Chemobrain Research Articles

Tibetan sound meditation for cognitive dysfunction: results of a randomized controlled pilot trial

Although chemotherapy-induced cognitive impairment is common among breast cancer patients, evidence for effective interventions addressing cognitive deficits is limited. This randomized controlled trial examined the feasibility and preliminary efficacy of a Tibetan Sound Meditation (TSM) program to improve cognitive function and quality of life in breast cancer patients. Forty-seven breast cancer patients (mean age 56.3 years), who were staged I-III at diagnosis, 6-60 months post-chemotherapy, and reported cognitive impairment at study entry were recruited. Participants were randomized to either two weekly TSM sessions for 6 weeks or a wait list control group. Neuropsychological assessments were completed at baseline and 1 month post-treatment. Self-report measures of cognitive function (Functional Assessment of Cancer Therapy (FACT)-Cog), quality of life (SF-36), depressive symptoms (Center for Epidemiologic Studies Depression Scale), sleep disturbance (Pittsburgh Sleep Quality Index), fatigue (Brief Fatigue Inventory), and spirituality (FACT-Sp) were completed at baseline, the end of treatment, and 1 month later. Relative to the control group, women in the TSM group performed better on the verbal memory test (Rey Auditory Verbal Learning Test trial 1) (p = 0.06) and the short-term memory and processing speed task (Digit Symbol) (p = 0.09) and reported improved cognitive function (p = 0.06), cognitive abilities (p = 0.08), mental health (p = 0.04), and spirituality (p = 0.05) at the end of treatment but not 1 month later. This randomized controlled trial revealed that TSM program appears to be a feasible and acceptable intervention and may be associated with short-term improvements in objective and subjective cognitive function as well as mental health and spirituality in breast cancer patients.

Trying to unravel the mysteries of chemobrain

As more patients live for longer after cancer treatment, oncologists and neurologists are working together to learn more about chemotherapy-induced cognitive impairment. David Holmes reports.

Clearing the Air: A Review of Our Current Understanding of “Chemo Fog”

An increasing number of cancer survivors has led to a greater interest in the long-term side effects of cancer treatments and their impact on quality of life. In particular, cognitive impairments have been frequently reported by cancer survivors as an adverse effect which they attribute to the neurotoxicity of chemotherapy and have dubbed "chemobrain" or "chemo fog." Research within the past 15-20 years has explored the many factors thought to contribute to cancer-related cognitive decline in an attempt to determine a potential cause. In spite of many confounding factors, there is growing evidence that the neurotoxicity of chemotherapy does contribute to cognitive changes. This review examines the evolution of "chemo fog" research with a look at methodological issues, the status of our current understanding, and suggestions for future research.

Diffusion tensor MRI of chemotherapy-induced cognitive impairment in non-CNS cancer patients: a review

Patients with non-central nervous system cancers often experience subtle cognitive deficits after treatment with cytotoxic agents. Therapy-induced structural changes to the brain could be one of the possible causes underlying these reported cognitive deficits. In this review, we evaluate the use of diffusion tensor imaging (DTI) for assessing possible therapy-induced changes in the microstructure of the cerebral white matter (WM) and provide a critical overview of the published DTI research on therapy-induced cognitive impairment. Both cross-sectional and longitudinal DTI studies have demonstrated abnormal microstructural properties in WM regions involved in cognition. These findings correlated with cognitive performance, suggesting that there is a link between reduced "WM integrity" and chemotherapy-induced impaired cognition. In this paper, we will also introduce the basics of diffusion tensor imaging and how it can be applied to evaluate effects of therapy on structural changes in cerebral WM. The review concludes with considerations and discussion regarding DTI data interpretation and possible future directions for investigating therapy-induced WM changes in cancer patients. This review article is part of a Special Issue entitled: Neuroimaging Studies of Cancer and Cancer Treatment.

