The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma - Results of a prospective, randomized, longitudinal trial
The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma - Results of a prospective, randomized, longitudinal trial
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DOI：
10.1002/cncr.20272
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发表时间：
2004-06-01
期刊：
影响因子：
6.2
通讯作者：
Meyers, CA
中科院分区：
文献类型：
--
作者：
Wefel, JS;Lenzi, R;Meyers, CA
背景回顾性试验;报告了一部分乳腺癌患者经历了化疗诱导的认知功能障碍。然而，最近的证据表明，在化疗开始前，一个子集在基线时也表现出认知功能受损。有必要进行一项前瞻性、纵向试验，纳入基线神经心理学评估，以确定在多大程度上认知功能障碍可归因于该人群的化疗。18名乳腺癌患者在治疗前和化疗后的短期和长期间隔进行了全面的神经心理评估。评估接受标准剂量辅助化疗的乳腺癌患者认知功能障碍的发生率、性质、严重程度和慢性程度。在开始系统治疗之前，当前队列中33%的女性表现出认知障碍。在短期化疗后时间点，61%的队列显示出相对于基线的一个或多个认知功能领域的下降，并报告更大的困难，在保持他们的工作能力。认知功能障碍最常见的领域与注意力、学习和处理速度有关。在长期化疗后时间点，大约50%的认知功能下降的患者表现出改善，而50%保持稳定。自我报告的能力，以执行工作相关的活动也提高了这一间隔。无论是基线损害还是随后的治疗相关认知下降，都没有表现出与情感幸福感或人口统计学或临床特征的任何统计学显著相关性。目前的研究是第一个纵向试验，报告了非转移性乳腺癌妇女亚组中认知功能障碍与化疗之间相关性的证据。使用前瞻性研究设计，适当的认知措施，统计方法来评估亚组的影响的重要性进行了讨论。有必要确定与认知功能障碍相关的机制和导致亚组脆弱性的风险因素。(C)2004年美国癌症协会。
BACKGROUND. Retrospective trials; have reported that chemotherapy-induced cognitive dysfunction was experienced by a subset of patients with breast carcinoma. However, recent evidence indicated that a subset also exhibited impaired cognitive function at baseline, before the start of chemotherapy. A prospective, longitudinal trial that incorporates baseline neuropsychologic evaluations is necessary to determine to what extent cognitive dysfunction is attributable to chemotherapy in this population.METHODS. Eighteen women with breast carcinoma underwent a comprehensive neuropsychologic evaluation before treatment and at short-term and long-term intervals after chemotherapy. The incidence, nature, severity, and chronicity of cognitive dysfunction developing in patients with breast carcinoma treated with a standard dose of adjuvant chemotherapy were assessed.RESULTS. Before the start of systemic therapy, 33% of women in the current cohort exhibited cognitive impairment. At the short-term postchemotherapy time point, 61% of the cohort exhibited a decline relative to baseline in 1 or more domains of cognitive functioning and reported greater difficulty in maintaining their ability to work. The most common domains of cognitive dysfunction were related to attention, learning, and processing speed. At the long-term postchemotherapy time point, approximately 50% of patients who experienced declines in cognitive function demonstrated improvement, whereas 50% remained stable. Self-reported ability to perform work-related activities also improved over this interval. Neither impairment at baseline nor subsequent treatment-related cognitive decline exhibited any statistically significant correlation with affective well-being or with demographic or clinical characteristics.CONCLUSIONS. The current study is the first longitudinal trial to report evidence of an association between cognitive dysfunction and chemotherapy in a subgroup of women with nonmetastatic breast carcinoma. The importance of using prospective research designs, appropriate cognitive measures, and statistical methods to evaluate subgroup effects was discussed. Identification of mechanisms associated with cognitive dysfunction and of risk factors contributing to subgroup vulnerability is necessary. (C) 2004 American Cancer Society.