants of self‐perceived cognitive dysfunction in a prospective, randomized, multicenter study

Abstract

Objective: Complaints of cognitive dysfunction are frequent among cancer patients. Many studies have identified neuropsychological compromise associated with cancer and cancer therapy; however, the neuropsychological compromise was not related to self-reported cognitive dysfunction. In this prospective study, the authors examined if confounding factors masked an underlying association of self-perceived cognitive function with actual cognitive performance. Determinants of self-perceived cognitive dysfunction were investigated.Methods: Self-perceived cognitive function and cognitive performance were assessed before treatment, at the end of treatment, and 1 year after baseline in 101 breast cancer patients randomized to standard versus intensified chemotherapy. Linear mixed-effects models were applied to test the relationships of performance on neuropsychological tests, patient characteristics, and treatment variables to self-reported cognitive function. Change of cognitive performance was tested as a predictor of change in self-reports.Results: Self-perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis. The personality trait negative affectivity, current depression, and chemotherapy regimen were consistently related to cognitive self-reports. No significant associations with performance in any of the 12 cognitive tests emerged. Change of cognitive performance was not reflected in self-reports of cognitive function.Conclusions: Neuropsychological compromise and self-perceived cognitive dysfunction are independent phenomena in cancer patients. Generally, cancer-associated neuropsychological compromise is not noticed by affected patients, but negative affectivity and treatment burden induce pessimistic self-appraisals of cognitive functioning regardless of the presence of neuropsychological compromise. Clinicians should consider this when determining adequate therapy for patients who complain of 'chemobrain'. Copyright r 2010 John Wiley & Sons, Ltd.Keywords: oncology; cancer; cognition disorders; adverse effects; neuropsychological tests; antineoplastic combined chemotherapy protocols ObjectiveAfter cytostatic treatment, many cancer patients complain about cognitive side effects such as attention and memory problems. As a result of these reports, cognitive function in cancer patients has been investigated in a growing number of studies and the existence of chemotherapy-associated cognitive compromise has indeed been confirmed by many of them. However, with few exceptions, cognitive compromise as assessed by neuropsychological testing appeared to be unrelated to self-reported cognitive dysfunction. The divergence of objectively assessed cognitive function and subjective reports has been found pretreatment [1][2][3], as well as during or after chemotherapy [4][5][6][7][8][9][10][11][12][13][14][15] or hormonal therapy [16] in patients with breast cancer [1,2,[5][6][7][8][9][10][12][13][14]16], testicular cancer [4], lymphoma [12,15], and in bone marrow ...

Cognitive Intervention for Breast Cancer Patients Undergoing Adjuvant Chemotherapy

“…impaired ability to think clearly is a possible symptom of depression), and which may exist pre-treatment, both subjective cognitive problems and emotional well-being are reported as to affect work ability. 31 suggest that even if subjective cognitive problems do not appear to be based on neuropsychological compromise, these factors need to be addressed. Therefore identifying and reducing the emotional distress associated with subjective cognitive functioning should be a key outcome measure for any intervention.…”

Challenges in research on the neural basis of „chemobrain”

“…It has been studied most extensively in the population of breast cancer patients with an estimated frequency of 20-40% of affected patients [4]. Cognitive dysfunction is revealed both by patients' self-reports and by neuropsychological tests, although both types of measures do not necessarily correlate with each other [5,6].…”

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

“…Estos resultados concuerdan con los datos que muestra la literatura (30) . En consonancia con los estudios realizados sobre el tema (6,8,28,31) , no se ha encontrado una correlación significativa entre la percepción subjetiva del funcionamiento cognitivo y los tests neuropsicológicos, lo que iría en la línea de la segunda hipóte-sis formulada. Aunque la persona verbaliza problemas de atención, dificultad para recordar palabras, hacer diversas actividades simultáneamente, etc, su rendimiento en las pruebas neurocognitivas puede ser plenamente normal, no observándose deterioro.…”

“…De hecho, el cuestionario de fallos cognitivos correlaciona con otros cuestionarios que evalúan la metamemoria y/o conciencia metacognitiva, es decir, la habilidad general para reflexionar sobre los propios procesos cognitivos, siendo consciente de sus limitaciones (26) . A su vez, también parece que la percepción subjetiva del funcionamiento cognitivo mantiene una fuerte relación con la presencia de malestar emocional (28,34,35) y de una afectividad negativa (31) , entendida como la disposición a experimentar sentimientos negativos como culpa, vergüenza, irritabilidad u hostilidad. Estas variables también han mostrado ser independientes del deterioro cognitivo objetivo.…”