Clinical cancer research: a fascinating field

Jame Abraham speaks to Joanna Milburn, Commissioning Editor: Dr Jame Abraham is the first Bonnie Wells Wilson and Distinguished Professor and Eminent Scholar in Breast Cancer Research at West Virginia University. He did his Fellowship in Hematology/Oncology at the National Cancer Institute (NCI) and National Heart Lung and Blood Institute of the National Institutes of Health. He did his residency at the School of Medicine, University of Connecticut (CT, USA) and medical degree from Calicut Medical College in India. He is a member of the Breast Cancer Working Group of the National Surgical and Adjuvant Breast and Bowel Project (NSABP) and has served on the board of Directors for the South Atlantic Division of the American Cancer Society. He is the principal investigator of more than 15 clinical trials at the Mary Babb Randolph Cancer Center. His translational research is focused on understanding the pathophysiology of chemotherapy-induced cognitive dysfunction. His research group has made notable contributions in preclinical and clinical settings, as well as the genomic understanding of ‘chemo brain’. He was the Institutional principal investigator for the Eastern Cooperative Oncology Group (2003–2012) and NSABP clinical trials at West Virginia University (WV, USA). Jame is the founding editor of Bethesda Handbook of Clinical Oncology. Jame is the chief editor of the Emerging Cancer Therapeutics series published by Demos Publishing, New York (NY, USA). He is also the editor of Community Oncology Journal, Elsevier (NY, USA). He is on the Editorial Boards of several journals, including Community Oncology, Supportive Cancer Therapy, Oncology and Biotechnology News and Expert Review of Anticancer Therapy. Jame has received several awards, including an award from the President of India (Vaidya Bhooshan, 2010), Dean’s Award for Excellence in Clinical Medicine (2010), Outstanding Faculty Award (2007) and Clinician of the Year Award (2006) by the Department of Medicine, Idea Award and Career Development Award from the Department of Defense (2002), and Merit Award from the American Society of Clinical Oncology (2001).

Abstract P2-11-10: Prospective memory impairment in early breast cancer survivors: Finally homing in on the real deficit?

Abstract Background There is still much debate about the impact of early breast cancer (EBC) treatment on memory functioning. One limitation of existing studies is that they are based on neuropsychological testing procedures which may not be sensitive enough to detect memory problems as encountered in daily life. In fact, no study has objectively assessed everyday memory performance in EBC. One crucial aspect of using memory in daily activities is to remember to do something at an appropriate time in the future without being asked to do so-defined as “prospective memory” (PM). Despite its importance for daily functioning, little is known about PM in EBC patients. Thus, we investigated whether EBC survivors who were within 1 year of having completed adjuvant chemotherapy have PM impairment in comparison to age-matched healthy controls. In addition, we evaluated the contributions of fatigue and depression to PM functioning. Methods We undertook a cross sectional quantitative case-control study (n = 80) comparing EBC patients from the Ottawa Hospital Regional Cancer Centre with age and education-matched healthy controls from the community. A standardized test of PM (Memory for Intention Screening Test) was administered to both groups. Impairment was defined as a score that fell 2 standard deviations below the mean performance of the control group. Standardized measures of depression (CESD) and fatigue (Fact-F) were also completed. Results Age was well balanced between the groups (case and control mean age 54y, p = .84). EBC patients performed more poorly than controls on the PM test (p < .001) and had a significantly higher rate of impairment (23% vs. 5%, McNemar χ2, p <.01, odds ratio=5.5, 95% CI=1.7745 to 17.1473). A series of hierarchical regressions showed that patients PM performance was affected by fatigue (p <.05), but not depression (p = .51). Conclusions The results demonstrate reduced memory performance in EBC survivors, with a specific impact on PM. Women who complain of ‘chemo fog’ should be evaluated carefully for PM deficits and their concerns should be acknowledged. An important finding from this study is the demonstration that fatigue is associated with memory deficits when memory as used in everyday life is evaluated. This finding which is suggestive of a common mechanism involved in fatigue symptoms and everyday memory disturbances raises the possibility that interventions targeted at improving fatigue may also improve memory functioning and quality of life in EBC survivors. Further longitudinal studies should be conducted to critically evaluate the role of chemotherapy by assessing PM before the initiation of chemotherapy and in EBC patients receiving only adjuvant hormonal therapy. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-11-10.

