Chemotherapy-related subjective cognitive impairment in breast cancer patients in semi-rural South Africa

Nicholas M Keetile,Antonio G Lentoor,Elzbieta Osuch

doi:10.4102/hsag.v26i0.1605

Nicholas M Keetile, Antonio G Lentoor + Show 1 more

Open Access

https://doi.org/10.4102/hsag.v26i0.1605

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Abstract

BackgroundBreast cancer is the most commonly diagnosed cancer amongst women worldwide. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients.AimThe current study sought to investigate self-perceived cognitive impairment in a group of breast cancer patients in semi-rural South Africa.SettingThe patients were recruited from an outpatient oncology clinic at a semi-rural, tertiary academic hospital in Gauteng, South Africa.MethodsIn a randomised, quantitative, time-based series study, 30 female patients aged 21–60 years (mean age = 50 years) diagnosed with stages II and III breast cancer on CMF (cyclophosphamide, methotrexate, fluorouracil) (n = 10) and FAC (fluorouracil, adriamycin, cyclophosphamide) (n = 20) chemotherapy regimens, completed the self-reported Functional Assessment of Cancer Therapy-Cognition (Fact-Cog) test as a measure of subjective cognitive functioning at three points during the course of treatment (T0, T1, T2).ResultsThe results of the paired sample t-tests showed the scores on the Fact-Cog test confirmed significant cognitive decline for both treatment groups from baseline (T0) to completion (T2) of chemotherapy; CMF group, t (9) = 2.91, p = 0.017 and the FAC group t (19) = 4.66, p < 0.001.ConclusionThis study confirms that self-reported subjective cognitive impairment is common in breast cancer patients who received chemotherapy in a sample of South African patients. The results have implications for the overall care of cancer patients.ContributionThe context-based knowledge engendered by the current study is expected to augment the continuum of care for breast cancer patients.

Highlights

Mounting evidence suggests that breast cancer is the most commonly diagnosed cancer amongst women worldwide (DeSantis et al 2015), accounting for 11.6% of all cancers globally (Bray et al 2018)
CMF, Cyclophosphamide, methotrexate, fluorouracil; FAC, fluorouracil, adriamycin, cyclophosphamide; T0, baseline; T1, cycle 3; T2, cycle 6; SD, standard deviation. *, Significance level set as p < 0.05
These results of subjective cognitive complaints are consistent with previous studies which showed that patients with breast cancer are at high-risk for chemotherapy-related cognitive impairment (CRCI) (Jansen et al 2011; Jim et al 2012; Kohli et al 2007)

Summary

Introduction

Mounting evidence suggests that breast cancer is the most commonly diagnosed cancer amongst women worldwide (DeSantis et al 2015), accounting for 11.6% of all cancers globally (Bray et al 2018). Current research across continents indicates that the therapeutic benefits derived from the use of chemotherapy for breast cancer have been accompanied by debilitating cognitive impairment (Loh et al 2016; Weiss, Walker & Wiernik 2010). This condition (commonly referred to as ‘chemobrain’) manifests as diminished memory, concentration, attention and executive function (Ono et al 2015; Simó et al 2013) and its symptoms are detected in up to 75% of patients during chemotherapy. Whilst current evidence indicates the therapeutic benefits from the use of chemotherapy, self-perceived cognitive difficulties emerged as a frequent occurrence during and after chemotherapy treatment in breast cancer patients

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