Cognitive Function in Breast Cancer Patients Undergoing Chemotherapy
Review TypeNone: Degree-based Submission
Review StatusNot Applicable (See Review Type)
Repository Posting Date2019-04-10T20:43:15Z
Author(s)Jansen, Catherine E.
Author DetailsCatherine E. Jansen, PhD, Oncology Clinical Nurse Specialist
Lead Author Sigma AffliationAlpha Eta
Level of EvidenceOther
Research ApproachQuantitative Research
CINAHL HeadingsBreast Neoplasms -- Drug Therapy; Chemotherapy, Cancer -- Adverse Effects; Cognition Disorders -- Chemically Induced; Cognition -- Drug Effects; Cancer Patients; Breast Neoplasms; Chemotherapy, Cancer; Cognition Disorders; Cognition
Background. Recent studies suggest that standard dose chemotherapy (CTX) may cross the blood-brain barrier. However, the evidence for CTX-induced cognitive impairments in breast cancer patients is inconsistent. Purposes. (1) to describe the literature about CTX-induced cognitive impairments in women with breast cancer; (2) to review the domains of cognitive function and their corresponding neuroanatomic structures as well as present current evidence for neurotoxicity associated with specific CTX agents and potential mechanisms for CTX-induced cognitive impairments; (3) to estimate the effect sizes for the effect of CTX on each domain of cognitive function; (4) to determine the sensitivity of neuropsychological tests which have been used to evaluate CTX-induced impairment in various domains of cognitive function in breast cancer patients; and (5) to assess changes in cognitive function over time in breast cancer patients receiving CTX, and evaluate potential relationships between cognitive function and anxiety, depression, fatigue, hemoglobin levels, menopausal status, and perceived cognitive function. Methods. We performed meta-analyses to measure effect sizes to determine CTX effect on various domains of cognitive function and to determine neurological test sensitivity. In the longitudinal study, we recruited a multicultural sample of thirty women with breast cancer for neuropsychological testing prior to the initiation and a week after completion of treatment with doxorubicin and cyclophosphamide CTX. Paired t-tests were used to evaluate changes in cognitive scores over time and linear mixed modeling was used to determine whether significant changes remained after controlling for anxiety, depression, fatigue, hemoglobin level, menopausal status, and perceived cognitive function. Findings. Only two domains of cognitive function (i.e., language, visual memory) had small albeit significant negative effect sizes in the meta-analysis of CTX-induced cognitive impairments in breast cancer patients. We evaluated thirty tests used to measure cognitive changes in breast cancer patients who received CTX, but found only six tests to be sensitive in detecting changes in four of eight domains of cognitive function (i.e., language, motor function, visuospatial skill, and verbal memory). In the longitudinal study significant decreases in cognitive function were found after CTX in visuospatial skill (p ≤ .001) and total cognitive (p = .001) scores over time.
DescriptionThis dissertation has also been disseminated through the ProQuest Dissertations and Theses database. Dissertation/thesis number: 3261235; ProQuest document ID: 304878866. The author still retains copyright.
Advisor(s)Dodd, Marylin J.
Degree GrantorUniversity of California, San Francisco
NotesThis item has not gone through this repository's peer-review process, but has been accepted by the indicated university or college in partial fulfillment of the requirements for the specified degree.
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