Abstract ES4-2: Cognitive Changes and Breast Cancer Treatments

Abstract Cognitive difficulties after cancer treatment are among the most feared outcomes voiced by patients who are approaching the start of chemotherapy. This phenomenon, sometimes referred to as “chemo brain” or “chemo fog,” is quite common during the acute course of chemotherapy treatment. This may result from direct antieneoplastic drug toxicity, use of premedications and anxiolytics to prevent nausea and vomiting, as well as the expected anxiety, depression, and sleep deprivation that accompanies a new diagnosis of cancer and initiation of treatment. For most patients, this fog clears after the completion of acute treatments, and as with many physical symptoms, resolves in the following months. However, 15–25% of post-treatment patients, cognitive complaints persist long after treatment ends. Reports of difficulty concentrating, remembering recent events, multi-tasking, and paying attention are frequent in such patients. For those used to carrying on demanding executive function activities prior to cancer treatment, this can lead to substantial disruption in work and home life. Most of the studies conducted to date with early stage breast cancer have not accounted for the impact of adjuvant endocrine therapy alone or added to adjuvant chemotherapy. This presentation will review emerging data regarding self-reported cognitive complaints, neuropsychological testing, and brain imaging as they related to adjuvant therapies for breast cancer. In addition, some of the developing information about potential mechanisms associated with this late effect will be discussed. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr ES4-2.

Abstract S6-3: Neurocognitive impact in adjuvant chemotherapy for breast cancer linked to fatigue: A Prospective functional MRI study

Abstract Background: Our previous research showed evidence of compromised cognitive function prior to adjuvant chemotherapy for breast cancer, with fatigue as a contributory factor. Fatigue is a common symptom reported by women treated for breast cancer, yet its association with neurocognitive function has not been systematically examined. In this prospective study, we examined possible alterations in neurocognitive responses, namely, working memory, from pre- to post- adjuvant treatment during functional magnetic resonance imaging (fMRI) and further investigated whether early fatigue might be linked to cognitive alterations over time. Methods: Women treated with either adjuvant chemotherapy (anthracyline-based combination regimen, n=29) or radiotherapy (n = 37) for localized breast cancer (Stages 0-IIIa) and age-matched healthy controls (n = 32) were enrolled. Participants performed a verbal working memory task (VWMT) with varying levels of demand for cognitive control during fMRI scanning and provided self-reports of fatigue (FACT-F) at two time points coincident with pre- and one-month post chemotherapy assessments. Imaging data were analyzed with general linear models using SPM5; comparative statistics were used to determine group differences, and correlational analyses addressed relationships of fatigue and neurocognitive measures. Findings: The chemotherapy group reported significantly greater severity of fatigue (p < .05) and performed less accurately on the VWMT both pre- and one-month post-treatment than the other groups. Greater fatigue was correlated with poorer performance on the VWMT at both time points across groups, with stronger correlation post-treatment (r = −.22, p = .03). A 2 time-point (pre- vs. post-treatment) × 2 group (chemotherapy vs. controls) × 2 demand-level contrasts (high minus low vs. medium minus low) analytic model showed a significant group × time interaction (p < .05), mainly due to lower pre-treatment activation in an area of the prefrontal cortex supporting working memory, the anatomical left inferior frontal gyrus (LiFG), at higher task demand in the chemotherapy group. The radiotherapy group scored between the other two groups with intermediate activation of those contrasts. Of interest, lower pre-treatment activation in the LiFG in the high-low demand contrast predicted severity of fatigue across all participants at the post-treatment assessment (r = −.27, p < .01), linking early compromise in neurocognitive performance with greater fatigue over time. Discussion: Neurocognitive alterations during a working memory task and greater fatigue were evident before any adjuvant chemotherapy for breast cancer. Notably, functional alterations in working memory processes were evident with fMRI before adjuvant chemotherapy and predicted severity of post-treatment fatigue. Importantly, across all participants, greater fatigue over time was correlated with reduced cognitive performance. Taken together, these findings indicate that pre-treatment neurocognitive compromise and fatigue are key contributors to the cognitive impact often attributed solely to chemotherapy. Early therapeutic interventions targeting fatigue may improve cognitive function and reduce the distress of “chemo brain” throughout the course of adjuvant treatment. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S6-3.

Cognitive function and breast cancer: promise and potential insights from functional brain imaging

Altered cognitive function can be a distressing side effect of cancer and its treatment. Women diagnosed and treated for breast cancer often report problems with memory, concentration, and other cognitive abilities that can pose significant barriers to full resumption of family, job, and social roles. Despite considerable neuropsychological research, many unanswered questions remain about cancer-related cognitive deficits and the underlying neural bases. Functional magnetic resonance imaging (fMRI) measures brain activation associated with different mental states and has significantly advanced our understanding of cognitive function and dysfunction in healthy and clinical populations. However, to date the application of fMRI to the study of cognitive function in breast cancer is limited. The current review addresses the potential importance of this method for understanding the neurocognitive effects of breast cancer disease and treatment. Along with reviewing published fMRI studies on breast cancer to date, we discuss potential major contributions of this method which include: (a) delineating components of cognitive function and underlying neural processes most affected by cancer and its treatment, (b) uncovering compensatory processes and their limits, (c) identifying altered resting state networks that may relate to subjective complaints and longer term outcomes, and (d) clarifying the relationship between pre-treatment alterations in brain activity and longer term neural and behavioral outcomes. Finally, we pose questions for future research that can be optimally addressed by integrating fMRI and other imaging modalities to clarify the nature and causes of "chemo brain" and guide interventions to improve cognitive function and the quality of breast cancer survivorship.

Data Point to Potential New Use for Common Antidepressant

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessData Point to Potential New Use for Common AntidepressantJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:21 Sep 2012https://doi.org/10.1176/pn.47.18.psychnews_47_18_15-bAbstractThe SSRI antidepressant fluoxetine may hold another benefit—helping people with mesial temporal lobe epilepsy who experience learning problems.Many patients with mesial temporal lobe epilepsy complain of learning and memory problems. So William Gray, M.D., a professor of neurosurgery at Cardiff University in Wales in the United Kingdom, decided to conduct research to better understand the situation and perhaps find a way to remedy these patients’ learning deficits.First Gray and his colleagues tested 12 mesial temporal lobe epilepsy subjects and 12 healthy control subjects to see how good their learning and memory capabilities were and found that the former group had more learning problems.They then turned to a rat model for epilepsy and tested rats with this condition for learning and memory abilities. Compared with healthy rats, the rats with the epilepsy-like condition showed evidence of learning and memory deficits, just as the human subjects had.Further testing suggested that the rats’ learning and memory impairments were due to reduced and abnormal production of new nerves in the hippocampus.The scientists then gave fluoxetine to the epilepsy rats to see whether it might improve their learning and memory, since fluoxetine is known to improve memory in people with mild cognitive impairment and those with memory difficulties due to chemotherapy, or what is sometimes called “chemo brain” or “chemo fog” (Psychiatric News, March 16).Fluoxetine did improve learning and hippocampal nerve regeneration in the study rats, but did not show any effect on memory improvement.Thus fluoxetine might prove useful for improving learning in people with mesial temporal lobe epilepsy, Gray and his colleagues concluded in a report in the August Brain. “A well-tolerated pharmacological therapy that restores learning to normal could be of great clinical benefit,” they wrote.They also remain hopeful that fluoxetine might help the memories of these epilepsy patients, at least in those with less-severe hippocampal damage, even though their animal tests did not point to this possibility.The research was funded by Epilepsy Research UK.An abstract of “Fluoxetine Restores Spatial Learning but Not Accelerated Forgetting in Mesial Temporal Lobe Epilepsy” is posted at http://brain.oxfordjournals.org/content/135/8/2358.abstract. > ISSUES NewArchived

Chemo fog becomes clearer

It has been known for a long time that chemotherapy may have neurotoxic effects on cognitive functioning, an effect commonly known as 'chemo brain' or 'chemo fog'. However, despite the important repercussions of these observations, little research has been carried out about whether—and to what extent—chemotherapy affects long-term cognitive functioning. Several recent large controlled studies have added evidence supporting the association of chemotherapy treatment and cognitive deficits. Heather Jim and colleagues have now scrutinized this information in a meta-analysis of data obtained from 17 studies that included a total of 807 survivors of breast cancer who had been treated with standard-dose chemotherapy at least 6 months earlier, and 291 controls. They assessed the effect of chemotherapy in eight cognitive domains: attention, executive functioning, information processing, motor speed, verbal ability, verbal memory, visual memory, and visuo-spatial ability. The researchers found that patients who had been previously treated with chemotherapy performed significantly worse on tests of domains such as verbal and visuo-spatial ability, than patients who had not been treated with chemotherapy or did not have cancer, respectively. Interestingly, age and education did not seem to have an effect in chemotherapy-induced cognitive deficit. This meta-analysis clears any doubts about the existence of chemo fog, and calls for future studies to address this important issue.

74. Interaction effects of IL6 and treatment on neurobehavioral functioning in women with breast cancer

Background: The biological mechanisms underlying “chemo brain” or neurobehavioral symptoms in cancer patients are largely unknown, however, an emergent literature links indicators of immune deregulation to these symptoms. We hypothesized higher concentrations of pro-inflammatory cytokine interleukin 6 in breast cancer (BC) patients at both pre and post-treatment assessment relative to healthy controls, and that IL6 levels would be associated with changes in neurobehavioral functioning. Methods: Post-menopausal BC patients were assessed prior to any local or systemic treatment and one month after completion of primary treatment. Age-matched Healthy controls (HC) were assessed at similar time intervals. Neurocognitive, behavioral, and IL6 data for 120 BC and 56 HC were examined. Results: Statistically significant differences in IL6 levels between BC and HC were not evident at baseline but were at follow up assessment, with increased levels in the BC group. Factorial ANCOVA which evaluated pre-post treatment change in the BC and HC groups found that BC patients with higher IL6 levels at baseline had significant declines in selected cognitive functioning relative to the comparison groups, including memory retention ( F (1,155) = 7.07; p = .009) and processing speed ( p = .055). Similar interaction effects were not found on measures of fatigue, mood, or pain. Conclusion: Breast cancer patients with higher IL6 levels prior to treatment appear to be at risk for worse functioning in selected behavioral outcomes following treatment.

Assessing the Relationship Between Physical Fitness Activities, Cognitive Health, and Quality of Life Among Older Cancer Survivors

Chemotherapy-related cognitive impairment, known as “chemobrain,” has been described as a side effect of chemotherapy and is associated with cognitive changes on quality of life especially among older cancer survivors. This longitudinal feasibility study examined the relationship between physical fitness, cognitive health, and quality of life among two groups of older adults: those on chemotherapy, and those who have completed chemotherapy. To assess cognitive health, we used the Montreal Cognitive Assessment and demographic information from the Healthy Brain Questionnaire. For quality of life, we used the McGill Quality of Life assessment. Physical activity was assessed using Metabolic Equivalency Tasks from the Compendium of Physical Activities classification system. t-Tests and regression analyses indicated that at Time 1 those on chemotherapy had lower cognitive health scores than those off chemotherapy. Yet at Time 2, as physical activities increased, cognitive health and quality of life improved for those on chemotherapy. However, those who had completed chemotherapy also benefited from an increase in physical activities over time. The results have implications for health care practitioners in oncology settings to better inform patients of cognitive challenges resulting from chemotherapy and the importance of participation in physical activities. Future research should compare different age groups among a larger sample.

Chemotherapy-related cognitive impairment: does integrating complementary medicine have something to add? Review of the literature

Chemotherapy-related cognitive impairment is a phenomenon of cognitive decline that some patients experience during and after chemotherapy. The prevalence of chemotherapy-related cognitive impairment in cancer survivors ranges from 14 to 85%. Memory loss and lack of concentration are the most frequent symptoms, often resulting in deterioration of daily functioning and a decreased quality of life. Despite ongoing research on chemotherapy-related cognitive impairment, a clear understanding of the underlying mechanisms of the neurotoxicity induced by chemotherapy and the factors that determine a patient's vulnerability are still lacking. We review current knowledge regarding the etiology of chemotherapy-related cognitive impairment, risk factors, conventional therapy, coping strategies, and potential complementary and integrative medicine treatments. Complementary and integrative medicine modalities that may improve chemotherapy-related cognitive impairment include mind-body techniques and acupuncture, as well as nutrition and herbal therapies. Studies on these modalities have not directly tested the hypothesis of modifying chemotherapy-related cognitive impairment and were done on different disorders of memory loss and lack of concentration. We recommend conducting further research on the potential role of complementary and integrative medicine modalities in the treatment and prevention of chemotherapy-related cognitive impairment.

Follow-Up of Breast Cancer Survivors

important study of the follow-up preferences of breast cancer survivors. However, I was struck by the marked disconnect between the study’s findings and the authors’ conclusions. In this survey of the self-perceived impact of follow-up by different types of providers, the 218 breast cancer survivors who completed the questionnaire overwhelmingly preferred follow-up with a medical oncologist to follow-up with a primary care physician (PCP) or nurse practitioner (NP). The odds ratios for the belief that medical oncologist follow-up relative to PCP follow-up would decrease breast cancer worry, and increase the chance of surviving cancer, were 36 (95% CI, 21 to 62) and 42 (95% CI, 24 to 74), respectively. Confidence in follow-up by an NP was nonsignificantly lower than that for a PCP. Nevertheless, the authors concluded that “Breast cancer survivors are comfortable with both PCPs and NPs providing follow-up care . . . the NP-led survivorship clinic model, with increased guidance for PCPs, offers a promising route for improving quality of and satisfaction with survivor care.” 1(p158) Breast cancer worry and fear of recurrence are high among breast cancer survivors, and often correlate poorly with objective prognosis. For example, in one study of 136 patients treated with curative intent, more than 50% had moderate to high levels of fear of recurrence. 2 It is inconceivable that a follow-up model that would exacerbate such fears would improve patient satisfaction. Shifting follow-up care from the oncologist to a PCP or NP could have more subtle detrimental effects on patient care, particularly for future medical oncology graduates, who would see far fewer follow-up patients during their training, and would never acquire the experience of monitoring large numbers of patients treated with adjuvant systemic therapy over several years. How will they be able to have balanced discussions with patients for whom the indication for chemotherapy is borderline if they have never seen the 40-year-old ICU nurse who can no longer work because of “chemo brain,” or the mother of six children who develops a cardiomyopathyrelated stroke? Nor will their perspective be balanced if they are asked to see only the patients with complications in the NP-led follow-up clinic next door. Even if patient care could somehow be unaffected, medical oncologists would have much to lose in terms of job satisfaction if we handed most, if not all, of our patients over to other health care professionals for follow-up. Undoubtedly most of us would prefer to see another patient responding to neoadjuvant chemotherapy than a whining but otherwise well survivor. But, more important, a clinic with several women in their thirties dying of metastatic disease is only bearable if, in the same clinic, there is also a patient, expected to have died 15 years ago of locally advanced disease, proudly showing pictures of her son’s wedding or daughter’s graduation. Referring patients with breast cancer who have completed active treatment to their PCP or a NP for follow-up is appropriate and optimal in many cases. Most patients, who greatly prefer medical oncologist follow-up initially, will gladly “graduate” back to their PCP after several years. However, the decision and timing should be made jointly by the patient and medical oncologist, taking into account factors such as patient preference and tumor prognosis. A health care system that allows both traditional and alternative follow-up models will maximize patient satisfaction, maintain the quality of oncology care, and avoid oncologist burn-out.

The Impact of Chemotherapy-Induced Cognitive Impairment on the Psychosocial Adjustment of Patients With Nonmetastatic Colorectal Cancer

Colorectal cancer is the third most commonly diagnosed cancer in Canada. Chemotherapy often is used as treatment for colorectal cancer, and studies have documented cognitive changes in patients after chemotherapy treatment. What remains unclear is the impact of such changes on a person's roles and relationships, herein referred to as psychosocial adjustment. The purpose of this research was to explore group differences in psychosocial adjustment and chemotherapy-induced cognitive impairment in patients with colorectal cancer. Participants were assessed cross-sectionally, at various time points along their treatment trajectory, using the Psychosocial Adjustment to Illness Scale-Self-Report (PAIS-SR) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). A statistically nonsignificant negative association was indicated between PAIS-SR and CANTAB results, indicating that they would have no meaning in a clinical context. No differences between groups were observed in terms of cognitive ability; however, patients who completed chemotherapy appeared to be at a higher risk for psychosocial maladjustment. This study suggests that cognitive changes do not influence patients' relationships and functional roles, as indicated from the PAIS-SR.

Longitudinal Impact of Yoga on Chemotherapy-Related Cognitive Impairment and Quality of Life in Women with Early Stage Breast Cancer: A Case Series

Adjuvant chemotherapy for women with breast cancer has significantly improved the cure rate; however, it has been associated with chemotherapy-related cognitive impact (CRCI). The literature provides preliminary support for the feasibility and efficacy of yoga interventions for the general cancer population, however, controlled trials are scarce and no studies have examined the effect of yoga on cognition for women with breast cancer during chemotherapy. This case series aims to identify the impact of yoga on measures of cognition, functional outcomes, and quality of life (QOL) for breast cancer survivors (BCS). Four women with a diagnosis of early-stage breast cancer prior to chemotherapy treatment were administered the following physiologic measures at baseline, 6, and 12 weeks during chemotherapy, and at one and three months after the conclusion of the study: Functional Reach test (balance) and Sit and Reach test (flexibility), and QOL, POMS (Mood) and FACT-B (QOL), at baseline. Primary outcomes of cognition were measured with the Perceived Cognition Questionnaire (PCQ) and CogState, a computerized measurement of cognition. Women attended an Iyengar-inspired yoga program twice a week for 12 weeks. Qualitative questionnaires were administered after the completion of the study to determine perceived benefits and challenges of the yoga program. Four women with Stage II breast cancer ranged in age from 44-65 years. CogState computerized testing showed changes in varying domains of cognition through treatment and follow-up. Improved balance, flexibility, and QOL were also noted over time. No adverse events were observed. Analysis of qualitative data revealed the yoga classes were helpful and subjects continued the practice elements of yoga including relaxation, breathing, and stretching. The most challenging aspect of the study was physical limitations due to various medical complications and included fatigue, decreased range of motion, and pain. This case series suggests that yoga may impact various aspects of cognition during and after chemotherapy administration as noted through quantitative measures. Women describe yoga as improving various domains of QOL through the treatment trajectory. This mind-body intervention may stave off CRCI; however, further investigation is needed for additional randomized controlled trials on the effects of yoga on cognition for women with breast cancer undergoing adjuvant chemotherapy treatment.

Neurocognitive Effects of Chemotherapy and Endocrine Therapies in the Treatment of Breast Cancer: Recent Perspectives

With an estimated 207,090 patients diagnosed with breast cancer in 2010, the role of chemotherapy-induced cognitive impairment is of growing importance. Studies to determine the impact of chemotherapy-induced cognitive impairment have been hindered by difficulties in study-design, in particular, study methodology. Here, we present a review of existing studies and discuss several mechanisms for chemotherapy-induced neurocognitive impairment in breast cancer patients, such as direct neurotoxic injury, telomere shortening, oxidative stress, cytokine dysregulation, estrogen-mediated effects, and the role of certain genetic polymorphisms. Decreased estrogen levels may serve as a link between multiple mechanisms potentiating the effects of the chemotherapy-induced cognitive impairment.

A Meta-analysis of Chemotherapy related Cognitive Impairment in Patients with Breast Cancer

The purpose of this study was to evaluate the cognitive effects of chemotherapy in patients with breast cancer. Using several databases, prospective studies were collected up to August 2011. Of 2,106 publications identified, 12 met the inclusion criteria, and 8 studies were used to estimate the effect size of chemotherapy on cognitive impairment. Twelve studies were done since 2005 and most of the research was performed in Europe or North America. Eight studies were used to generate effect size across the cognitive domains of attention/concentration, verbal and visual memory, executive function, visuospatial skill, language, and subjective cognitive function. Each of the cognitive domains showed small effect sizes (-0.02 ~ -0.26), indicating diminished cognitive function for the chemotherapy group compared with non-chemotherapy groups. Finding suggests that breast cancer patients who undergo chemotherapy may experience mild cognitive decline. Further study is needed to generate knowledge and guideline for interventions to address chemotherapy related cognitive impairment in these patients.

Daños Neuropsicológicos Asociados a los Tratamientos Quimioterapéuticos: Una Propuesta de Evaluación

Chemotherapy treatments in cancer patients may cause cognitive impairment in a percentage ranging from 15 to 50%, and cause significant deficits in their quality of life. We present the main methodological problems in this field and the recommendations for overcoming them, in terms of design, sampling, impairment criteria, assessment tools and control groups. We present a proposal to assess chemotherapy-induced cognitive Impairment in Spanish samples. The guidelines aim to assess three cognitive domains that may be at risk of deterioration: Verbal memory, executive function and psychomotor abilities, as well as modulating variables: Quality of life, fatigue and emotional state (anxiety and depression). The study design should be longitudinal, with assessment at the baseline, before chemotherapy, posttreatment and follow-up. We present the most suitable instruments to assess each of the variables, and recommendations about impairment criteria, interpretation and analysis.